Structured Query Language (SQL): Pharmacy Data, Up Close and Personal
Patrick Spoutz Pain Clinical Pharmacy Specialist & Data Manager
March 20th, 2018 Objectives
• Understand the types of information that available via SQL
• Describe the syntax of a basic query
• Become familiar with techniques to write efficient code on the Field Reporting Enclave (FRE)
• Become familiar with viewing SQL query cost
VETERANS HEALTH ADMINISTRATION Background
• Completed PGY1 Residency at the Ann Arbor VA – Worked with Allison Brenner (Pharmacy CAC) designing order menus, reminder dialogs
• Completed PGY1 Residency at the VISN 15 PBM Office in Kansas City – Pharmacy Outcomes and Healthcare Analytics – Learned SQL, reporting services, Pyramid
• Population Health Specialist – Designing dashboards, reports, clinical processes on VISN Data Warehouse (VDW) – Anticoagulation, Cost Savings, Hepatitis C, Chronic Disease Management (DM, hypertension, hyperlipidemia)
• Pain Clinical Pharmacy Specialist – 75% of time in pain clinic – Now coding on the Field Reporting Enclave (FRE) instead of the VDW
VETERANS HEALTH ADMINISTRATION 2 Corporate Data Warehouse (CDW) Overview – slide 1
• Updated once daily (overnight)
• Primary data source is VISTA • There are some non-VISTA data sources
• Per the CDW Guide Introduction and Policies • “The data comes from the source systems (mostly Vista) without “scrubbing”, filtering and without business logic applied. The data is not optimized for any particular use but rather it is fairly normalized to allow its use by varied types of queries for analyses and reports.”
VETERANS HEALTH ADMINISTRATION 3 Corporate Data Warehouse (CDW) Overview – slide 2
VETERANS HEALTH ADMINISTRATION 4 Corporate Data Warehouse (CDW) Overview
VETERANS HEALTH ADMINISTRATION 5 Data Available
• Structured Query Language (SQL) – Lab values – Problem lists – Vital signs – Encounters / workload – Visit diagnoses – Prescriptions – Many more…. • Non-structured data is more difficult to access or query – Free text of notes – Imaging – Typically stored in other databases
VETERANS HEALTH ADMINISTRATION Interacting with VA Data
VETERANS HEALTH ADMINISTRATION Microsoft SQL Server Reporting Services (SSRS) – slide 1
VETERANS HEALTH ADMINISTRATION Microsoft SQL Server Reporting Services (SSRS) – slide 2
VETERANS HEALTH ADMINISTRATION Pyramid Analytics
VETERANS HEALTH ADMINISTRATION Microsoft SQL Server Management Studio (SMSS)
VETERANS HEALTH ADMINISTRATION 11 TOAD
VETERANS HEALTH ADMINISTRATION 12 Reporting Services vs. Pyramid vs. SQL: Choosing the Right Tool for the Job
VETERANS HEALTH ADMINISTRATION Project Example Using SQL: AHA/ACC Heart Risk Calculator - 1
VETERANS HEALTH ADMINISTRATION Project Example Using SQL: AHA/ACC Heart Risk Calculator - 2
VETERANS HEALTH ADMINISTRATION 15 Project Example Using SQL: AHA/ACC Heart Risk Calculator-3
VETERANS HEALTH ADMINISTRATION Project Example Using SQL: AHA/ACC Heart Risk Calculator -4
VETERANS HEALTH ADMINISTRATION 17 Other Projects
• Various ways of obtaining customized lists of patients – Example: All patients on etodolac who have not previously tried meloxicam
• Complex patient cohorts – Example: All patients with a specific disease state diagnosis and not receiving a specific medication within the last year
• Complex dashboards that present data with SSRS – Example: All Academic Detailing reports are built on SQL code with an SSRS interface
VETERANS HEALTH ADMINISTRATION 18 Basic SQL Queries-1
Select [stuff that you want!]
