RESEARCH PAPERS

HEALTHCARE DATA WAREHOUSING

By
ARUNACHALAM S. * TOM PAGE ** THORSTEINSSON G. ***
* Senior Lecturer, Department of Mechanical Engineering, University of East London, London.
** Senior Lecturer, Electronic Product Design, Loughborough University, UK.
*** Professor, Department of Design and Craft, University of Iceland, Iceland.

Date Received: 08/02/2017 Date Revised: 09/03/2017 Date Accepted: 08/05/2017

ABSTRACT
The term data warehouse was first used by Inmon in 1990 which he defined as “A warehouse is a subject oriented,
integrated, time-invariant and nonvolatile collection of data in support of management decision making process”
[Inmon, 1990]. On the other hand, Ralph Kimball provided a much simpler definition of the data warehouse. In the book
‘The Data Warehouse Toolkit’ he said that a data warehouse is “a copy of transaction data specifically structured for query
and analysis” [Inmon and Kimball, 1996]. This paper provides theoretical description of data ware housing.
Implementation of clinical Data warehousing were analyzed, finally evaluating them. The proto type considered for
implementation has been collected from the East Hospital London Clinical Data Warehouse Project.
Keywords: Healthcare, Data Warehousing, Clinical Data Warehouse.

INTRODUCTION must have strategic weapon in today's business world.

A data warehouse can be normalized or denormalised,
as it can be a relational database, multidimensional
database, flat file, hierarchical database, object
database, etc. With the widespread availability of the ever
changing computer technologies, telecommunication
technologies and internet access, most of the business
handles huge amounts of data. The business
organizations collect, examine and take their decision for
the next move. The information they collect from different
sources help the decision makers to take the right decision
at the right time. Data warehouse which acts as a decision
support system, extracts, integrates, and stores relevant
information. This is to support the information needed by
the information workers and decision makers. Finally,
“Data warehouse is a process, not a product, for
assembling and managing data from various sources for
the purpose of gaining a single, detailed view of part or all
of a business” [Stephen, 1998].
Today data warehousing is a part and parcel of the whole
decision support solution for a business organization. For
the huge potentiality of the data warehouse, most
corporations have discovered that a data warehouse is a
Now most of the big corporations have built or are building
data warehouses to support business analysis activities
and decision making tasks.
The Clinical Data Warehouse
The Clinical Data Warehouse (CDW) is a place where
healthcare providers can gain access to clinical data
gathered in the patient care process. It is also anticipated
that such data warehouse may provide information to
users in areas ranging from research to management
[Sen, and Jacob, 1998]. A clinical data warehouse is a
tailored data warehouse for the needs of users in clinical
environment. The clinical data warehouse combines
information from a variety of legacy healthcare database
and extract operational data to form a centralized
repository to answer the informational needs of all clinical
users. The data in a clinical warehouse are not only used
by the patients, nurses and doctors, but also used by
researchers, scientists, and medical students. The clinical
data warehouse is all the above, for clinical administrators
“for example, a clinical responsible for utilization
management may retrieve data on all patients with a
specific DRG/CMG and determine how many lab tests of

