As federal stimulus money begins to be portioned out for creating a nationwide network of electronic medical records (EMRs), agencies seeking federal stimulus money for them may want to follow the advice of Cynthia Green-Edwards, the director of the Data Management Division of the Michigan Department of Community Health (MDCH), and deploy a data warehouse in conjunction with those records. A data warehouse stores various databases and can compare databases to produce analytics.

The health databases states keep on citizens could provide a case for deploying data warehouse projects in conjunction with stimulus-funded EMR projects, according to Shelby Solomon, executive vice president of Ingenix, the vendor that provided Michigan's data warehouse. State-generated health databases could be connected to EMRs via the data warehouses to give doctors more complete information. For example, Michigan has registries of citizen immunizations and children who have been tested for lead poisoning. The state plans to use its data warehouse for just that purpose if it receives EMR stimulus money. Vendors are waiting to see whether or not states can use stimulus money to fund data warehouse components of EMR projects.

Once a state has the data warehouse, it can use the tool to perform other helpful analytics, like examining Medicaid databases to cut costs and improve care, Green-Edwards said. Michigan began aggressively comparing Medicaid-related records within its data warehouse in 2003 and erased $200 million in annual health-care costs. Most of that savings came from reclaiming money improperly paid to health-care providers. For example, the MDCH compared a database of Medicaid payments to providers and a database of the insurance individual patients had in addition to Medicaid. This revealed cases in which patients paid for services with Medicaid when they had other insurance that was able to cover those services. In these cases, the MDCH either filed a claim with the insurance company in question or reclaimed the money directly from the provider. That left the private provider to file its own claim with the insurance company.

The data warehouse uncovered numerous forms of fraud, like providers charging Medicaid for treating deceased patients. One of Michigan's databases is a death-certificate registry. However, a death certificate takes a while after the person dies to reach the MDCH, explained Green-Edwards. That produces a window of time in which the agency can pay unknowingly for services to dead people. Once the death certificate arrives, however, the MDCH compares it to the database of payments and goes after the fraudulent claims. Before the agency's data warehouse, those claims usually fell through the cracks, Green-Edwards reported.

"We had a very old Medicaid system for claims payments. We were very limited in what we could do," she said.

A side benefit of the project was that it improved the accuracy of the MDCH's records, commented Green-Edwards. After comparing the database of children tested for lead poisoning to the database of Medicaid patients, many children on Medicaid appeared to have never had lead-poisoning tests. However, a closer look showed those children often were on the lead-poisoning database, but the identifying information used for comparison was wrong either on the lead-poisoning database or Medicaid database. For example, the first and last names were sometimes entered backwards in one of the databases, or one database had the Social Security number wrong. Other times the date of birth or gender in one of the databases was incorrect.

"The whole process helps you clean up your data," Green-Edwards said.