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Business Intelligence Solutions in Healthcare A Case Study: Transforming OLTP

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 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut
Business Intelligence Solutions in Healthcare
A Case Study: Transforming OLTP system to BI Solution
Osama T. Ali, Ali Bou Nassif and Luiz Fernando Capretz
Electrical and Computer Engineering
The University of Western Ontario
London, Ontario, Canada, N6A 5B9
{oali8,abounas,lcapretz}@uwo.ca
Abstract – Healthcare environment is growing to include not
only the traditional information systems, but also a business
intelligence platform. For executive leaders, consultants, and
analysts, there is no longer a need to spend hours in design and
develop of typical reports or charts, the entire solution can be
completed through using Business Intelligence “BI” software.
This paper discusses current state-of-the-art B.I components
(tools) and outlines hospitals advances in their businesses by
using B.I solutions through focusing on inter-relationship of
business needs and the IT technologies. We also present a case
study that illustrates of transforming a traditional online
transactional processing (OLTP) system towards building an
online analytical processing (OLAP) solution.
Keywords- business intelligence; healthcare informatics; data
warehouse; data mining; data analytics; decision support;
I. INTRODUCTION
Health Informatics is one of the rapidly growing fields that
focus on applying “Computer Science” and “Information
Technology” to medical and health data.
Every day hospitals are collecting huge volumes of data,
and the challenge they now have is how to make the raw data
inside the relational databases meaningful information for
executive leaders in the organization to make effective
decisions based on what is going on now and to predict what
will happen in the near future.
The implementation of BI solutions within healthcare
settings is still one of the controversial issues among
healthcare providers, analysts and executive managements’
levels, which executive leaders like to see high level of
aggregated data to make strategic decisions. On the other
side, analysts need to work with the transactional data to
build daily basis operational and monitoring reports.
The hierarchy of different organizational solutions based
on their complexity and strategic insight levels can be
depicted in the Fig. 1.
High
Strategic Insight
H.W & S.W
Complexity
Low
Fig. 1: Organizational solutions according to strategy and complexity
Eventually, the destination of all healthcare administration
levels is to use analysis service tools in a very efficient way
978-1-4673-5307-6/13/$31.00 ©2013 IEEE
to make the right decision whether at enterprise or
departmental level, and this service requires many other
important components, such as clinical/operational data
stores (ODS), data warehouse (DW), OLAP, query and
reporting, data mining (DM), etc.
II. WHAT IS BUSINESS INTELLIGENCE (BI)
BI is the one of hottest buzzword for the last 4-5 years in
the business administration and information management
fields. There are a lot of definitions for BI as follows:
A “BI is a strategic initiative by which organizations
measure and drive the effectiveness of their competitive
strategy” [1]. In order to achieve this grand goal, there is
need for analysis, software, resources, technical leadership,
process specialists, executive leaders and much more.
Gartner [2] also defines a BI platform as a “software
platform that delivers the 14 capabilities within three main
categories of functionality” as follows:
1) Integration: BI infrastructure, Development tools,
Metadata management, Collaboration.
2) Information Delivery: Reporting, Ad-hoc query,
Dashboards, Data integration, Search-based BI, Mobile BI.
3) Analysis: Online analytical processing (OLAP),
Interactive visualization, Data mining and Predictive
modelling, Scorecards (Key Performance Indicators -KPIs,
Performance Management Methodology) [2].
III. BUSINESS INTELLIGENCE ARCHITECTURE
Fig. 2 represents the essence of BI with the proper
workflow of the interdependent components as follows:
A. The Multidimensional Data Warehouse
Data Warehouse (DW) is the core of any solid BI solution.
Data Warehouse can be defined as a “repository for keeping
data in a subject oriented, integrated, time variant and non-
volatile manner that facilitates decision support” [3][4].
Basically it is a big database containing all the data needed
for performance management, decision making, and
prediction. The multi-dimensional modeling techniques is
using facts and dimensions within relational or multi-
dimensional databases and it is typically used for the design
of corporate data warehouses and departmental data marts.
Such a model can adopt one of the data mart’s building
schema whether a star, snowflake, or fact constellation
schema [5]. The task of designing and construction of a Data
warehouse is very complex, it involves many technical issues
related to a number of fields and subfields [6].
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 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut
Fig. 2: The main components of BI architecture [7]
A Clinical Data Warehouse (CDW), as defined by Gray
[8], is a “Place where healthcare providers gain access to
clinical data gathered in the patient care process”. Some
researches consider the extent of the essential background
knowledge of the architect is slightly different between DW
and CDW which is the CDW is immensely complex to build,
and maintain when compared to other business.
B. The source systems:
The source systems are not really considered as a part of
the BI environment, but they feed the BI solution and so they
are at the basis of whole architecture and should be totally
understood by the developers. One of the important things in
the set-up of BI environment is that to consider all the types
of data that may need to be included in the analysis process.
The BI architect should take in his/her consideration to
include all information in databases, external data feeds from
other stakeholders, e.g. through XML; or connecting to
Enterprise Resource Planning (ERP) systems on application
server level; or uploading Excel sheets and flat data files
(always needed); and many more candidate data sources.
C. ETL: Extract, transform and load:
It’s a process of pulling the required data from different
data sources and populates the multi-dimensional data
warehouse within BI environment, the potential connectivity
issue is a keyword here. After extraction task, the data needs
to be transformed. The transformation process can mean a lot
of things which includes all tasks to make the data match and
fit the multi-dimensional model.
Given the significant difference between entity relational
and multi-dimensional models, the transformation process
may become quite complex specially when it includes extra
210
work to clean up and harmonize the data coming from
different systems, that’s why most of BI professionals