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which type were ordered, to see if services appear to be researchers, scientists, and medical students. To design a
under or over utilized. An administrator may want to look at clinical data warehouse it is necessary to find out the
the average length of stay over all patients or selected requirements of the client. Since the clinical data
groupings. A department manager may want to review warehouse is used by various medical organizations, it is
the number of paid staff hours that is required for each necessar y to choose the correct vendor or
type of test performed for those tests that actual methodologies to avoid complications.
turnaround times within a certain range during the Research Methodology
summer versus the winter” [Covvy, 2000].
The research for the paper started with several literature
The clinical data warehouse can provide significant and journal study covering data warehouse, data
improvements in patient care, hospital management, warehouse architecture, data warehouse methodologies,
organisational effectiveness, etc. Clinical data and the importance of data warehousing in a clinical
warehouse can facilitate efficient storage, enhance context. After that reading books in the related field and
timely analysis and increase the quality of real time taking important notes and writing down for the future use
decision making process. The clinical data warehouse is of the clinical data warehouse.
a place where health care providers can gain access to
The Project Scope
clinical data as a part of the patient care process. The
This research describes the data warehouse as well as the
clinical data warehouse can produce improved patient
clinical data warehouse elaborately. This research also
care service and improved clinical research. They can
describes the problems that rise while designing a clinical
reduce the medical errors and enhance quality
data warehouse and gives the possible solutions. This
measurement. They also can decrease costs and at
research also contains a case study based on the
times, increase revenue.
University of Virginia Clinical Data Warehouse which helps
Clinical data warehouse is much more complex than the
someone to understand the clinical data warehouse.
business facts of average data warehouse data.
Those who want to build a clinical data warehouse can
Furthermore, a clinical data warehouse demand even
have a picture of the problems. At the same time they will
more security measures and less downtime than a
get the possible solutions for those problems. This paper
conventional data warehouse. But a conventional data
also used some data warehouse and clinical related
warehouse and a clinical data warehouse do not differ so
terminology which is assumed to be understandable to
much. After all, they use the same technology, but in the
the interested readers of this project.
case of a clinical data warehouse everything gets more
1. An Overview of Data Warehousing
complex and complicated.
1.1 The Definition
The Project Objectives
The term data warehouse was first used by Inmon in 1990
The primary objective of this paper is to evaluate a data
which he defined as “A warehouse is a subject oriented,
warehouse in a clinical context. Data warehouse in
integrated, time-invariant and nonvolatile collection of
clinical context has traditionally been administrative in
data in support of management decision making
nature, focusing on patient-billing and patient-care
process” [Inmon, 1990]. Inmon (1990) defined the terms in
management. The clinical data warehouse combines
the sentence as follows:
information from a variety of legacy healthcare database
·Subject oriented: The data in the data warehouse are
and extract operational data to form a centralized
organised. All the relevant data about a subject is
repository. The data is, then used for making crucial
collected and stored in a useful format. The data are
decisions. The data in a clinical warehouse are not only
given information about a particular subject instead
used by the patients, nurses and doctors, but also used by
about a company's ongoing operation.

