data management marco gonzales, pharm.d. ucsf, partners in e [email protected]

Data Management

Marco Gonzales, Pharm.D.UCSF, Partners in [email protected]

Objectives:

• Describe the core components of database management systems.

• Describe the differences between transactional data and analytical data.

• Describe the role of data warehouses, clinical data repositories and data mining in healthcare.

• Describe the various ways a pharmacist may interact with analytical data.

Fox

Chapters 6 & 7

Data(Numbers, dates, names, codes, descriptive text)

Information(who, what, when, where, how)

Knowledge(information transformed into something we can use)

“Data mining” helps us get to Knowledge Discovery in Databases (KDD)

Why is data managementimportant for the pharmacist?

• To effectively communicate with both clinicians & IT professionals in order to improve quality and efficiency of healthcare systems.

• To be data-independent, and not reliant on others to manage your data needs.

• To not be just a passive consumer of data.Rather, to actively participate in knowledge discovery from data… data is power.

Meaningful Use for Pharmacist?

Transaction Data

The data contained within a transaction or message event.

Every lab/x-ray order & result, every med order and administration, every claim and payment is transmitted and then stored in a system to be used later.

The primary use of most data is communication, like transmitting and messaging.

Transaction Data

Structured (and hopefully standardized) data are streamed ‘computer to computer’

Transactions may still be accessible as history.

HHS-mandatedHIPAA Transaction Standards

• In the pharmacy/medical domain:NCPDP Telecommunications D.ØASC X12 5010 (telecom)NCPDP SCRIPT HL7 v2 or v3

• ANSI-accredited Standards Development Organizations (SDO)– NCPDP (National Council for Prescription Drug Plans)– ASC X12 (Accredited Standards Committee)– HL7 (Health Level Seven)

Transaction Data

5827934|Garcia|Jerry|11.7|54.2|2343135827935|Moon|Keith|12.7|63.7|2963135827936|Bonham|John|12.1|55.2|2343135827937|Lennon|John|12.3|54.7|2343135827938|Cobain|Kurt|12.7|55.5|2343135827939|Murcury|Fred|13.2|60.2|2343135827940|Garcia|Jerry|12.5|59.9|2343135827935|Moon|Keith|12.7|63.7|2963135827935|Moon|Keith|12.7|63.7|296313

5827934|Garcia|Jerry|11.7|54.2|234313

The primary use of most data is communication, like transmitting and messaging.

In above use case, transaction was an HL7 message sent within an affiliated medical system

Lab

Transmission of lab results as a message

EHR

Transaction Data5827934|Garcia|Jerry|11.7|54.2|2343135827935|Moon|Keith|12.7|63.7|2963135827936|Bonham|John|12.1|55.2|2343135827937|Lennon|John|12.3|54.7|2343135827938|Cobain|Kurt|12.7|55.5|2343135827939|Murcury|Fred|13.2|60.2|2343135827940|Garcia|Jerry|12.5|59.9|2343135827935|Moon|Keith|12.7|63.7|2963135827935|Moon|Keith|12.7|63.7|296313

Transaction data: (example of one source)

Moon, Keith Clinic: Mission

AGE: 64 eRx:Y Consent:Y

Diagnosis History: 30 OCT 2012 PERSISTANT DEATH 25 SEP 1980 DEATH BY ASPHYXIATION

Lab History Lab 45 Lab 46 17 OCT 2012 12.7 63.7 05 OCT 2012 12.7 63.7 26 SEP 2012 12.7 63.7

Clinical data repository

Structure and store transactions for quick and reliable retrieval of patient-level “real-time” information

EMR/EHR

Might also be considered an Operational Data Store

updating

Transaction (Operational) Data

Transaction data is continuously inserted into EMR’s clinical data repository from various clinical sources to deliver real-time patient-specific information.Extracting data for standardized Quality Improvement (QI) and other population-based reports can be automated without manual chart reviews.

