Why the Data Steward’s Role is Critical to Sustained Outcomes Improvement in Healthcare

Why the Data Steward’s Role is
Critical to Sustained Outcomes
Improvement in Healthcare – Brian Eliason

© 2014 Health Catalyst
www.healthcatalyst.com
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Data Stewards
In the field of healthcare
analytics, data architects,
managers, and analysts are
immediate family members.
We know who they are –
their habits, their strengths
and their weaknesses.
By comparison, the data steward is a distant, perhaps
underappreciated, relative who generously supports the
rest of the family.
In reality, this position is as vital as a multilingual translator
in the business of international diplomacy.

What Makes a Good Data Steward?
Data stewards are not direct
owners, but appointed caretakers.
They are responsible for the data
within their domain. An ideal data
steward understands the data.
The ideal data steward comes
from the business side and can
talk the business language.
She can help with data validation,
check data quality, and ensure it’s
complete, accurate and consistent.

At Health Catalyst, when one of
our partner health systems starts
working on analytics applications,
it’s crucial for us to have an expert
on the business side.
She might be on the EDW team,
but more clinical than technical.
It’s a very valuable role because
she can talk clinical jargon–help
find data and verify data accuracy.

The data steward function has not
been fully understood. Data-
related initiatives can be very IT
focused, with projects started and
managed purely by the IT team.
An emphasis on the technical,
rather than the clinical, aspect of
these projects, is reflected in the
experience of the staff working on
these projects.

Data management may not be a
data steward’s primary role. She
will retain her primary job and her
responsibilities around that job.
One hospital we work with has five
data stewards right now, but might
have 20 stewards in the future.

An Inside Look at One Data Steward Role
Danna Caillouet fills the role of
data steward at Thibodaux
Regional Medical Center, a
patient-experience-award-
winning hospital that’s about 60
miles southwest of New Orleans.
One day she was asked to take
on the care transformation work
at the hospital, her title changed
to Physician Analyst and now
she fills the role of data steward.
Danna’s background
• Employed at TRMC since 1989
• Nine years as critical care director
• Six Sigma Green Belt
• Ran the Evidence-Based Practice
Council for Nursing

An Inside Look at One Data Steward Role
Danna first worked with Health Catalyst on two care
transformation projects, blood culture and wound culture
contamination rates. She explains the response to this new
realm of data stewardship:
“At that point everybody had heard of data warehousing, but nobody
really understood the ramifications of the data we were going to
have at our fingertips. Health Catalyst put together some things for
us so we could monitor our blood and urine cultures by nurse, by
unit, by date, and by contamination. Then we sat down with our
“customers,” handed them this new app, and all the information that
used to take hours and hours to organize was suddenly available. To
see the looks on their faces was priceless. I used to be a nurse
manager and I know what it was like to have to merge 20
spreadsheets. It’s very rewarding to be able to give the directors in
the hospital the tools they need to take care of their patients.”

Stewards Help Users Understand
Information in a Clinical Context
When a non-clinician studies the
data the data steward may need to
answer some basic questions:
• When the data is being entered?
• Where the data is being entered?
• Who is entering the data?
• Why the data looks differently if
entered elsewhere.
The data steward can help clinical
people understand why certain
things looks the way they do.

Stewards Help Users Understand
Information in a Clinical Context
The data steward helps us to understand the clinical
workflow so we can develop properly. She works back and
forth between the clinical and analytics teams and she
works with the data architects to make sure data is flowing
properly into the EDW.
Data
Steward
Clinical
Teams
Analytic
Teams
Data
Architect

Finding the Data Steward Diamond
in Your Rough
Rarely does a healthcare system
already have this specific data
steward role.
Mostly, the function is identified,
but it comes via a data architect,
system analyst, or a system
source manager.
Some organizations will hire a
data steward, but others fill the
role from the internal ranks.

in Your Rough
We’ve noticed how the data steward
can hide in plain sight.
This is not a new person brought in
from the outside. She is already in
the system, but with another role.
She is often a business user with
expert knowledge of the business
process and how data flows.
She is recognized by her colleagues
as the go-to expert, so it just
becomes a matter of officially
deputizing her as the data steward.

in Your Rough
Examples of Data Sources Examples of Possible Data Stewards
Clinical-domain-specific data definitions Departmental Clinician
Master file of IDs (patient, provider, member, etc.) IT MDM steward or SME
Lab codes (LOINC) Lab Director
Pharmacy Codes (RxNORM, etc.) Pharmacy Director
Order catalog Member of IT staff (usually clinician)
Diagnostic and procedure codes Director of HIM
Charge master Director of Finance
Here are some examples of Data sources
and staff roles where you could possibly
find the perfect data steward already
working within the organization.

Successes in the Data Steward Role
When Thibodaux Regional Medical
Center did a sepsis improvement
initiative, it tapped Danna Caillouet’s
experience.
She was already familiar with the
lab work, which is a key component
for identifying septic patients.
Danna had this background. She was familiar with the
workflow, the doctors and she had the respect of this group.
She was already the go-to person.
The data steward could be a nurse on the floor or an
impassioned doctor who wants to really focus that passion
around whatever domain is in question.

A health system in the eastern United
States with 17 hospitals and over 3,000
beds converted a clinician, a registered
nurse, who wanted to move beyond
clinical practice. She moved over to the
EDW team and is filling the role of data
steward quite nicely.
She has filled the gaps for Health Catalyst in terms of working
with the clinical teams on some advanced patient safety apps,
helping with translation and validation.
She stepped into this role by default and helped fill that data
steward need. All we have to do is help her balance her
project manager focus with a data steward focus.

