In many healthcare organizations, comparative effectiveness research and quality improvement (QI) investigations are hampered by a lack of access to data created as a byproduct of patient care. Data collection often hinges upon either manual chart review or ad hoc requests to technical experts who support legacy clinical systems. In order to facilitate this needed capacity for data exploration at our institution (Duke University Health System), we have designed and deployed a robust Web application for cohort identification and data extraction—the Duke Enterprise Data Unified Content Explorer (DEDUCE). DEDUCE is envisioned as a simple, web-based environment that allows investigators access to administrative, financial, and clinical information generated during patient care. By using business intelligence tools to create a view into Duke Medicine's enterprise data warehouse, DEDUCE provides a guided query functionality using a wizard-like interface that lets users filter through millions of clinical records, explore aggregate reports, and, export extracts. Researchers and QI specialists can obtain detailed patient- and observation-level extracts without needing to understand structured query language or the underlying database model. Developers designing such tools must devote sufficient training and develop application safeguards to ensure that patient-centered clinical researchers understand when observation-level extracts should be used. This may mitigate the risk of data being misunderstood and consequently used in an improper fashion.

Purpose Data generated in the care of patients are widely used to support clinical research and quality improvement, which has hastened the development of self-service query tools. User interface design for such tools, execution of query activity, and underlying application architecture have not been widely reported, and existing tools reflect a wide heterogeneity of methods and technical frameworks. We describe the design, application architecture, and use of a self-service model for enterprise data delivery within Duke Medicine. Methods Our query platform, the Duke Enterprise Data Unified Content Explorer (DEDUCE), supports enhanced data exploration, cohort identification, and data extraction from our enterprise data warehouse (EDW) using a series of modular environments that interact with a central keystone module, Cohort Manager (CM). A data-driven application architecture is implemented through three components: an application data dictionary, the concept of “smart dimensions”, and dynamically-generated user interfaces. Results DEDUCE CM allows flexible hierarchies of EDW queries within a grid-like workspace. A cohort “join” functionality allows switching between filters based on criteria occurring within or across patient encounters. To date, 674 users have been trained and activated in DEDUCE, and logon activity shows a steady increase, with variability between months. A comparison of filter conditions and export criteria shows that these activities have different patterns of usage across subject areas. Conclusions Organizations with sophisticated EDWs may find that users benefit from development of advanced query functionality, complimentary to the user interfaces and infrastructure used in other well-published models. Driven by its EDW context, the DEDUCE application architecture was also designed to be responsive to source data and to allow modification through alterations in metadata rather than programming, allowing an agile response to source system changes.

PurposeThe purpose of this paper is to understand if accounting is an un‐Australian activity, contrasting the notion of the bush and bushman present in popular Australian poetry and cultural myth with the notion expressed by Maltby of the link between the soul of the middle class and the practice of bookkeeping. The paper aims to explore the notion of a tension between what might be seen as indigenous values and the values of Western capitalism.Design/methodology/approachThe paper presents an analysis of Australian poetry to identify in this culturally significant media how the city and the technologies of accounting are negatively contrasted with the bush and the bushman. Since many Australians migrated from European countries, we might expect bookkeeping to claim a foundational place in the Australian soul.FindingsThis literature shows bush dwellers as being exploited by those from the city, and city professionals such as the accountant and the lawyer as having lost their sense of self and soul. The sense of “other” reflected by the concept of the bush in Australian literature represents a tension between a structured and ordered European sense of self expressed by Maltby and an archetypical sense of self implied by the character of the bushman and connected to the Australian landscape, with its inherent but little acknowledged debt to the Aboriginal. In this landscape the absence of both accounting and the associated rhetoric of economic rationality allow other forms of rationality to emerge.Originality/valueThis is the first time that poetry has been examined in relation to accounting. It shows a deep insight into the place of archetype of the accountant in Australian cultural identity. In addition it argues that responses to accounting can reflect underlying rhetorics of rationality.

Many proficiency tests are operated with a consensus value derived from the participants' results. Apart from technical issues, one of the reasons often mentioned is that proficiency tests operated with consensus values would be cheaper than those using reference values obtained from a priori characterisation measurements. The economy of a proficiency test must of course be balanced by the need of the participants, and the quality of the comparison in general. The proficiency tests selected in this study had both a reference value and a consensus value, one of which was used for assessing the performance of the participating laboratories. In this work, both a technical and an economical assessment of how the comparisons were operated is made. From the evaluation, it follows that usually the use of consensus values does not necessarily reduce the costs of a proficiency test. However, frequently it may be observed that the quality of the assessment of the laboratories is better with a reference value.

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