describe ETL work as 70% of the IT side of a BI project.
Through working on the development of ETL component, a
separate database in the data warehouse is reserved as storage
space for intermediate results of the required transformations.
This area is called staging area or work area. Once the
transformation work is done, the prepared data can be loaded
into the multi-dimensional model.
D. Operational Data Store (ODS):
Operational data store is an off-line copy of one or more
production source systems which has some characteristics as
follows:
1) Has Entity Relational (ER) data model.
2) Has additional functionality of storing historical
versions of the data.
3) Potentially has some or full integration between the ER
models of different applications
In any case the ODS is built for supporting the operational
reporting that related to the functional scope of a specific
application and it is not to support strategic decision making.
E. Online Analytical Processing (OLAP) cubes:
OLAP is analysis techniques including variety of
functionalities such as aggregation, summarization, and
consolidation as well as the ability to view information from
different angles [5]. OLAP offers high performance in
analysis and loading of the data. OLAP cubes have had very
high success rates for business environments where the BI
solution is used for what-if analysis, financial simulations,
budgeting and target setting, etc. Fig. 3 shows the logical
representation of multi-dimensional cube.
Fig. 3: A 3-D data cube representation of the data, according to the
dimensions time, age groups, and location. The measure displayed is number
of patients [9]
F. Semantic layer for reporting:
The objective of a BI solution is to offer a tool that enables
end users easily access to information for analytical
purposes. Unfortunately, databases are often not user-
friendly, therefore most vendors of reporting solutions started
to create a layer between the database and the reporting
 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut
which made data access easier for end users. In this layer the
database fields can be translated into Objects, each object has
a business definition. These objects can be easily dragged
and dropped onto a report, making report creation easy.
G. BI portal:
When the amount of different reports begins to grow, the
best solution is to create a single point of access to
information within the organization. Usually the efforts of
creating a single point of access is results into building some
kind of intuitive portal solution that contains different reports
with clear descriptions of the scope of each report, as well as
indication who is the business owner of the report.
H. Data mining:
Data mining is “the automated process of discovering
previously unknown useful patterns within structured data.”
The data warehouse is a perfect environment to conduct data
mining exercises along with online analytical processing
OLAP in which users can slice and dice, pivot, sort, filter
data to discover patterns often using visual data mining form.
Without applying data mining techniques, it is difficult to
realize the potential of data collected within healthcare
organization as data under analysis is massive, multi-
dimensional, distributed and uncertain [10].
IV. BI APPLICATIONS FOR HEALTHCARE
BI applications in healthcare can be categorized in two
major sets of solutions as shown in Fig. 4 [11]:
Business Solutions Technology Solutions
Patients (Demographic and
Satisfaction) Analysis
Decision Support Systems
Electronic Health Record
Analysis Executive Information Systems
Performance Analysis
(Staffing & Scheduling, Case Costing) Online Analytical Processing
Fund Channel Analysis (OLAP)
Query & Reporting Services
Productivity Analysis
Data Mining (Predictive Model)
Behavioural Analysis
Operational Data Services
Supply Chain Analysis
Integration Services (ETL)
Wait Time Analysis
Fig. 4: BI business and technology focused applications [11]
A. Technology Solutions: It’s Data & Information Tools and
Services, as follows:
1) Decision Support Systems (DSS): Support managerial
decision making, usually day-to-day tactical.
2) Executive Information Systems: Support decision making
at the senior management level which provide and
consolidate metrics-based performance information.
211
3) Online Analytical Processing (OLAP): Support analysts
with the capability of perform multi-dimensional analysis of
data (i.e rollup, drill down, slice-and-dice, ‘what if’ analysis).
4) Query and Reporting Services: Provide quick and easy
access to the data with predefined report design capabilities.
5) Data Mining (Predictive Model): Examines data to
discover hidden facts in databases using different techniques
(i.e, statistical analysis, machine learning, frequent
pattern/relation finding, infer predictive and descriptive
information). Examples of successful predictive models
include [12][13][14].
6) Operational Data Services: Collect data from end users,
organizing data, establishing solid data structures and store
them in different databases, retrieve data from multiple
databases.
7) Integration Services: Design and implement of process
flow of data extracting, transforming, and loading to the data
warehouse.
B. Business Solutions: Business focused analytical
applications, as follows:
1) Patient Analysis: Focuses on analysis of patients’
demographic and satisfaction processes.
2) Electronic Health Record Analysis: Focuses on analysis
of the quality of clinical data (illness, diagnosis, medication,
etc.)
3) Performance Analysis: Streamline and optimize the way
that a business uses its resources (budget, human,
equipment).
4) Fund Channel Analysis: Devise, implement, and
evaluate fund strategies, then use the corporate metrics to
continuously monitor and enhance the fund process
5) Productivity Analysis: Focuses on building business
metrics for activities such as quality improvement, risk
mitigation, asset management, capacity planning, etc.
6) Behavioural Analysis: Understanding and predicting
trends and patterns that provides business advantage.
7) Supply Chain Analysis: Monitor, benchmark, and
improve supply chain activities from materials ordering
through service delivery.
8) Wait Time Analysis: Focuses on the factors that are
associated with longer waiting times and the effects of delays
in scheduling and operation.
There is a big competition among BI vendors based on
many factors, such as performance, customization, risk
tolerance, and business improvement.
V. CASE STUDY: TRANSFORMING OLTP
RELATIONAL DB TO B.I SOLUTION
A. Corporate Project Purpose
London Health Sciences Centre (LHSC) continues to have
significant challenges related to infection rates, reporting
rates well above the provincial average and often showing
LHSC as one of the poorest performing teaching centres in
Ontario. The corresponding costs to the organization (time,
energy, supplies and equipment) are extreme. Reducing
infections has become a strategic priority for LHSC.
 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut

