title: Insights from advanced analytics at the Veterans Health Administration.
abstract: Health care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data.
authors.affiliation: Stephan D. Fihn (Stephan.Fihn@va.gov) is director of the Veterans Health Administration (VHA) Office of Analytics and Business Intelligence in Washington, D.C., and a professor in the Departments of Medicine and Health Services at the Schools of Medicine and Public Health, respectively, at the University of Washington, in Seattle.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.affiliation: Joseph Francis is director of clinical analytics and reporting at the VHA Office of Analytics and Business Intelligence in Washington, D.C.
authors.forename: Joseph
authors.initials: J
authors.lastname: Francis
authors.affiliation: Carolyn Clancy is the assistant deputy under secretary for health for quality, safety, and value at the VHA in Washington, D.C.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Clancy
authors.affiliation: Christopher Nielson is director of predictive modeling at the VHA Office of Analytics and Business Intelligence in Reno, Nevada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielson
authors.affiliation: Karin Nelson is an investigator in the Health Services Research and Development Department at the Veterans Affairs Puget Sound Health Care System and an associate professor of medicine at the University of Washington, both in Seattle.
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.affiliation: John Rumsfeld is the national program director of cardiology at the VHA and a professor of medicine at the University of Colorado, both in Denver.
authors.forename: John
authors.initials: J
authors.lastname: Rumsfeld
authors.affiliation: Theresa Cullen is the director of health informatics in the VHA Office of Informatics and Analytics in Silver Spring, Maryland.
authors.forename: Theresa
authors.initials: T
authors.lastname: Cullen
authors.affiliation: Jack Bates is the director of the Business Intelligence Service Line in the Office of Information and Technology, Department of Veterans Affairs, in North Little Rock, Arkansas.
authors.forename: Jack
authors.initials: J
authors.lastname: Bates
authors.affiliation: Gail L. Graham is the assistant deputy under secretary for health for informatics and analytics in the VHA Office of Informatics and Analytics in Washington, D.C.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Graham
mesh_terms: D003627:Data Interpretation, Statistical; D057225:Data Mining / Q000379:methods*; D066264:Datasets as Topic; D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D008490:Medical Informatics; D016347:Medical Records Systems, Computerized; D012984:Software; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D058014:Veterans Health
keywords: Analytics; Big Data; Healthcare Technology; Information Governance; Patient-Centered Medical Home