In another example we worked with a
west coast health system to setup a
community coordinated care project.
Part of the work was to build a cross-
functional team to take on medically
complex patients and manage their
care through this team.
Being able to understand the data, knowing where it came
from, and knowing how the data would be used was very
important, so having a data steward there was critical.
Not only did the team have physician leads, registered nurses
and data architects, but the knowledge provided by the data
steward was essential to the success of the project.

Challenges Assigning the Data Steward
The most pressing challenge for the
data steward position is that she gets
spread really thin.
She is accessed by everybody at the
hospital so it’s hard to get her time.
This is symptomatic across all of our
health systems. These individuals
are very busy because they are one
of the few people who have vast
knowledge of the domain landscape.

Data Stewardship as Part of
Data Governance
In the overall data governance model, senior
leadership is there to empower, the data governance
committee is there to coordinate, and the data
steward is there to inform and optimize.
Additionally, she:
1. Reinforces the global data governance
principles. She would be familiar with
these, espousing and evangelizing them.

Data Governance
Additionally, she:
2. Helps develop and refine details of local
data governance practices.

Data Governance
Additionally, she:
3. Is the eyes and ears of the organization
with respect to data governance and the
governance committee.

Data Governance
Additionally, she:
4. Provides direction to peers, architects,
the data governance committee, and data
analysts regarding appropriate data
definitions, usage, and access.

Data Governance
Additionally, she:
5. Anticipates local consequences of
global changes proposed by the data
governance committee.

Data Governance
Additionally, she:
6. Addresses local data issues and
escalates them to the data governance
committee when necessary.

Data Governance
Additionally, she:
7. Identifies data literacy gaps and is able
to escalate those when appropriate.

Data Governance
Additionally, she:
8. Analyzes and resolves data accuracy
and integrity issues

Data Governance
The data steward is there to
establish trust with the end users
of the data. If the trust is absent,
the data remains dormant.
The steward’s role is crucial to
identifying dirty data, fixing it with
the cross functional team, and
then reestablishing the trust and
continuing use of the data.
In essence, the data steward’s
role is critical to becoming a data-
driven organization.

Tools of the Trade
A great data steward can manage
and maintain the visualizations of
the data under her management.
Health Catalyst has a clinical
hierarchy that they rolled out to their
health systems to help scale this
and other roles.
With Atlas, the freestanding, web-
based metadata tool developed by
Health Catalyst that connects end
users with data, the data steward
has full access and ownership.

Prepping Your Organization for
Data Stewardship
When Health Catalyst does an assessment, our health
systems will grade themselves on their maturity by
answering many different questions and, without fail, there’s
a gap between the ideal state and where they currently are.
THE
IDEAL
STATE
WHERE
WE ARE
TODAY

Prepping Your Organization for
Data Stewardship
Health Catalyst conducts assessments for both existing and
prospective health systems around three systems:
Analytics Best Practices Adoption
We do comprehensive assessments where we interview a
lot of folks and ask a lot of questions to assess the
organization’s overall maturity level.
Ultimately, what we’re trying to answer is whether or not the
organization is able to transform care. If not, we offer
solutions for improvement in each of the three systems.

Conclusion
The IT department perception of a
data steward is someone who
owns the data movement instead
of someone who is the knowledge
expert and overall manager of a
particular care domain.
Although data stewardship is very
important, organizations have yet
to standardize the role.

Conclusion
Without a data steward engaged in
outcomes improvement projects—
data quality, governance, access,
navigation, visualizations, to name
a few processes—the outcome
improvement fails to materialize.
It’s not just about pulling people in
and moving things around in an
inefficient way.
It’s about recognizing where you
are and understanding the vital
and numerous responsibilities of
data stewards.

More about this topic
Healthcare Data Stewardship: The Key to Going from Information Poor to Information Rich
Eric Just, Technology, VP
Health Data Stewardship and Its Importance in Healthcare Analytics
John Wadsworth, Technical Operations, VP
6 Essential Data Analyst Skills for Your Healthcare Organization
John Wadsworth, Technical Operations, VP
Why Data Governance Requires a Henry Kissinger
Dale Sanders, Strategy, SVP
Master Data Management in Healthcare: 3 Approaches
Brian Eliason, Technical Operations, VP
Jason Burke, Technical Director
Pete Hess, Chief Data Architect, VP
Link to original article for a more in-depth discussion.
Why the Data Steward’s Role Is Critical to Sustained Outcomes
Improvement in Healthcare

For more information:

Brian Eliason brings more than 10 years of Healthcare IT experience to Health
Catalyst, specializing in data warehousing and data architecture. His work has been
presented at HDWA and AMIA. Prior to coming to Health Catalyst, Mr. Eliason was
the technical lead at The Children's Hospital at Denver with experience using I2B2.
Previously, he was a senior data architect for Intermountain Healthcare, working
closely with the disease management and care management groups.
Additionally, he helped Intermountain bridge clinical programs with the payer-arm, Select Health. Mr.
Eliason holds an MS in business information systems from Utah State University and a BS from Utah
Valley University.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Neil Andersen joined Health Catalyst as a data architect in October 2011. Prior to
joining the Catalyst team, he was a partner at Practice Advisory Group. While there,
he improved financial outcomes and the overall efficiency and productivity for many
medical practices throughout Arizona. He also built and used analytical tools to
monitor and direct management decisions. Prior to working at Practice Advisory
Group, he worked at Grant Thornton as an IT and securities auditor. Neil graduated
from Brigham Young University with a Bachelor of Science degree in business
information systems brings more than 10 years of Healthcare IT experience to
Health Catalyst.

Why the Data Steward’s Role is Critical to Sustained Outcomes Improvement in Healthcare

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