The infection safety solution will consist of multiple
projects and strategies to improve infection rates of antibiotic
resistant organisms (AROs) across LHSC. Having a solid
framework for collecting, managing and reporting data and
information will be a key success factor in these projects and
overall solution.
The intent of this project is to define and recommend an
appropriate data management and reporting structure to
support the Infection Safety corporate strategy. This will
include (but may not yet be inclusive) the following
deliverables:
1) Hand Hygiene Audit Technology
2) Corporate Data Warehouse with Data Integration and
Analysis Tools
3) Infection Prevention and Control (IPaC) Reporting Tool
/ Dashboard
B. Project Scope:
This project will cover the approaches of analysis and
implementation of B.I solution for traditional OLTP
relational database in order to expand the classical use of
data from different perspectives through showing how SQL
Server 2008 Integration and Analysis Services solves many
business problems in a simple and cost-effective manner via
providing a simple, integrated view of data, data mart and
specialized application consolidation, intelligent views of
data, and real-time business intelligence data.
The most challenging part of this project was the analysis
and design of data warehouse model by using the Star
schema as well as building the cube and KPI.
C. Project Outcomes:
The expected outcomes from the project include the
following:
1) All Data Management and Reporting
• Understanding of our current state regarding how data is
collected, analysed, and disseminated including what
infrastructure, tools and support exist.
• Defining standards and processes regarding future
collection, analysis and reporting of data related to
infection safety.
• Recommending infrastructure, appropriate tools and
technology required to support quality data management
and reporting.
• Creating a solid data infrastructure which is made up by a
collection of heterogeneous systems
• Automating the process of extraction, transformation, and
loading in order to integrate all the different data sources
in central repository.
• Building multi-dimensional cubes to provide with all the
required information to different level of users (managers,
specialists, consultants, analysts, etc.).
4) Infection Prevention and Control (IPaC) Reporting
Tool/Dashboard
• Review existing Internal and External reporting
processes, tools and reports for ARO and Safer healthcare
Now (SHN) indicators and evaluate effectiveness and
efficiency of data analysis and review.
• Obtain feedback from IPC and identify internal
departmental reporting needs.
• Solicit clinical director and manager level feedback re
current ARO reports, formats, delivery.
• Consider dashboard/ business intelligence approach;
benchmark with other healthcare organizations regarding
software tools, review potential vendors in collaboration
with ITS and make recommendations
D. Technology used for design and implementation:
• For Data Mart Building: Microsoft SQL Server 2008 R2
Management Studio
• For Data Transformation (ETL): SSIS packages
(Business Intelligence Development Studio with Visual
Studio 2008
• For Reporting: SSRS or MS Excel 2010
E. Traditional System’s Diagram:
Fig. 5 illustrates the traditional solution architecture and
workflow.

