HITAM. Business Intelligence for Hospitals: Empowering Healthcare Providers to Make Informed Decisions through Centralized Data Analysis

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1 Business Intelligence for Hospitals: Empowering Healthcare Providers to Make Informed Decisions through Centralized Data Analysis

2 Healthcare providers today are impacted by an acute combination of rising costs, declining margins and demanding patients wanting the best quality care. They are consequently trying to do more with less, operate more efficiently and provide the best quality patient care by making informed decisions. Rich data, poor information availability Virtually every stakeholder in a healthcare organization is demanding timely information about performance, quality, safety and costs. However, disparate and disjoined silos of data across various departments cause severe information bottlenecks affecting the ability to make critical decisions. Absence of a strong Decision Support System Many hospital executives feel they are unable to effectively utilize the data to make decisions. Most reports are not germane to organizational objectives and it s quite possible to miss important trends within the voluminous reports. Spotting trends helps executives to carefully pick the spots where costs can be reduced and where investments can be continued. Hence, making informed decisions is critical to operational efficiency. Set the ball rolling Performance Management is the key to measuring and monitoring operational, financial and clinical activities that are aligned to enterprise vision and strategy. Performance management consists of a set of management and analytic processes that enable organizations to define strategic goals, measure and then manage performance against set goals. Performance management involves consolidation of data from various sources, querying, analysis of data and acting upon the derived insights. However, Hospitals today face a problem in clearly defining their objectives and measuring their progress with respect to those objectives. There is a clear need for a structured solution approach to identify objectives and measure progress. Solution Approach A study into successful approaches used by healthcare providers reveals that identifying user needs, the organizational change agenda, influencers of strategic goals and key performance indicators result in viable strategy maps and scorecards. These results can then be used to develop operational reports and dashboards that provide administrators and clinical executives with operational decision support to improve business efficiencies.

3 Stakeholder Analysis The approach begins with a detailed study of needs of the Stakeholder in the hospital. This analysis enables developing a hierarchy of objectives that could be used to derive an organizational goal. For instance doctors most often require facility expansion, the addition of new service lines, increased budget for research and development, support from pharmaceutical companies and senior doctors in the field. The organization management needs to increase revenues and improve profitability by optimizing costs. Management aims to increase market share by providing the best patient satisfaction. The next step would be to formulate a hierarchy of objectives based upon the needs of all stakeholders including Doctors, Patients, Management, Community, Vendors (Contractors, Suppliers), Staff (Nurses, Technicians, Others), Payers, Pharmaceutical Companies, Government and Regulatory agencies. This hierarchy of objectives is a valuable fundamental to building strategic organizational goals, while keeping the best interest of all stakeholders. The Change Agenda Just as people evolve, change occurs when an organization evolves through various life cycles. For organizations to develop, they often must undergo significant change at various points in their development. Below is a change agenda that acts as a summary of the current state and of a desired state in the future. By defining desired changes across the various dimensions in the change agenda, an organization can identify its set of objectives rightly called the desired destination state.

4 Causal Influence Diagrams Healthcare providers find themselves caught in the complexity of the non-linear relationships between the various influencers of success. The components have dynamic, interdependent relationships that are often unstable. A useful method for representing relationships among various influencers in such a complex system is causal influence diagramming. Cause & effect linkages between various Key Performance Indicators (KPIs) should be analyzed and the Performance Management Solution should be used to understand the loops linking the various influencers. This would empower the hospital management to make the right decisions. Below is a snapshot of an influence diagram that shows the non-linear pattern of cause and effect linkages between the length of stay of patients and various other influencers. Such pattern analysis helps in identifying the various influencing factors that commonly remain hidden. An ideal performance management solution should showcase these hidden linkages, enabling hospitals to identify influencers and ensure prolonged solutions. For instance, you might notice increase in revenue and link it to reduction in the length of stay in the last two months. However, if improvement of Treatment Effectiveness and reduction in Medication Errors is left unattended, it will affect revenue eventually. Also, with such non-linear analysis hospitals can create predictive reports and thus help the hospital as well as the patients to forecast and make the right decisions. Analyzing causal effect relationships between various KPIs enables evidence-based decisions, helping hospitals to balance quality healthcare with reduced costs. Key Performance Indicators Once an organization has understood stakeholder needs and identified strategic objectives, it needs a way to measure progress towards a set of objectives. KPIs help an organization define and measure progress towards organizational goals. Healthcare providers can achieve continuous improvement through KPI-enabled process performance monitoring against the set targets. Also, while choosing KPIs the healthcare provider needs to consider and incorporate national guidelines issued by organizations such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), National Association of Health Data Organizations (NAHDO) and CMS(Centers for Medicare and Medicaid Services) amongst others. These KPIs also help in performance comparisons between competitive hospitals that can enable patients to choose the best rated hospital. Hospital executives need to focus their energy on monitoring the KPIs that are aligned with the hospital goals. Here is an example of Financial, Operational, Clinical and Claims KPIs:

5 Financial Clinical Operational Claims Days cash on hand Risk Adjusted Mortality index Patient days A/R turn-around time Return on Investment Risk Adjusted Complications index Bed Occupancy Rate Denial Rate Lost Revenue Core Measures Average Percent Average length of stay (ALOS) Payor Performance Cost per adjusted patient day Medication errors Average time emergency department (ED) door to bed Billed but did not receive Cost per unit of service Re-admission Rate FTEs per Adjusted occupied bed Percentage of A/R > 90 days Charitable contributions Number of patients with HAI (Hospital Affected Infections) Patient Satisfaction Index Number of Claims In order to get a clear picture of each functional area, KPIs could be grouped under four main categories: Financial, Operational, Clinical and Claims. This helps executives select the KPIs that are most important to achieve organizational objectives. Strategy Maps and Balanced Scorecards A strategy map is a visual representation of organizational strategy. Once objectives are identified for the hospital, there has to be a structured way of measuring the progress with respect to those objectives. A strategy map serves that purpose and can be used for laying out the identified objectives in four important Balanced Scorecard perspectives. Financial Strength Targeted services Physician friendly relationship Financial Perspective Grow volume through Physician Cost-effective care relations Patient Perspective Innovative programs for Patient friendly experience Payers/Employers Process Perspective Increase patient base Holistic health Growth and Development Patient Experience Operational Excellence Community Service Growth through alliances Effective care delivery Exceptional clinical outcomes Community education Brand development Optimize patient experience Continuous process improvement Ensure compliance Learning Perspective Mission oriented workforce Accountability & collaboration Patient-centric culture Technology for decision support The objectives in the four perspectives are linked together by cause-and-effect relationships. Performance is commonly measured by financial metrics. This approach overlooks the influencing factors and linkages for financial measures. As a best practice, hospitals also need to monitor other perspectives. Investment and improvement in learning lead to process efficiency. Efficient processes enhance patient satisfaction, resulting in healthy financial strength. Reporting & Dashboards Dashboard and reporting is a natural subset of balanced scorecards and is being increasingly used by healthcare organizations to stay focused on critical areas that affect overall performance. Performance Management solutions should integrate disparate data sources, extract data, transform it into a

6 dimensional model and visually present information for interactive and on-demand analysis. The solution should also provide predictive analysis and data discovery capabilities that give power users full investigative control into any corner of the data to explore various outcomes or solve complex problems. Also, Dashboard & Scorecards have evolved from being specific to each group of professionals for example, a scorecard for the doctors, another for the nurses to a multidisciplinary scorecard that includes information for all the professionals who interact with patients. This helps achieve a more patient-centric view that lends itself to higher quality and outcomes. For instance, when a Top Management Executive sees that there is a dip in contribution from the Cardiology Service Line in the month of July, she can analyze to find the cause for the dip, on-demand. On further drill-down, she learns that it is because of a dip in contribution from DRG2 of the Cardiology Line of Service. The user then moves to the next level and understands that there is a sudden increase in cost per case in the month of July. On further analysis, she identifies that among the cost drivers, increase in Extended Length of Stay has caused the dip in contribution from the Cardiology Line of Service. With the on-demand availability of personalized information, the user can instantly act on the situation instead of spending time looking for information. Conclusion The need of the hour is for an end-to-end hospital performance management solution that extracts data spread across a number of systems and brings it into centralized, secure, historical repositories, which is organized for business users to slice, dice, and sort and sums it efficiently in order to support situationbased decisions. The solution approach for deploying performance management should focus on quickly achieving results, rather than being a complex planning, data management and deployment exercise. Such a system with pre-built and re-usable components can become fully functional and deliver results in just a few weeks. The right performance management solution can empower healthcare providers to make informed decisions that can enable them to master the balancing act of reducing costs while providing quality healthcare. from Lister Technologies is an innovative Enterprise Performance Management solution framework for Hospitals. is built on Service Oriented Architecture (SOA) using Open Source BI to ensure reduced Total Cost of Ownership. It integrates disparate financial, clinical and operational data to provide decision support for managing Cost, Quality of Care and Patient Satisfaction. is a prepackaged, yet customizable solution designed for rapid deployment within 90 days. helps hospitals address the challenge of data integration and provide a holistic view for evidence based decision making. For more details contact bd@listertechnologies.com