Many organizations struggle with the business decision of whether to build their own healthcare data warehouse and decision support solution or to license a solution from an organization that specializes in healthcare data analytics.

Most healthcare payer organizations have some form of an operational data store (ODS) that serves as a storage site for their claims adjudication system data.  The temptation to expand the ODS data sources to include non-claims adjudication system data sources and layer data tools on top is strong. But is this the right course of action? Should the ODS be transformed into a full healthcare business intelligence solution? If not, what role should a third party business intelligence solution play?

In my opinion, the answer is a bit of both – an ODS for operational reporting and a third party business intelligence tool for cutting edge business analytics.  I postulate that the following structure optimizes the strengths of both models:

1. The payer organization builds and maintains an ODS that has frequent (or real time) updates of claims adjudication system data. The data is subjected to little or no transformation or enhancement.
2. The ODS has a limited number of “operational” reports written against it. The defining metric on if a report should be written against the ODS is the “currency” of the data. If you need a near real time list of open claims, this is a report that should populate from the ODS.
3. Layer on top of the ODS a “best in class” healthcare decision support system. This system is typically characterized by periodic data updates, typically monthly, and a number of advanced data analytic enhancements. Enhancements include methods like risk scores, service classification grouping, episodes of care, quality metrics, completion factors, attribution methods, benchmarks etc.
4. Included as part of the decision support system are user tools such as dashboards, OLAP cubes, standard reports and user portals.  These different interfaces provide for access to a wide variety of users in the organization.
5. The decision support system also allows for a wide variant of different data sources to be combined together in a standardized format. By combining data from pharmacy benefit managers, third party carve outs such as vision or mental health, lab results, wellness programs or even administrative data, powerful new analysis can be accomplished.

Where do you draw the analytic line between your ODS and BI solution?