2) Hand Hygiene System

• Clear definition of roles and responsibilities regarding the
auditing and data entry process.
• To have a short-term interim solution that will allow us to
deliver monthly audits as soon as possible until a long-
term solution has been developed and implemented.
• Inform requirements and support ITS as they consider an
appropriate long term solution for the auditing.
Fig. 5: Diagram of data systems and infrastructure of the existing traditional
3) Data Warehouse Building systems [15]
• Creating a standard data dictionary for all heterogeneous
information

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 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut

F. Project Methodology:
In this project as a mid-sized solution, the BI developer
was applying the following development life cycle phases:
1) Design the data warehouse first through using SQL
Server Management Studio. In particular, design the tables
(dimensions and fact) that are needed as part of the DW,
ignoring any staging tables as shown in the Fig. 6.

Fig. 6: Star schemal data mart design (dimensions and fact tables)

2) Design the ETL by using SQL Server Integration

Services project which contains a lot of data integration
components as shown in the Fig. 7, also sometimes the stored
procedures have been used within the production databases:
• Its fine if any staging tables are required as part of the
ETL, but at the same time they should get cleaned up. A
staging table used only as part of a single series of ETL
steps should be truncated after those steps are completed.
• SSIS packages refer to the OLTP database at least to pull
data into the staging tables. Depending on the situation,
they may process the OLTP tables directly into the data
warehouse.
• Documenting and make it clear what inputs are used by
each package, where the output goes, and the criteria by
which the input are selected (i.e. last 24 hours? Since last
success? New identity values? All rows?)
Fig. 7: Building the ETL framework by using SQL server integration
3) Designing Analysis Service project by using VS 2008 services project
SSAS as follows:
• Create Data Source. 4) Build required reports by using SSRS or Excel 2010
pivot table.
• Create Data Source View.
5) Data mining component
• Create associated dimensions plus DateTime Dim.
• Create multi-dimensional cube. VI. CONCLUSIONS
• Create KPI’s (Key Performance Indicators) to display In this paper, the general architectural approaches for BI
monthly metrics. solution have been outlined and its major development