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·Integrated: Integration is the process storing data in
such a format that everybody could understand.
Data in a data warehouse gathered from a variety of
sources and merged into a single database. This data
is made consistent in a data warehouse.
·Time-variant: All data in the data warehouse is
identified with a particular time period. The data
warehouse contains a history of the subject. As
opposed to operational databases, historical data is
of high importance in the data warehouse world. The
changes to the data in the data warehouse are
tracked and recorded and these changes are shown
in reports.
·Non-volatile: Non volatility means that data in data
warehouses are stable. The information is consistent in
data warehouse regardless of when the warehouse is
accessed. The data is static, read-only, and retained
for future reporting.
A single subject data warehouse is typically referred as
data mart, whereas data warehouses are generally
enterprise in scope. Data warehouses can also be
volatile. Due to the large amount of storage required for
data warehouse, only a certain number of periods of
history are kept in the data warehouse.
On the other hand, Ralph Kimball provided a much
simpler definition of the data warehouse. In his book, ‘The
Data Warehouse Toolkit’, he said that a data warehouse is
“a copy of transaction data specifically structured for
query and analysis” [Kimball and Inmon, 1996].
Both Bill Inmon and Ralph Kimball agree that a data
warehouse integrates data from various operational
source systems. In Inmon's approach, the data
warehouse is physically implemented as a normalized
data store. In Kimball's approach, the data warehouse is
physically implemented in a dimensional data store.
2. The Clinical Data Warehouse (CDW)
This section provides an overview of Clinical Data
Warehouse. Section 2.1 provides the brief introduction to
the Clinical Data Warehouse. Section 2.2 describes the
fields of application of the Clinical Data Warehouse.
Section 2.3 describes the comparison between the
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Clinical Data Warehouse and the data warehouse.
2.1 The Introduction of the Clinical Data Warehouse
Data warehouse in clinical context has traditionally
been administrative in nature, focusing on patient-
billing, and patient-care management. Patient-billing
systems manage financial systems and are primarily
concerned with providing information for financial
optimization, managing costs, and coordinating health
insurance providers. They typically contain demographic
information about the patient, length of stay in the
hospital, costs, etc. On the other hand, patient-care
systems generally manage information about individual
patients such as patient's location in the hospital,
medical tests, prescribed medicines, etc. They are
mainly concerned with optimizing administrative efforts
within the hospital. They were mainly operational
databases where large quantities of data were
collected. But later it was also being required sorting,
combining and analysis of data. As a result, the clinical
data warehouse comes into the limelight. A clinical
data warehouse is a tailored data warehouse for the
needs of users in clinical environment. The clinical data
warehouse combines information from a variety of
legacy health-care database and extract operational
data to form a centralized repository to answer the
informational needs of all clinical users. The data in a
clinical warehouse are not only used by the patients,
nurses and doctors, but also used by researchers,
scientists, and medical students.
2.2 Fields of Application
The clinical data warehouse has various fields of
application. Some of them are as follows:
2.2.1 Clinical Research
·Case Finding: for example, identify patients for
clinical trials
·Explorator y Analysis: for example, “assess
preoperative changes in neuroendocrine function in
patients undergoing pituitar y microsurger y ”
(Einbinder, et al. 1999).
·Specific Research: for example, trying for new kind of
medicine for specific disease on different patients.
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2.2.2 Patient Service
·Give patients advice about the disease.
·Help patients finding the right doctors.
·In the case of emergency, give patients the
temporary solutions before an ambulance arrives.
2.2.3 Quality Improvement
·Outcome Evaluation and Assessment: for example,
“assess mortality of children with severe neuro
developmental disabilities who receive tube
feeding” [Einbinder, et al. 1999].
·Treatment Patterns: for example, evaluate before
and after treatment results.
·Medical Management: for example, improve
patient services, improve the knowledge of the
doctors and nurses, medical staff activities, etc.
2.3 A Comparison between Data Warehouse and
Clinical Data Warehouse
As the authors have mentioned earlier, the data
warehouse is a data structure that is optimized for
distribution, mass storage, and complex quer y
processing. Data warehousing methodologies share a
common set of tasks, including business requirements
analysis, data design, implementation, and deployment.
On the other hand, the clinical data warehouse is a place
where healthcare providers can gain access to clinical
data gathered in the patient care process. It is also
anticipated that such data warehouse many provide
information to users in areas ranging from research to
management (Sen and Jacob, 1998). The clinical data
warehouse is all the above, for clinical administrators
“for example, a clinical responsible for utilization
management may retrieve data on all patients with a
specific DRG/CMG and determine how many lab tests
of which type were ordered, to see if services appear to
be under or over utilized. An administrator may want to
look at the average length of stay over all patients or
selected groupings. A department manager may want
to review the number of paid staff hours that is required
for each type of test performed for those tests that
actual turnaround times within a certain range during
the summer versus the winter ” [Covvy, 2000]. At the
