title: Toward best practice: leveraging the electronic patient record as a clinical data warehouse.
abstract: Automating clinical and administrative processes via an electronic patient record (EPR) gives clinicians the point-of-care tools they need to deliver better patient care. However, to improve clinical practice as a whole and then evaluate it, healthcare must go beyond basic automation and convert EPR data into aggregated, multidimensional information. Unfortunately, few EPR systems have the established, powerful analytical clinical data warehouses (CDWs) required for this conversion. This article describes how an organization can support best practice by leveraging a CDW that is fully integrated into its EPR and clinical decision support (CDS) system. The article (1) discusses the requirements for comprehensive CDS, including on-line analytical processing (OLAP) of data at both transactional and aggregate levels, (2) suggests that the transactional data acquired by an OLTP EPR system must be remodeled to support retrospective, population-based, aggregate analysis of those data, and (3) concludes that this aggregate analysis is best provided by a separate CDW system.
authors.affiliation: Department of Medicine, University of Toronto.
authors.forename: C S
authors.initials: CS
authors.lastname: Ledbetter
authors.forename: M W
authors.initials: MW
authors.lastname: Morgan
mesh_terms: D019985:Benchmarking / Q000379:methods*; D018672:Community Health Planning; D003628:Database Management Systems / Q000458:organization & administration*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007253:Information Centers / Q000458:organization & administration*; D016247:Information Storage and Retrieval; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D009864:Ontario; D019982:Organizational Case Studies; D010934:Planning Techniques; D019095:Point-of-Care Systems; D018511:Systems Integration