CMS Dashboard delivers health care data STAT

In a medical emergency, doctors call for the data they need “stat,” which is short for the Latin statim, or immediately. But when it comes to getting medical statistics, it was anything but stat.

The Centers for Medicare and Medicaid Services (CMS) at the Health and Human Services Department collects data on the nearly 45 million Medicare and 51 million Medicaid beneficiaries, in addition to the 6 million children covered by the Children’s Health Insurance Program. But that data wasn’t readily accessible.

“We have some of the richest repositories of health care information in the world because we pay for care for so many people,” said Julie Boughn, CMS’ CIO and director of its Office of Information Services (OIS). “There is an incredible demand for this data from outside our agency, but our data can be incredibly difficult to use, especially in raw format, and only an experienced health care data researcher can grapple with it.”

That changed during the past year as CMS created a public portal on which people can run custom reports and create graphs that cover Medicare Part A expenditures. Data for a given quarter is now published less than three months after the end of that quarter, compared with the 18 months or more it would take previously.

From left, Mary Kapp, Bryan Wilson, Yadira Sanchez, Adam Driscoll, Rosanne Hodge, Julie Slater, Sherry Wilke, Valerie Hartz and Bing Nguyen.

Short Schedule

In August 2009, Federal CIO Vivek Kundra asked that CMS create a dashboard — and have it ready in six weeks.

“Doing these types of analytical tools was something that was always on our to-do list, but this provided the impetus to get it done rapidly,” Boughn said. “We had a clear goal in mind, a product to create and a named release date.”

A team of about a dozen key players at CMS, together with outside contractors and vendor representatives, quickly set out to create the dashboard.

Rosanne Hodge, director of the Division of Information Reporting Services at OIS’ Enterprise Databases Group, spearheaded the design, development and implementation of the CMS Dashboard Beta Program and led an extensive outreach effort to promote the dashboard to CMS' executive leadership.

Other key players at OIS included Valerie Hartz, who helped manage the day-to day operations for the analysis, design and development work; Bing Nguyen, who conducted an architecture assessment; Kimberly Finnegan, who coordinated all technical efforts between IT and business professionals; Deb Thomas, who coordinated the efforts to analyze and populate the data in the dashboard; Adam Driscoll, who led the design and integration of the CMS business intelligence portal; and Julie Slater, who coordinated the capture and delivery of the data from the Integrated Data Repository to the dashboard.

“We got some very engaged data subject-matter experts to work with the technical staff, without whom this would not have been a success at all,” Boughn said. “It was a huge challenge to get it done in six weeks, and that target created incredible focus in the team.”

Fortunately, everything did not need to be created from scratch. The team could use the existing data warehouse and business intelligence system. CMS’ Integrated Data Repository includes a Teradata Active Enterprise Data Warehouse 5600 with the Teradata 12 Database operating on Linux. The 84T system stores and manages data details for billions of claims and reference data, with more than 280 million claims added monthly. The data was all there; it just needed to be made accessible.

“The challenge was how to take data that is very complex and hard to understand — a normal person would never want to look at it — and render it in a way that is understandable and provides useful information while protecting the privacy of the individuals,” Boughn said. “We had to integrate portal technology with BI tools with our enterprise data warehouse environment in a way that we had never done before.”

Rapid Development

CMS decided to focus on one narrow area: Medicare Part A. The team then created a rapid prototype to show users possible features, solicited their feedback and incorporated that feedback into the portal design.

“Often, people who use technology can’t describe their requirements,” Boughn said. “But if you show them something, then they start asking questions about possible features, and you start to elicit requirements.”

The dashboard was created by using an interface produced by Microstrategy that masks the complexity of the underlying analytic structure and displays the results in a variety of formats that are easy for users to understand, including grids, bar charts, bubble charts and line graphs. IBM’s WebSphere Portal acts as a secure entry point for all users.

The internal beta went online in October 2009, just five weeks after the initial assignment. That version was accessible to CMS, HHS, White House and Office of Management and Budget staff members. In April, CMS made it available to the public as one of HHS' Open Government Flagship Initiatives.

Boughn said that although the dashboard is still considered a beta release, she doesn’t foresee any major changes before its final release later this year. Her team is already working on additional dashboards, including one for the Medicare prescription drug benefit. The team is also working closely with the Center for Program Integrity on ways to better detect instances of fraud, waste and abuse.

“Internally, we have needs for managing the programs, looking for trends and mining data to explain them, and identifying utilization of services to indicate where fraud might be,” she said. “The dashboard is being used a lot, and we are working on more dashboard products that people are very excited about.”

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