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same time, clinical data warehouse is a tool for care
providers and researchers. Care providers check out
data of an individual patient and compare it to the
previous ones. They also check the medical records,
diagnosis, medications, etc. On the other hand,
researchers are interested in many patients just like
conventional data warehouse users. Their interest lies in
the retrieval of complex clinical data of the patients that is
organized in more complex networks. In these cases,
exploratory knowledge discovery and advanced data
mining techniques are used.
The clinical data warehouse is much more complex than
the business facts of average data warehouse data.
Sometimes physicians or researchers have to go into the
deep to get a patient's original healthcare record. For this,
fast calculating power and massive storage are required.
Furthermore, a clinical data warehouse demand even
more security measures and less downtime, but a
conventional data warehouse and a clinical data
warehouse do not differ so much. After all, they use the
same technology, but in the case of a clinical data
warehouse ever ything gets more complex and
complicated.
3. The Challenges and Issues of Clinical Data Warehouse
From the previous section, we have learned that the
clinical data warehouses are complex in nature in
comparison to a data warehouse. It is important to build a
clinical data warehouse successfully. Clinical data
warehouses require extensive analysis on data design,
architectural design, implementation, and deployment.
When designing a clinical data warehouse, data
integration tasks of the medical data store are
challenging scenarios. As the clinical data warehouse
systems are much more complex, they must operate
reliably to deliver continuous patient care service. Any
fault in any medication or test result could be fatal to a
patient. We should keep this in mind to avoid mistakes and
ignorance. For these reasons and others, it is therefore
important to train people who understand healthcare,
information technology, health information regulation
and have knowledge about using clinical data
warehouse to work in a clinical data warehouse. Only a
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successfully implemented clinical data warehouse can
provide patient safety, quality and organizational
efficiency, but there are many challenges and risks
involved while implementing a clinical data warehouse.
Among the many challenges and issues, the most
prominent are architectural issue, data quality, patient
privacy, report consistency, scalability, and user
involvement.
3.1 Architectural Issue
While designing a clinical data warehouse, several
technical issues are to be considered, but among them
the architectural challenge is the most important. There
are some technologies for data warehouse available in
the market, but not every one of them are suitable for
designing a clinical data warehouse. Due to the
confidentiality of healthcare data and the privacy policy
of the patient, it is important to choose the right
technology for designing a clinical data warehouse.
During the design, and planning process, it is important to
study the functionality of different departments. For
example, patient management scenarios may differ
from the mental health management scenarios.
Inpatient care management analysis is conducted for
admission, discharges and transfers, length of stay,
patient's diagnosis, severity of illness, etc., but for the
mental health management, the scenarios are different.
In this context, it is essential to monitor health service
activities and investigate patient outcomes. The middle or
senior management could neither effectively monitor
levels of team activities, nor they can determine the
predictive factors of the clinical outcomes of mental
health patients. As a result, the reporting on the behaviour
of the mental is an important element for analysis while
designing a clinical data warehouse for a mental health
care.
Some issues need to be addressed while designing a
clinical data warehouse. Among them data location,
technical platforms, and data formats are important.
Organisational behaviour on processing the data is also
important while designing a clinical data warehouse.
These factors are very important and if these factors are
not dealt with properly, the required levels of quality
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decision making and analysis cannot be achieved. Data
integration is another factor to be dealt with while
designing a clinical data warehouse. In a clinical data
warehouse, scenario data is collected from various
departments, laboratories, and related administrative
processes. Not every department or laboratories would
use the same platform or the same vendor to store data.
A clinical data warehouse should be able to collect
data from different sources. So it is important that the
clinical data warehouse has the ability to data
integration.
3.2 Data Quality
One of the major issues in the development of the clinical
data warehouse is data quality. As a decision support
system is one of the main aspects of the data warehouse
and it is not exceptionally for the clinical data warehouse.
Poor data quality can lead to poor decision which could
be even fatal for the patient. Poor data quality can destroy
the whole clinical data warehouse project. Data quality in
a clinical data warehouse is critical as strategic decision is
made on the basis of the data available in the clinical
data warehouse. Improved data quality is one of the main
issues of running a clinical data warehouse project
successfully. Improved data quality:
·reduces the risk from bad decisions,
·enables better customer service,
·reduces costs and at the same time add better value
to the services,
·enhances strategic decision making, and
·improves productivity.
It is important that data in a clinical data warehouse is
good in quality. Bad data can destroy the whole clinical
data warehouse project. The data that is stored in the