Pharmacy Data Example

• Pharmacy Provider Info• Patient (beneficiary) Info• Prescriber Info• Drug Info (Name(s), Strength, Quantity, mfg, aux

warnings, etc)• Date, Prescription Number, Barcode, Days Supply, Sig

Image source: http://www.pharmacy.ca.gov/licensing/labels.shtml

Transaction Data

7817934222|Garcia|Jerry|30|90|552223|…8148416605|Moon|Keith|30|30|552224|…0005027901|Bonham|John|30|30|552225|…6525558505|Lennon|John|60|60|552226|…8845788115|Cobain|Kurt|10|150|552227|…8058777701|Murcury|Fred|30|60|552228|…5525569330|Garcia|Jerry|30|90|552229|…5827936601|Moon|Keith|60|120|552230|…5827937601|Moon|Keith|30|30|552231|…

7817934222|Garcia|Jerry|30|60|552232|…

PayerPBM

The primary use of most data is communication, like transmitting and messaging.In above use case:• transaction used the NCPDP Telecom standard.• Transaction did not interact with EHR.

Rather, pharmacy interacted with a Pharmacy Benefits Manager (PBM)

Pharmacy

Transmission of pharmacy claim requesting reimbursement

Transmission of paid pharmacy reimbursement

7817934222|Garcia|Jerry|paid|$73.54|…

NCPDP

• Telecom (messaging for payment)• SCRIPT (messaging for ePrescribing)• Post Adjudication• Billing Unit Standard

• NCPDP Telecom Standard D.0• Sends real time online ‐ Rx data for payment.• Product Based Pricing from NDC

Transmitting Pharmacy Data for Payment

Transaction (Operational) Data• Transaction data can be difficult to summarize from native

applications. Mostly reliant on ‘canned’ reports.

• Transaction data may be difficult to query, unless user has special privileges and and/or special extraction skills.

• Used for adding, updating, omitting info in a standard view/list of patient’s “chart”.

• However,Patient’s “chart” can be packaged into a standardized HL7 document for exchange with another system. (CCD)

Transaction (Operational) Data

• Most EHRs are programmed in “M”

• M is robust for setting and retrieving key & value combinations, but …

• M is not user friendly, hard to link to other data sources, and potentially quite dangerous to the healthcare system.

Transactional (operational) Dataversus

Data Warehouse Analytical Data

Transactional data need to be extracted and then loaded into a data warehouse for substantive analytical database functionality to occur. i.e. ad hoc QI reporting, data mining and outcomes research,… or any kind of secondary use.

Analytical Data

Data that are stored and structured for analysis.

Transaction data that have been extracted, transformed, and combined with many other data sources into a database framework that allows: sophisticated reporting (QI, trending, financial), decision support, data mining, research extraction, or other type of complex/experimental population analysis.

Analytical Data


Transaction data: (example of one source)

Transaction sources and data from other data sources are periodically extracted and then loaded into a data warehouse for in-depth analysis.

Reports, Decision Support, Dashboards & Data Mining

Data Warehouse: Usually as tables within a relational database

ETL

SQLSASR

Relational DatabaseAn approach to designing databases based on mathematical set theory to ensure that data integrity is maintained during ‘update’, ‘add’, and ‘remove’.*

Standard Query Language (SQL) can effectively interrogate, query, and maintain database.

Business Intelligence. Data -> Info -> Knowledge

*Dumitru, D. The Pharmacy Informatics Primer. 2009 ASHP.

Relational Database

Table 2. Patients

Patient_ID Name Gender DOB2589 Marco M 2/29/19729987 Lisa F 4/30/19628976 Mike M 1/21/1966

Table 1. Pharmacy Prescriptions

RxNumber NDC DrugName Patient_ID7405 63402051001 Xopenex 25897407 63739052010 Prednisone 25897408 44183044001 Midrin 9987

• Normalized

• Joined by Primary Key and Foreign Key

• Tuple or Row. Column, Field, or Data Element

Foreign Key Primary KeyPrimary Key

Data Warehouse


Clinical data repository

This kind of operational data is great for patient care and canned reports.However, harvesting data could be tricky.

