Structured Query Language (SQL): Pharmacy

Data, Up Close and Personal

Patrick Spoutz
Pain Clinical Pharmacy Specialist & Data Manager

March 20th, 2018

Objectives

• Understand the types of information that available via SQL

• Describe the syntax of a basic query

• Become familiar with techniques to write efficient code on the Field Reporting
Enclave (FRE)

• Become familiar with viewing SQL query cost

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Background

• Completed PGY1 Residency at the Ann Arbor VA

– Worked with Allison Brenner (Pharmacy CAC) designing order menus, reminder dialogs

• Completed PGY1 Residency at the VISN 15 PBM Office in Kansas City

– Pharmacy Outcomes and Healthcare Analytics
– Learned SQL, reporting services, Pyramid

• Population Health Specialist

– Designing dashboards, reports, clinical processes on VISN Data Warehouse (VDW)
– Anticoagulation, Cost Savings, Hepatitis C, Chronic Disease Management (DM, hypertension,
hyperlipidemia)

• Pain Clinical Pharmacy Specialist

– 75% of time in pain clinic
– Now coding on the Field Reporting Enclave (FRE) instead of the VDW

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 Corporate Data Warehouse (CDW) Overview – slide 1

• Updated once daily (overnight)

• Primary data source is VISTA

• There are some non-VISTA data sources

• Per the CDW Guide Introduction and Policies

• “The data comes from the source systems (mostly Vista) without “scrubbing”,
filtering and without business logic applied. The data is not optimized for any
particular use but rather it is fairly normalized to allow its use by varied types of
queries for analyses and reports.”

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Corporate Data Warehouse (CDW) Overview – slide 2

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Corporate Data Warehouse (CDW) Overview

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Data Available

• Structured Query Language (SQL)

– Lab values
– Problem lists
– Vital signs
– Encounters / workload
– Visit diagnoses
– Prescriptions
– Many more….
• Non-structured data is more difficult to access or query
– Free text of notes
– Imaging
– Typically stored in other databases

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Interacting with VA Data

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Microsoft SQL Server Reporting Services (SSRS) – slide 1

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Microsoft SQL Server Reporting Services (SSRS) – slide 2

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Pyramid Analytics

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Microsoft SQL Server Management Studio (SMSS)

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TOAD

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Reporting Services vs. Pyramid vs. SQL: Choosing the Right
Tool for the Job

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Project Example Using SQL: AHA/ACC Heart Risk
Calculator - 1

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Project Example Using SQL: AHA/ACC Heart Risk
Calculator - 2

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Project Example Using SQL: AHA/ACC Heart Risk
Calculator-3

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Project Example Using SQL: AHA/ACC Heart Risk
Calculator -4

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Other Projects

• Various ways of obtaining customized lists of patients

– Example: All patients on etodolac who have not previously tried meloxicam

• Complex patient cohorts

– Example: All patients with a specific disease state diagnosis and not receiving a specific
medication within the last year

• Complex dashboards that present data with SSRS

– Example: All Academic Detailing reports are built on SQL code with an SSRS interface

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Basic SQL Queries-1

Select [stuff that you want!]

From [where should the computer look]

Where [restrictions to filter to what you want]

Order by [orders the output]

Regular Life Analogy: “Honey, please get the milk from the store, but not the 2% kind, and
put it on the top shelf”

[Exercise for the reader: match the select, from, where, and order by clauses with relevant
part of sentence]

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Basic SQL Queries-2

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 Getting Started with SQL-1
• Obtain necessary software
– Microsoft SQL Server Management Studio; Toad for SQL Server Software generally obtained
through the VISN Database Administrator
– SSMS installation on your desktop/laptop is requested through your local software installation
request process (refer to applications section in table at https://vaww.cdw.va.gov/Regions/fr/
for installation files/information)
– Some VISNs have Citrix-based SSMS/TOAD; contact your VISN Data Warehouse POC for more
information (https://vaww.cdw.va.gov/Regions/fr/SitePages/VISN_POCs.aspx).

• Learn the programming language

– Moodle courses link: https://vapharmacytraining.remote-
learner.net/course/index.php?categoryid=39
– Kathi Kellenberger book (available through TMS Skillsoft Books).

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 Getting Started with SQL-2
• CDW Support
– https://vaww.cdw.va.gov/support/Training/
– Sign up for CDW Training Announcements
– Frequently Asked Questions link: https://vaww.cdw.va.gov/support/cdwcs/Pages/CDW-
Frequently-Asked-Questions.aspx
– Attend CDW Insights, SQL Office Hours
– CDW Introduction and Policies link: https://vaww.cdw.va.gov/Pages/CDWHome.aspx

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Switching Gears to Efficient Coding on the Field Reporting
Enclave (FRE)

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Introduction to Efficient FRE Coding-1

• Querying on the FRE is not free

– Heavy data loads, complex queries, multiple users slow processing down
– Poorly or inefficiently written code adds to the backlog
– Adopting best practices can improve performance (or at least prevent performance
degradation)

• LSV vs. CDWWork

– Users initially receive access to LSV tables
– Contains data for last three years ONLY (data >= 10-1-2014)
– If access needed for older data or national data due to role, file a VHA NDS Access Form
Health Operations Request form link:
http://vaww.vhadataportal.med.va.gov/DataAccess/HealthcareOperationsRequestProce
ss.aspx
• Recommend only requesting CDW_FULL and using LSV for SPatient/SStaff needs

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Introduction to Efficient FRE Coding-2

• Developed by Samantha McClelland [formerly Samantha Wright] and LeAnn Radcliffe

• Available at https://vaww.cdw.va.gov/Regions/fr/

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MetaData – “Data about data”

• Detailed MetaData information available at:

https://vaww.cdw.va.gov/metadata/default.aspx#
• Spreadsheet version available at:
https://vaww.dev.fre.cdw.va.gov/sites/D03_VISN12/Documents/Metadata_Table_
with_Queries.xlsx

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More MetaData: Identifying Indexes

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Improving Efficiency Example-1

1 Minute and 39 Seconds

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Improving Efficiency Example-2

<1 Second
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Query Plans

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Query Plans: A Comparison-1

In depth education on query plans available at

https://vaww.cdw.va.gov/support/Training/
“Bad Query” “Less Bad Query”

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Query Plans: A Comparison-2

“Bad Query” “Less Bad Query”

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Incremental Loads

• Advanced technique
• Uses
– Scanning large fact tables daily
– Processing data for entire VA

• Downsides
– Complex to construct
– Break easily
– May inadvertently create copy of
entire CDW

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Acknowledgements

• CDW Insights Presentations on MetaData & CDW Support in general

• Samantha McClelland (Wright) and LeAnn Radcliffe’s Query Efficiency Tool

• Spencer Schaefer, Eric Wagner, Samantha McClelland, and Linda Chia for feedback
on presentation slides

• Monica Schaefer for mentorship

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Questions?

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