clinical data warehouse, may lead to a bad decision or
incorrect medication. These reasons could be fatal for a
patient. A bad quality data:
·increases the risk of bad decisions which could be
fatal,
·reduces the quality of customer service,
·reduces productivity, and
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·creates problem in strategic decision making.
Error in data is the main reason for bad quality data. There
are mainly five data errors:
·Design errors.
·Collection errors.
·Strategic errors.
·Integration errors.
·Query errors.
Design, collection, integration and query errors are
technical in nature. Data in a clinical data warehouse is
collected from different sources. Integration of these
kinds of data are an important task and also important
problem to tackle, but the main problem of a clinical
data warehouse is data collection. “Incorrectly
recorded values, mixed records, dropped data,
incorrect units, inconsistent standards or untimely
collection practices can contaminate the data with
scant evidence of error ” [Berndt, et al., 2001].
3.3 Patient Privacy
Another major issue for the clinical data warehouse is the
concern regarding the protection of the patient privacy.
As the personal data as well as the medical data of a
patient stored in the clinical data warehouse, any user
who has the authority to access the clinical data
warehouse can see the personal data of a patient. A
clinical data warehouse not only is used by the doctors or
nurses, but also by the researchers or medical students for
their research. So the priority of the patient privacy should
be high while designing a clinical data warehouse. It is
important to keep a patient's data private. If a patient's
privacy be broken, the patient might lose his confidence
in coming to the health care centre. The patient might
also be in the embarrassing situation if the patient suffers
any sexual disease and it comes to the public. The clinical
data warehouse contains sensitive data and so, security
measures are essential.
3.4 Report Consistency
Report consistency is another issue for the clinical data
warehouse. In a clinical data warehouse, data are
collected from different sources. The sources of data that
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is collected may be from several disparate mainframe
environments. This may be time-consuming and at the
same time, it increases the chances of inaccuracies and
conflicts of data. Sometimes it leaves a little time to
analyze the data and produce a correct report. Usually a
doctor takes his decision based on the report he got from
different data analysis. Based on the test report, diagnosis
report and medication report, the doctor takes his
decision for the patient whether the patient needs an
operation or further medication. For example, the
situation of a patient is critical and doctors need to take a
quick decision about the patient. If the collection of
data takes long time, it leaves only a little time to analyze
the data. This may lead to delay in taking decisions
which may be fatal for the patient. So it is important that
data is collected accurately which helps making report
consistent.
4. Implementation: Designing a Clinical Data
Warehouse (Prototype)
This section presents an implementation of a clinical data
warehouse project. Section 4.1 provides the conventional
way designing a data warehouse. Sections 4.2 describes
the project overview. Section 4.2 and 4.3 give a brief
description about MySQL and SQLyog, respectively.
Section 4.4 describes the implementation process of the
prototype clinical data warehouse. Finally, section 4.5
provides the summary of this section.
4.1 The Conventional Data Warehouse Design Process
Data warehouse design is complex. It requires extensive
survey and analysis. There are some steps in designing a
data warehouse. Before designing a data warehouse, it is
very important to understand and represent the user
requirements accurately. The strategies used for this are
interviews, document analysis, surveys, company
activities, etc. After getting the requirements, the data
model is created. Then logical data is created by using an
Entity Relation Diagram (ERD) or some other type of
conceptual model. Then in the process of physical
design, this logical data is translated into a star schema or
snowflake schema. The next is the architecture design
procedure. There are mainly four strategies available to
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design data warehouse architectures. They are
centralized data warehouse, data warehouse and data
mart, distributed data warehouse and hybrid deployment
strategy. Based on their demands, the organizations will
choose the most suitable methodology. This project has
been developed by following centralized data
warehouse methodology. The next step is the
implementation process. The implementation can be
facilitated by some RAD tools. SQLyog tool has been used
for implementation. One of the important aspects of
designing a data warehouse is the metadata
management. Almost all vendors focus on metadata
management. Building a data warehouse will be
successful if only all the procedures be followed.
4.2 Project Overview
The aim of the project is to build a clinical data warehouse
for the proposed “East London Hospital”. The authors have
designed and created a clinical data warehouse, and also
created a centralized database which will be residing in the
hospital. Administrators and doctors in the hospital can
collect data from different sources. For example, a patient
is referred to the hospital from the clinic. So the doctor in the
hospital need not go to the clinic to collect data. The doctor
or administrator can extract data from the clinic. On the
other hand, if a doctor wants to see the report for a patient,
the doctor does not have to go to the laboratory. The doctor
can easily collect data from the laboratory. At the same
time, a doctor can see the patient's past record whether the
patient was suffering from any major illness. After collecting
all the information, the doctor can prescribe the best
