Meaningful Use

Ravi S Iyer, PhD | ravi.shankar@axiomhealthbi.com

The BI community is growing fast, and theres a jargon born every minute. I have met the ETLELT twins. I am all in favour of SCD (its not a disease) and CDC (No, not the Center for Disease Control), and I dont frown at anything ODS but I look askance at the wanton distortion of the venerable 'metrics', 'measures' and 'KPIs'. I cringe when advised that 'metrics' is a two-dimensional measurement, and shudder when told that 'measures' are equipment for measurement. It all seems to have started (I suspect in marketing) with an as-long-as-I-can-get-away-with-itwho-cares attitude, and in true Chinese whisper style, these terms seem to have bobbed away slowly from their true meanings. It's time to pull them back. So, what is a metric? This is what NIST * has to say about metrics
Metrics are indicators of system, user, and group performance that can be observed, singly or collectively, . Metrics such as time, length of turn, and other countable events are directly measurable and can often be collected automatically.
* National Institute of Standards and Technology, U.S.A see http://www.nist.gov http://zing.ncsl.nist.gov/nist-icv/documents/section5.htm.

I draw your attention to the last line - Metrics are directly measurable and can often be collected automatically. That says it all. A metric is something that can be directly measured (e.g., read off a log, a clock, a thermometer, any sensor, ). Consider, for example, the following observation the patient was admitted at 09:43 Hrs on It is obvious that time of admission is a metric because it can be read off a clock, and in this example, takes the value 09:43 Hrs on . Metrics tend to be simple, primitive and obvious. In contrast, measures are calculated or derived from metrics or other measures. NIST has a lot to say on measures
task completion time (a requirement-level measure) is based on start and end time metrics. A measure can also be a combination of interpreted metrics and other measures. A complicated measure, like efficiency, is partially derived from the interpretation of metrics such as time, as well as user ratings and tool usage. In addition, measures of system breakdown contribute to efficiency.

Logically speaking, shouldnt it be the other way around? Measures should be things that can be measured (sounds logical) and metrics should be all the other stuff. . Never mind. We shall defer to the boffinsa at NIST and go with their definitions.
a A British slang meaning technical experts

Let us reinforce all this with an example. Consider, the parameter Average Length Of Stay (ALOS). It is derived using the formula ALOS = 1 Number of patients Length of stay of patient i
i { all patients }

ALOS is derived from two parameters. It is therefore a measure. Lets delve a little deeper. Consider the two parameters defining ALOS

i) Number of patients Number of patients can be read off a roster of discharged patients. It is not derived or calculated from any other parameter. It is therefore a metric. It may however depend on a slew of other parameters e.g., ward, time interval, location, etc. As an analogy, consider the ambient temperature. Clearly it is a metric (you can read it off a thermometer). However, the ambient temperature does depend on other parameters e.g., location, time of year, weather etc. ii) Length of stay of a patient This is clearly a measure. It is derived from two metrics, viz. a) Time at which the patient was admitted b) Time at which the patient was discharged and is calculated as the time interval (the difference) between the two. Finally, what is a Key Performance Indicator (KPI)? The name says it all. A KPI is an indicator of how someone or something has performed in some task. But note performance is always relative. Logically, a KPI consists of two parts. The first is a measure (or metric) of the actual performance. This is called the Primary Parameter. That parameter is then compared against a benchmark (Reference Parameter), and the result of that comparison is the value provided by the KPI. Consider this example. Acme, Inc has reported a net income ( a measure ) of 1 Million dollars this year. Should we, as investors, fire the CEO, or pull out the champagne? Depends. It depends on many parameters industry (the industry may be going through a slump, and most companies are in the red); size; stage in companys evolution, etc. Thats where a reference parameter comes in. If the reference parameter (maybe the target set to the CEO) is to minimize losses, and we see a net income (profit), there is cause to celebrate. If however the expected net income is a hundred million dollars, we start looking for a new CEO. In summary, A Metric is a primitive parameter that can be counted, measured or read off some device. A Measure is a complex parameter that is calculated (derived) from other metrics and/or measures. A KPI is a quality of performance indicator obtained by taking a measure and comparing it with a given benchmark