From [where should the computer look]
Where [restrictions to filter to what you want]
Order by [orders the output]
Regular Life Analogy: “Honey, please get the milk from the store, but not the 2% kind, and put it on the top shelf”
[Exercise for the reader: match the select, from, where, and order by clauses with relevant part of sentence]
VETERANS HEALTH ADMINISTRATION Basic SQL Queries-2
VETERANS HEALTH ADMINISTRATION Getting Started with SQL-1
• Obtain necessary software – Microsoft SQL Server Management Studio; Toad for SQL Server Software generally obtained through the VISN Database Administrator – SSMS installation on your desktop/laptop is requested through your local software installation request process (refer to applications section in table at https://vaww.cdw.va.gov/Regions/fr/ for installation files/information) – Some VISNs have Citrix-based SSMS/TOAD; contact your VISN Data Warehouse POC for more information (https://vaww.cdw.va.gov/Regions/fr/SitePages/VISN_POCs.aspx).
• Learn the programming language – Moodle courses link: https://vapharmacytraining.remote- learner.net/course/index.php?categoryid=39 – Kathi Kellenberger book (available through TMS Skillsoft Books).
VETERANS HEALTH ADMINISTRATION
Getting Started with SQL-2
• CDW Support – https://vaww.cdw.va.gov/support/Training/ – Sign up for CDW Training Announcements – Frequently Asked Questions link: https://vaww.cdw.va.gov/support/cdwcs/Pages/CDW- Frequently-Asked-Questions.aspx – Attend CDW Insights, SQL Office Hours – CDW Introduction and Policies link: https://vaww.cdw.va.gov/Pages/CDWHome.aspx
VETERANS HEALTH ADMINISTRATION 22 Switching Gears to Efficient Coding on the Field Reporting Enclave (FRE)
VETERANS HEALTH ADMINISTRATION 23 Introduction to Efficient FRE Coding-1
• Querying on the FRE is not free – Heavy data loads, complex queries, multiple users slow processing down – Poorly or inefficiently written code adds to the backlog – Adopting best practices can improve performance (or at least prevent performance degradation)
• LSV vs. CDWWork – Users initially receive access to LSV tables – Contains data for last three years ONLY (data >= 10-1-2014) – If access needed for older data or national data due to role, file a VHA NDS Access Form Health Operations Request form link: http://vaww.vhadataportal.med.va.gov/DataAccess/HealthcareOperationsRequestProce ss.aspx • Recommend only requesting CDW_FULL and using LSV for SPatient/SStaff needs
VETERANS HEALTH ADMINISTRATION Introduction to Efficient FRE Coding-2
• Developed by Samantha McClelland [formerly Samantha Wright] and LeAnn Radcliffe • Available at https://vaww.cdw.va.gov/Regions/fr/
VETERANS HEALTH ADMINISTRATION MetaData – “Data about data”
• Detailed MetaData information available at: https://vaww.cdw.va.gov/metadata/default.aspx# • Spreadsheet version available at: https://vaww.dev.fre.cdw.va.gov/sites/D03_VISN12/Documents/Metadata_Table_ with_Queries.xlsx
VETERANS HEALTH ADMINISTRATION More MetaData: Identifying Indexes
VETERANS HEALTH ADMINISTRATION 27 Improving Efficiency Example-1
1 Minute and 39 Seconds VETERANS HEALTH ADMINISTRATION Improving Efficiency Example-2
<1 Second
VETERANS HEALTH ADMINISTRATION 29 Query Plans
VETERANS HEALTH ADMINISTRATION 30 Query Plans: A Comparison-1
In depth education on query plans available at https://vaww.cdw.va.gov/support/Training/ “Bad Query” “Less Bad Query”
VETERANS HEALTH ADMINISTRATION Query Plans: A Comparison-2
“Bad Query” “Less Bad Query”
VETERANS HEALTH ADMINISTRATION Incremental Loads
• Advanced technique • Uses – Scanning large fact tables daily – Processing data for entire VA
• Downsides – Complex to construct – Break easily – May inadvertently create copy of entire CDW
VETERANS HEALTH ADMINISTRATION 33 Acknowledgements
• CDW Insights Presentations on MetaData & CDW Support in general
• Samantha McClelland (Wright) and LeAnn Radcliffe’s Query Efficiency Tool
• Spencer Schaefer, Eric Wagner, Samantha McClelland, and Linda Chia for feedback on presentation slides
• Monica Schaefer for mentorship
VETERANS HEALTH ADMINISTRATION Questions?
VETERANS HEALTH ADMINISTRATION 35