possible medication for the patient. If it is a serious condition,
the hospital administration can create a medical board
and analyse all the records, test reports, diagnosis, previous
medication, etc. After analysis, the medical board can take
their decision. The data warehouse here acts as a decision
support system for them. This makes the doctors, work easier
than before. Not only that, because of the massive
calculating power and reliability, the chance of errors are
less likely. A clinical data warehouse requires massive
storage support because it stores the patient's history and
medical data. The more the patients are the more the data
storage requires. A clinical data warehouse, typically
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supports more than 10 terabytes. To record data in a clinic,
doctors chamber, laboratory, etc., front end tools like
Microsoft Excel, Microsoft Access or any other customised
software can be used. All these features support MySQL.
That’s why MySQL is getting more and more popularity. By
using tools like SQLyog Enterprise, we can create a
database, create table design schemas, etc.
4.3 MySQL
MySQL is one of the leading open source database
solutions in the market. It provides consistent fast
performance, and high reliability. Furthermore, it is easy to
use. MySQL powers many online enterprises, embedded,
and business intelligence applications for over twelve years.
4.4 SQLyog
SQLyog is the MySQL Graphical User Interface (GUI). It is
one of the most powerful MySQL manager and admin
tools. It combines the features of the MySQL query
browser, administrator and various other MySQL front ends
and MySQL clients in a single interface. It helps creating
databases, tables, and generates schemas. SQLyog is an
'All in One' tool. We do not have to switch between
different applications to perform database related tasks.
4.5 Project Implementation
The proposed East London Clinical Data Warehouse will
be implemented now. There are some steps to
implement. The following sub-sections describe the steps.
4.5.1 Installing MySQL
From the previous sections, the authors find that to build a
clinical data warehouse one need to plan, analyse and
choose the right database vendor. In this case, they will
use MySQL which is open source and free. It is reliable
and easy to maintain. It supports almost all the features
of other expensive database vendors. Many well
recognized companies use this MySQL. So for this
project, they have choosen MySQL. It is open source and
free. So they download it to their laptop. For the project
they used MySQL server 6.0 version.
4.5.2 Installing SQLyog
To build a data warehouse, first we need to create tables
and design a schema. For creating table effectively and
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easily, we will use SQLyog Enterprise Edition (30 day trial ·After clicking, the initial page will open.
version). This software also helps to create tables and ·We will press 'continue' to proceed. Then the
insert data. To install the SQLyog Enterprise, they need to connection wizard will appear.
'click' on the download link from the vendor's website.
·We will 'click' connect to connect to the MySQL host
4.5.3 Schema Design and to go to the main page of the software.
To design a data warehouse, they need to design a ·On the left hand side of the page, we can see the
schema. There are mainly two schemas available to database that the authors have created for this
design a data warehouse. One is star schema and the project. If we 'click' on the database, table folder will
other is a snowflake schema. appear. Now from the table drop down menu we will
4.5.3.1 Star Schema 'click' 'create table' to create tables.
Star schema is the simplest form of data warehouse ·When completed, the tables will be appearing in the
schema which contains one or more dimensions and fact 'el hospital' database.
tables. The central table of the star schema is called as a ·Now we can insert data, update data, making query,
fact table. The entity-relationship diagram between etc. Figure 2 shows the data inserted in the doctor
dimensions and fact tables are like a star and so, it is Table. Figure 3 shows the data in patient Table. Figure
called star schema. In this schema, one fact table is 4 shows the data in private clinic Table. Figure 5 shows
connected to multiple dimensions. In the centre of the the data in lab Table. Figure 6 shows the data in
star schema, there is a large fact table and it points hospital table. The hospital table is the fact Table.
towards the dimension tables. For this project, they will use
·After creating the Tables, now it is possible to query.
star schema. Figure 1 shows the diagram of a star
Data can be added and updated using this GUI.
schema.
5. Evaluation
4.5.4 Schema Diagram of the Project
The title of this research is “An Evaluation of the Clinical
For the project, star schema is used to design the schema
Data Warehouse”. So, the primary task is to evaluate a
is used. The star schema will meet their goal to design the
clinical data warehouse. In this process the research
project. In this project there is a fact table which is called
shows the benefits and that application of clinical data
hospital and four dimensional tables, namely private
warehouse in theory and practice. The design process
clinic, lab, patient, and doctor.
and the methodologies are also described. These
4.5.5 Creating Tables
The next step is to create tables in the database. This
project is about clinical database and so, tables are
created where clinical data can be stored. The data
warehouse will be residing in the hospital. From the
schema design, we will find that we need to create five
tables. They are a Hospital, lab, private clinic, patient and
doctor. To create a table, we will use SQLyog which is a GUI
for MySQL. We can easily create table using this software. It
is very easy to use and improves performance. It also
reduces a significant amount of time. The steps to create
tables in the database:
·From the start menu, we need to SQLyog enterprise to
start SQLyog. Figure 1. Star Schema Design of the Project

