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e-Health Data Warehousing Projects

Greg Reed has been handed the task of managing Ontario's e-Health program after the government tied the can to his predecessor, Sarah Cramer. Greg has inherited a huge undertaking which has been described elsewhere as a "program of programs". It is large both in terms of budget (>$3Bn) and schedule (projected finish of 2015). Its many stakeholders, the technology it relies on, and its many programs and projects makes it complex. One of the key programs in e-Health is the centralization and standardization of medical records. This is at the heart of the program - electronic records must be standardized and accessible in order to meet many of the objectives of this program. The program we're talking about here is a data warehouse program and the e-Health program will have to meet all the challenges that any other data warehousing program is faced with.

Reed says that the key challenge faced by the program is the standardization of the data which will define the electronic medical records. Hate to say it, but this is the same challenge faced by any Data Warehousing initiative: each group will have its own definition of a data element which means that data attributes will vary from group to group and the data cannot be used to communicate, or be stored in a central database. Reed is appealing for all the stakeholders who manage these data elements to collaborate and agree that to provincial standards for the data. Good luck with that Greg. It's not that I don't agree with the statement, it's just that without solid, visible support from the highest government levels, the collaboration you need won't be forthcoming.

The key to success for any Data Warehousing/Data Standards initiative is the championing of the project at the highest level of the organization. Everyone who uses a common data element must understand, that data does not belong to your group, it belongs to the organization. Then we come to the question of who is to pay for the effort to redefine the data according to the new standards. There is a continual struggle between hospitals and the minister of health for funds. Will the eHealth program pay for data conversions and application upgrades? Does anyone know how much that would cost? Would the hospitals pay for this out of their own budgets? Will doctors and clinics be expected to absorb the costs of conversion? It's not clear to me if these questions have been answered or not, but based on Reed's appeal in the Star, I'd say they haven't.

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