Building a Shared Data Warehouse for FQHC

The Colorado Associated Community Health Information Exchange (CACHIE) is a HIT entity initiated to provide federally qualified health centers (FQHC) in Colorado with a clinical data warehouse (CDW) and the reporting tools to support reporting for mandated needs, quality improvement and benchmarking, clinical registries, and ad hoc end-user reporting.

The design of the CDW began with an exploration of end-user challenges and needs utilizing business process analysis methods at several FQHCs. Topics included (1) mandated and other reporting needs, (2) current reporting methods and tools, and (3) challenges and barriers. Interviewed FQHC partners desired a CDW that supported efficient and user-friendly reporting for identification of quality gaps, quality improvement initiative assessment, quality benchmarking across FQHCs, creation of clinical registries, mandated UDS reporting, and reporting to support policy, advocacy and funding proposals. Barriers and challenges varied by EHR vendor but included difficulty identifying and retrieving required data from EHR databases, limitations with retrospective queries, lack of uniform quality metric definitions among FQHCs, and costs. User and technical requirements were specified. Using diabetes and tobacco cessation reporting as the initial use cases, Phase1 included CDW design and extraction-transfer-load of required data for tobacco and diabetes, including identification of the required data types, standardized vocabularies, and query requirements, e.g., being able to aggregate data by provider, clinic site, or clinic. Beginning with a single EHR vendor employed at two FQHCs data profiling identified data location and data quality issues. A data mart was created to support rapid uniform queries of the data.