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descriptions, the authors believe, would be very
beneficial for the interested readers and for those who
would like to develop a clinical data warehouse.
Another aspect of this research is to find out the
challenges and issues available in the present world.
There are many challenges and issues. After learning all
the major challenges, they tried to figure out some
possible solutions. These solutions are based on their
research in this field. By reading some very good articles,
they have gathered huge knowledge which will be
beneficial for future life. The challenges and issues and
the possible solutions of those would be very beneficial for
the clinical data warehouse developers.
Today data warehouse is considered as a must strategic
business weapon. So using the appropriate product for
the business is important. There are many vendors who
provide data warehouse solutions. Some vendors provide
DBMS engines while others give infrastructure solutions.
The infrastructure tools typically work with database
engines. There are many vendors who provide data
warehouse solutions like Microsoft, Oracle, Sybase, etc.
Different vendors support different attributes and features.
Figure 2. The Doctor Table
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These vendors as well as some of the vendors who give
data warehouse solutions are analyzed based on
different attributes. This, it is believed that it would be a
great help for the interested readers and the data
warehouse developers.
To get the overall activity of a clinical data warehouse, a
case study has been looked upon. This case study is
based on the clinical data warehouse for academic
purpose. This is based at the University of Virginia. This case
study provides the design and architectural background.
It also provides user statistics. This case study is of great
benefit for their understanding and helpful for their
implementation.
The East London Hospital Clinical Data Warehouse project
prototype is implemented to depict the architectural and
design aspects that are discussed throughout the
theoretical work in the paper. At the same time, the
ELHCDW is intended as a clinical data warehouse design
solution for the interested reader. Building a clinical data
warehouse in real world environment is a massive work to
do. There are design steps, data modelling steps, schema
design steps, architectural steps, implementation steps,
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Figure 3. The Patient Table

