• Stephan D Fihn, Joseph Francis, Carolyn Clancy, Christopher Nielson, Karin Nelson, John Rumsfeld, Theresa Cullen, Jack Bates, and Gail L Graham.
• Stephan D. Fihn (Stephan.Fihn@va.gov) is director of the Veterans Health Administration (VHA) Office of Analytics and Business Intelligence in Washington, D.C., and a professor in the Departments of Medicine and Health Services at the Schools of Medicine and Public Health, respectively, at the University of Washington, in Seattle.
• Health Aff (Millwood). 2014 Jul 1; 33 (7): 1203-11.

AbstractHealth care has lagged behind other industries in its use of advanced analytics. The Veterans Health Administration (VHA) has three decades of experience collecting data about the veterans it serves nationwide through locally developed information systems that use a common electronic health record. In 2006 the VHA began to build its Corporate Data Warehouse, a repository for patient-level data aggregated from across the VHA's national health system. This article provides a high-level overview of the VHA's evolution toward "big data," defined as the rapid evolution of applying advanced tools and approaches to large, complex, and rapidly changing data sets. It illustrates how advanced analysis is already supporting the VHA's activities, which range from routine clinical care of individual patients--for example, monitoring medication administration and predicting risk of adverse outcomes--to evaluating a systemwide initiative to bring the principles of the patient-centered medical home to all veterans. The article also shares some of the challenges, concerns, insights, and responses that have emerged along the way, such as the need to smoothly integrate new functions into clinical workflow. While the VHA is unique in many ways, its experience may offer important insights for other health care systems nationwide as they venture into the realm of big data.Project HOPE—The People-to-People Health Foundation, Inc.

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