Epic Clarity Is Not a Data Warehouse

It’s not even the reporting tool for which your clinicians have been asking!

I have attended between four and eight patient safety and quality healthcare conferences a year for the past five years. Personally, I enjoy the opportunities to learn from what others are doing in the space. My expertise lies at the intersection of quality and technology; therefore, it’s what I’m eager to discuss at these events. I am most interested in understanding how health systems are addressing the burgeoning financial burden of reporting more (both internal and external compliance and regulatory mandates) with less (from tightening budgets and, quite honestly, allocating resources to the wrong places for the wrong reasons).

Let me be frank: there is job security in health care analysts, “report writers,” and decision support staff. They continue to plug away at reports, churn out dated spreadsheets, and present static, stale data without context or much value to the decision makers they serve. In my opinion, patient safety and quality departments are the worst culprits of this waste and inefficiency.

When I walk around these conferences and ask people, “How are you reporting your quality measures across the litany of applications, vendors, and care settings at your institution?,” you want to know the most frequent answer I get? “Oh, we have Epic (Clarity)”, “Oh, we have McKesson (HBI),” or “Oh, we have a decision support staff that does that”. I literally have to hold back a combination of emotions – amusement (because I’m so frustrated) and frustration (because all I can do is laugh). I’ll poke holes in just one example: If you have Epic and use Clarity to report here is what you have to look forward to straight from the mouth of a former Epic technical consultant:

It is impossible to use Epic “out of the box” because the tables in Clarity must be joined together to present meaningful data. That may mean (probably will mean) a significant runtime burden because of the processing required. Unless you defer this burden to an overnight process (ETL) the end users will experience significant wait times as their report proceeds to execute these joins. Further, they will wait every time the report runs. Bear in mind that this applies to all of the reports that Epic provides. All of them are based directly on Clarity. Clarity is not a data warehouse. It is merely a relational version of the Chronicles data structures, and as such, is tied closely to the Chronicles architecture rather than a reporting structure. Report customers require de-normalized data marts for simplicity, and you need star schema behind them for performance and code re-use.”

You can’t pretend something is what it isn’t.

Translation that healthcare people will understand: Clarity only reports data in Epic. Clarity is not the best solution for providing users with fast query and report responses. There are better solutions (data marts) that provide faster reporting and allow for integration across systems. Patient safety and quality people know that you need to get data out of more than just your EMR to report quality measures. So why do so many of you think an EMR reporting tool is your answer?

There is a growing sense of urgency at the highest levels in large health systems to start holding quality departments accountable for the operational dollars they continue to waste on non-value added data crunching, report creation, and spreadsheets. Don’t believe me? Ask yourself, “Does my quality team spend more time collecting data and creating reports/spreadsheets or interacting with the organization to improve quality and, consequently, the data?”

Be honest with yourself. The ratio, at best, is 70% of an FTE is collection, 30% is analysis and action. So – get your people out of the basement, out from behind their computer screens, and put them to work. And by work, I mean acting on data and improving quality, not just reporting it.

7 thoughts on “Epic Clarity Is Not a Data Warehouse

  1. “So why do so many of you think an EMR reporting tool is your answer?”
    You jump to a conclusion. Its not “The Answer”…it’s just a HUGE step in the right direction.
    Many hospitals are still trying to query disparate systems & paste together ballpark stats to come up with Quality Measures & Decision Support Data. They do, as you say, spend way too much time manually trying to manufacture data. My facility is looking forward to EPIC, and I am excited at the data reporting improvments we’ll see.
    As for your article title and quote…..”star schema” topology is not the determining factor of what is or is not a data warehouse, but rather a relational linking topology…yes it improves perfomance, if indexed & normalized appropriately.
    I, for one, look forward to an ‘EPICally’ big step improving our reporting. And, then beyond that for future tools & improvments.

    • Jim you won’t see reporting improvments by using EPIC. You will create thousands of static crystal reports that don’t allow people access to the information they really need. We recently did an assessment with an organization that had moved to EPIC and all the groups we met with (service line management, process improvement, quality, finance, nursing) we are still in Excel hell. Using EPIC is in no way an information strategy. Unfortunately EPIC tries to portray that they are and they are leading executives and their clients down a primrose path to EPIC failure.

    • Jim, thanks for your comment. I think I can clarify. Actionable reporting requires data from multiple sources. Some measures have their raw components in one source, but the majority of the quality measures driving healthcare reform require data from multiple places like billing, lab, pharmacy, cost accounting system, registration, and so on. If you agree with this premise, then I think you’d agree that Epic is only one source. Do we agree? Yes it’s a big system and a huge step in the right direction, as you point out, but I’d argue for a different reason. Epic (and other EMRs) are a step in the right direction for the industry to get off paper and become 100% electronic. In addition, it’s a fairly flexible architecture (compared to say McKesson) and allows for APIs and other extensions to it’s core. Now, getting back to our main point, reporting – Epic will still only allow for reporting of the data that lives in the Epic system. That is NOT a strategy healthcare organizations can afford. Reporting out of one system, yes will help automate and save costs associated previously with manual, paper laden processes. But truly integrated reporting, that enables advanced analytics and eventually, near real time response, will only come from a vendor and technology- independent architecture. If you look at leading institutions like Geisinger, UPMC, Mayo, KP and others, they are establishing BICC (Business Intelligence Competency Centers) or BI CoE (Business Intelligence Centers of Excellence) and none of them use their EMR as the core for their reporting.

  2. Pingback: What I Learned at Health Connect Partners Surgery Conference 2012: Most Hospitals Still Can’t Tell What Surgeries Turn a Profit | Edgewater Technology Weblog

  3. Shands Hospital at the University of Florida uses the Jun Reporting Engine form Jun Consulting. This provides data integration with near real-time data from Epic. Users can develop detailed reports on their own without needing and having to wait for a Clarity report writer.

  4. You can create meaningful data from Epic Clarity if you create SQL view of linked tables in Epic Clarity. For instance, billing data (Epic Resolute) can be linked to patient encounter data (PAT_ENC) when joined with CLARITY_TDL_TRAN. Once the view is created, you can query these tables without the huge run time processing that occurs when linking table directly (especially joining 25-30 tables or more). Organizations like Kaiser Permanente have created reports of productivity, patient access to providers, utilization, etc,… that use these principles of SQL coding and all of these various Kaiser regions have joined together to create virtual data marts that use similiar coding since they often participant in health research with the Federal Government and other research entities in order to understand how best to improve patient care.

  5. I ran across this randomly. I retired from 30 years of Health Care IT after spending two incredibly stoopid years working with people who didn’t get it; who didn’t get what is pointed out in your blog. For two years it was endless stream of 22 year olds from Verona Wisconsin armed with checklists. Our own management didn’t care about anything except checking off deliverables so they could get reimbursed and release 20 million dollars to Epic. Everyone was so proud when they could mark a check on the list. Fortunately I could afford to walk away and become an artist. I sometimes miss doing econometrics, auditing, forecasting, epidemiology and all the other valuable things to do with health data. I have never missed installing 1000s of “standard epic clarity” reports. God save the Queen! lol

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