Figure 4. The Private Clinic Table

etc. So designing a clinical warehouse in three months is clinical data warehouse. They have also learned the
not enough. During this research period they have architectural designs and the methodologies behind it.
gathered knowledge about the data warehouse and the The benefits of the data warehouse and the clinical data

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Figure 5. The Lab Table

Figure 6. The Hospital Table

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warehouse were also learnt.
A data warehouse extracts data from different sources,
integrates them, and stores them in a centralize data
repository system to support decision making. In this
implementation they have tried to show this process. In
the project, the proposed East London hospital has a
centralized data repository database where all the data
were collected from different sources like private clinic
or laboratory. This data is then analysed and the doctors
and administrators of the hospital could make a
decision for a patient. For this prototype clinical data
warehouse design, they use MySQL which one of the
most popular databases available. To facilitate the
creation of tables and query, they also use SQLyog
which is a GUI for MySQL. This software is useful, easy to
use, and saves time.
The ideas are that are given in this research are based on
extensive research, prior knowledge, and good
understanding of a data warehouse. Due to time
constraint, implementation, development was only
completed with 40% of the overall development. The rest
60% could be completed as a future work along with the
possible modification and upgrades. The design and
implementation of the project closely follow the rules for
developing the clinical data warehouse as presented in
the previous sections. Had the prototype been done
completely, this prototype should be able to benefit the
healthcare sectors. The interested readers and the data
warehouse developers will get the knowledge of
designing a clinical data warehouse. This will help them to
build and develop a data warehouse in a clinical context.
Conclusion and Future Work
The paper provides a good theoretical description of
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data warehousing. As mentioned earlier, because of the
short period of time, the project implementation was only
completed with 40% of the overall project. The rest 60%
could be completed as a future work along with the
possible modification and upgrades. Future research
could also focus on developing and extending the
prototype and incorporating more features to make the
prototype more applicable to the healthcare sector.
Finally, in further research, for more analysis about the
clinical data warehouse and to identify new challenges
and issues with the activities to resolve those, is suggested.
References
[1]. Berndt D. J., Fisher J. W., Hevner A. R., and Studnicki J.,
(2001). “Healthcare Data Warehousing and Quality
Assurance”. IEEE Computer Society, Vol.34, No.12, pp.56-
65.
[2]. Covvy D., (2000). “What is a Data Warehouse?”
Healthcare Information Management in Canada. Vol.14,
No.2, pp.36-38.
[3]. Einbinder J. S., Scully K., Pates R. D., Schubart J.R.,
Reynolds R. E., Spraggings T. A. and Krumholz R.M.,
(1999). “Web-Accessible Patient data Warehouse at the
University of Virginia”. AMIA Symposium, pp.12-16
[4]. Inmon W H, (1990). Building the Data Warehouse. QED
Information Sciences.
[5]. Sen A. and Jacob VS. (1998). “Industrial Strength Data
Warehousing”. Communication of the ACM, Vol.41, No.9,
pp.28-31.
[6]. Stephen R., (1998). “Building the Data Warehouse”.
Communication of the ACM, Vol.41, No.9, pp.52-60.
[7]. Kimball and Inmon, (1996). The Data Warehouse
Toolkit. John Wiley: New York.
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ABOUT THE AUTHORS

Dr. Subramaniam Arunachalam is a Senior Lecturer in the Mechanical Engineering Group in the University of East London. He
holds a Doctorate in Mechanical and Manufacturing Engineering. He has many years of experience in teaching and developing
course materials at undergraduate and postgraduate levels in Mechanical Engineering and Manufacturing Engineering
programmes. He has published 203 articles in high profile journals, edited books and international conferences in the area of
Mechanical and Manufacturing Engineering. His papers have been cited more than 3387 times. He serves on the editorial
advisory board of many International Journals. Dr. Arunachalam is a visiting fellow at several universities abroad and serves as an
academic advisor to promote international research and academic link.

Dr. Tom Page is a Senior Lecturer in Electronic Product Design in the Department of Design and Technology at Loughborough
University. He obtained his BSc. and M.Phil in Engineering Design from Napier University, in 1988 and 1992. He obtained a PhD
from the University of Hertfordshire in 2002. He is an external examiner on Engineering and Manufacturing programmes at
Sheffield Halllam University. He is a visiting scholar at Iceland University and the University of Lapland in Finland and has been an
external examiner on undergraduate fields in Product Design and Manufacturing Engineering at the University of East London.
(2008 to present). Among his main research areas are in the Research and Development of Computer Applications for Design
and Technology Education, Logistics and Supply Chain Management and Electronic Product Design.

Dr. Gisli Thorsteinsson is a Professor in the Department of Design and Craft at Iceland University of Education. He completed his
PhD study at Loughborough University, where he explored the values of using Virtual Learning Environment for ideation in general
school education. Dr. Gisli has been the Chairman of the Association of Icelandic Industrial Arts Teachers since 1995 and is
associated with the NST Coalition of Industrial Arts Teachers in Scandinavia. From 2000 he has been on the Board of 'Nordfo', the
Pan Scandinavian co-operative researching art and design projects in Scandinavia. In 1999 he was involved in the National
Curriculum development for Technology Education in Iceland and wrote the curriculum part for Design and Craft. Gisli has
written numerous articles concerning Design and Craft education and has published several textbooks about Innovation
Education.

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