Normalized Relational DatabaseGreat for analytics, research & sophisticated reporting

Data Warehouse

7817934222|Garcia|Jerry|30|90|552223|…8148416605|Moon|Keith|30|30|552224|…0005027901|Bonham|John|30|30|552225|…6525558505|Lennon|John|60|60|552226|…8845788115|Cobain|Kurt|10|150|552227|…8058777701|Murcury|Fred|30|60|552228|…5525569330|Garcia|Jerry|30|90|552229|…5827936601|Moon|Keith|60|120|552230|…5827937601|Moon|Keith|30|30|552231|…

Periodic

extract, transfo

rm & load

Many Different Transaction Data Sources

Continuously updating

Structured Data• Unstructured is just free text or some binary artifact.

Computers are unable to “make sense” of data and is unable to do something with it. The computer just passes on the data to human for interpretation.

• Structured data utilizes Controlled vocabularies so information can be machine readable:

NDC, FDB GCNs, ETCs, & SKsSNOMED, ICD-9 -> ICD-10

Using Analytical Pharmacy Data

• Reporting (Fiscal and Quality)• Unsupervised Machine Learning:

– Fourier Transform– Principal Component Analysis => Plotting

• Predictive Analysis• Dashboards and Visualizations• Research

For example:• Formulary management• Clinical decision support• Policy development• Patient population healthcare management

Using Analytical Pharmacy Data

Data mining is defined as the process of discovering patterns in data.

Source: Witten & Frank (2005). Data Mining: Practical Machine Learning Tools and Techniques. Elsevier. 2nd Edition, p 5.

Safety SurveillanceSaving MoneyOutlier DetectionFinding Topics to Research

Databases & Business Intelligence Tools

1. MS Access, MySQL, Oracle, …2. SAS, SPSS, STATA, MATLAB, & R3. WEKA & Python (with ML Libraries)

4. Business Objects5. MS Excel6. GraphViz7. Online tools (mind your PHI)

Tip for working with “little data”

preparing

understand what data elements are available and which ones you will need. for example, do you need to consider other explanatory variables. create practice data and go thru the entire exercise.

sample size

spreadsheets and database what tools will you need?

collecting

download and import whenever possibledata cleansing?

if not, meticulously gather & transcribe

assume you will need to export data to another software program. i.e. keep your data clean

keep your data clean

small and descriptive data element names, without spaces or special characters.ex) DtService, PtId, NDC, DrugDesc, Prescriber, …

use discrete buckets- limit the possible values for categorical variables and be consistent with your convention

if you really must, you may have one field for all of your messy notes


use existing controlled terminologies, if possible.ex. SNOMED, ICD-9, DSM, RxNorm, NDC, MRN

or, create your own controlled way to express your data, without using subjective and inconsistent free-text.


IDServiceDatehiclgnnMRNQTYDaysSupplyPrescriberNotes

hiclgnnCategoryPriceClassMax

NPIProvNameAddressCityStateProvType

Edward Tufte

• Data-Ink Ratio:

• A large share of ink on a graphic should present data-information, the ink changing as the data change. Data-ink is the non-erasable core of a graphic, the non-redundant ink arranged in response to variation in the numbers represented.

chartjunk

please read Edward Tufte “data-ink-ratio”

chartjunk

chartjunk

A B

C

Some Recent Work

Heatmap

SAS 9.2™

Unsupervised Machine Learning

SAS 9.2™

Social Network Analysis

GraphViz™

Predictive Analysis: Regression

GeoSpatial

Medi-Cal Pharmacy Providers that “specialize” in HIV

GeoSpatial

FFT: Normal

FFT: Abnormal

After Intervention($1.4M recovery)

Flow Analysis

Westminster gets has high transactions per prescriber 55

Slopegraph

DASHBOARDS

Conclusion

• Operational Data and Analytical Data have different functions

• Pharmacists need to understand where data come from, how we can get it, and how we can use it.

data management marco gonzales, pharm.d. ucsf, partners in e [email protected]

Documents

data data

data mining

analytical data

data numbers

standardized data

transactional data

data needs

operational data store