213
 ICCIT-2013: Special Session-Computational Intelligence Applications in Software Engineering (CIASE), Beirut

components have been introduced in order to give the reader
a high level picture with some important details regarding
healthcare informatics.
Many healthcare organizations struggle with the lack of
utilization of data collected through non-integrated OLTP
system which have been used for decision making and data
mining. For successful healthcare organization it is important
to empower the staff and management with data warehousing
based on critical thinking and knowledge management tools
for strategic decision making.
Decision support tools such as data mart, OLAP and data
mining techniques can support on building a solid foundation
for clinical data warehouse.
A data mart is a subset of data warehouse. It focuses on
selected business subjects. OLAP solutions provide a multi-
dimensional view of the data found in relational databases.
Storing and presenting data in three dimensional format as a
OLAP cube makes it possible to analyze potentially large
amount of data with very fast response times and provides
the ability for users to go through the data and drill down,
roll up, or slice-and-dice through various dimensions as
defined by the data structure.
The primary motivations of the case study in this paper
have been to expand the horizon of a software engineer to
mix the business acumen with the technical expertise in order
to maximize the strategic thinking through moving from
classical information systems towards enterprise BI
solutions.
[7] R. Guro. Components of business intelligence. The Business Intelligence
Guy [Online]. 2011. Available: http://www.the-business-intelligence-
guy.com/components-of-business-intelligence-bi/.
[8] G. W. Gray, "Challenges of Building Clinical Data Analysis Solutions,"
Journal of Critical Care, vol. 19, pp. 264-270, 2004.
[9] Information technology for students and professionals. United States
Information Source [Online]. Available: http://www.info-source.us/.
[10] H. Kaur and S. K. Wasan, "Empirical Study on Applications of Data
Mining Techniques in Healthcare," Journal of Computer Science, vol. 2, pp.
194-200, 2006.
[11] M. Peco, "TDWI Business Intelligence Fundamentals: From Data
Warehousing to Business Impact," The Data Warehouse Institute, 2011.
[12] A. B. Nassif, D. Ho and L. F. Capretz, "Towards an Early Software
Estimation Using Log-linear Regression and a Multilayer Perceptron
Model," Journal of Systems and Software, vol. 86, pp. 144-160, 1, 2013.
[13] A. B. Nassif, L. F. Capretz and D. Ho, "Estimating software effort
based on use case point model using sugeno fuzzy inference system," in
23rd IEEE International Conference on Tools with Artificial Intelligence,
Florida, USA, 2011, pp. 393-398.
[14] A. B. Nassif, L. F. Capretz and D. Ho, "Software effort estimation in
the early stages of the software life cycle using a cascade correlation neural
network model," in 13th ACIS International Conference on Software
Engineering, Artificial Intelligence, Networking and Parallel & Distributed
Computing (SNPD), Kyoto, Japan, 2012, pp. 589-594.
[15] A project charter, "Data Management System for Infection Prevention
and Control," IPAC Project Team, London Health Sciences Centre, 2011.

VII. FUTURE WORK

Within big healthcare organizations there is vast potential
for implementation of BI solutions (Clinical Data
Warehouse, Information Visualization, and Data Mining
Applications), such as, operational performance, quality and
risk management, case costing, patient safety factors, wait
time management, staffing and scheduling, evaluation of
effective treatment and best practices, predictive medicine,
image and pattern recognition, etc.
Through data mining and predictive analytics, historical
data can reveal patterns that are used to predict trends.
Historical data analysis and predictive analytics, together
with expert knowledge will effectively assist in the diagnosis
and treatments of numerous diseases.

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