HCA Improves financial, managerial, and clinical processes with arcplan Enterprise

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1 Healthcare Fiacial ad Operatioal Reportig arcpla case study HCA Improves fiacial, maagerial, ad cliical processes with arcpla Eterprise Process-Drive Aalytics I the face of icreasig competitio, a growig umber of uisured ad uderisured patiets, ad stricter guidelies by private isurers ad govermet, HCA, which ows ad operates approximately 179 hospitals ad approximately 104 freestadig surgery ceters i 21 states, Eglad ad Switzerlad, is o the cuttig edge of usig data to work smarter.

2 arcpla allows us to respod to aythig goig o i the idustry. -- Lisa Summers, HCA Fiacial Services Group COO HCA employs arcpla Eterprise across the corporatio, to improve fiacial, maagerial ad cliical processes ad make more iformed decisios to better patiet care, reduce risk, cut costs, ad cotiue expasio i at least five separate major iitiatives. The followig study details two of HCA s more recet ad larger applicatios built with arcpla s Process-Drive Aalytics.. These user-friedly applicatios spa multiple ad varied data sources cotaiig pheomeal amouts of data: the Reveue Cycle Executive Maagemet ad Reportig (EMR) portal, ad Emergecy Departmet (ED) Dashboard applicatios. EMR Dashboard: The Challege I 2001 HCA embarked o a iitiative to cetralize service reveue cycle operatios ad automate reportig for its 178 hospitals ad 92 outpatiet surgery ceters. Exteral market forces drivig the move icluded laggig collectio rates due to a icreasig umber of uisured ad uderisured patiets. HCA accoutats ad aalysts had difficulty extractig meaigful data from the existig paper-based reportig system. This icluded accessig targeted iformatio cocerig HCA s 1.6 millio admissios (or almost 2.5 millio equivalet admissios) a year from a umber of stad-aloe iformatio silos. Aalysts attempted to aswer may questios with umerous complex reports, which cotaied redudat iformatio. I additio to the sheer volume of data 18 terabytes ad the challege of mergig two diverse systems ito oe frot-ed portal solutio, HCA wated to maitai a commo look ad feel for all reports while meetig the eeds of a diverse group of users. Striget HIPAA privacy ad security requiremets would also eed to be met. Last but ot least, HCA kew its employees faced a paradigm shift from a labor itesive, paper-based reportig eviromet to that of a dyamic, Web-based, user-drive oe. The time had come for its 10 Patiet Accout Service Ceters to fid a more efficiet ad effective way to icrease access to, ad ehace aalysis of, the icredible amouts of data from its NCR Teradata data warehouse ad Hyperio Essbase systems. It did t wat to commit the resources to develop a frot-ed reportig solutio i-house or implemet a geeric, off-the-shelf solutio, which might meet oly some of their requiremets. The Solutio After a previously usuccessful attempt usig a competitor s reportig tool o a much smaller scale i oe of its busiess uits, HCA reviewed the field of busiess itelligece providers thoroughly ad decided to implemet arcpla Eterprise for Process-Drive Aalytics. A proof of cocept proved that arcpla Eterprise could rapidly build ad maitai custom applicatios to satisfy its summary ad detail reportig requests. HCA s Busiess Itelligece Service Ceter ad Eterprise Reportig Committee the teamed up with cosultig firm Ifiis Icorporated, a iformatio techology solutio s provider, ad arcpla cosultats to help pla ad deliver the iovative arcpla-based Reveue Cycle Executive Maagemet ad Reportig (EMR) portal solutio. The first report wet ito productio i March of The solutio s ed users, fiacial aalysts, accoutats ad maagers alike, were also cosulted durig the desig process.

3 EMR Software i Use: arcpla Eterprise Hyperio Essbase NCR Teradata From the start, the team decided to begi the project with a clea slate by takig stock of where the busiess was goig ad what its future eeds might be. They decided ot to replicate the labor-itesive processes or staid look ad feel of its old reports. arcpla eabled the buildig of graphically rich reports, easily accessed ad customized to HCA s 950-plus ed user s prefereces, to ehace visualizatio ad uderstadig of data. Whe the project completed i October of 2003, the EMR solutio automated the trackig of umerous performace metrics, icludig performace ad productivity, ad credit balace, isurace deial, discrepacy ad upfrot collectio aalysis. A user eed oly access the portal, choose the desired reports ad the select dimesios, time periods ad whatever view they wish to have of the data. Drill-dow to patiet details could be made with the click of a mouse. arcpla s flexible platform eabled us to quickly build very dyamic applicatios, said Steve Huddlesto, HCA s director of Fiacial Services. For istace, our accoutats ca still view tables of data, but, for those who are more visual, it s simple to toggle betwee grids, graphs ad chart formats. We believe our solutio is iovative because we are the first large healthcare compay to use techology such as this i operatios, he added. EMR also provides tight itegratio with HCA s Active Directory profiles to provide seamless logi ad automated security, esurig access level-based viewig of patiet iformatio to meet striget HIPAA privacy ad security requiremets. User acceptace of the arcpla-based portal solutio is measured weekly ad rus up to 1,000 hits per week. A similar busiess itelligece tool, previously i place agaist oe of the patiet data marts, averaged less tha 100 hits a week as it lagged i performace thus frustratig users. User acceptace is high because EMR has made it easy for users to iteract with our data warehouse, Huddlesto said. Ad it s also fast, eablig HCA s accoutats to pull up aggregatios of up to 200 millio records i less tha 20 secods. EMR has proved a hit with HCA employees ad cotiues to grow as it is marketed out to the field, ew cubes built ad more reports placed o the portal. The Beefits The portal solutio, which eables users to go from summary level iformatio to patiet-level detail, has improved HCA s processes, culture ad bottom lie. The solutio has elimiated batch reportig, removed redudacies ad reduced cofusio i the data, improved cash flow, ad helped HCA recuce bad debt through better risk maagemet. Ed users, freed up from performig the more clerical ad techical duties of reportig, are empowered to perform more targeted aalysis. The automated system makes data istatly available, elimiatig the eed to pull data or cruch umbers. Mothly ad quarterly closes take oe day istead of five. Everyoe from the aalyst to the executive gets the iformatio they eed whe they eed it from oe cetral repository of iformatio. We see this tool as the delivery platform for the whole departmet ad feel it will cotiue to meet our eeds as the busiess chages. said Huddlesto. We re idirectly makig better decisios as more data is made readily available ad it s empowered the user commuity to fid their ow aswers.

4 This tool has eormously reduced the hours we sped each moth ruig queries to aalyze chages ad treds i our busiess, Ted Moody, CFO, HCA Accout Services i Sa Atoio, added. The solutio greatly improved HCA s uderstadig of their demographics ad helped it defie target markets while guidig collectio processes ad up-frot paymet policies. Ad this importat iformatio is ot oly cetralized, but easily shared. What best practices are leared i oe of HCA s 10 area service ceters are shared with the rest. For istace, if the service ceter i Las Vegas is qualifyig a patiet i 30 days, that practice ca be shared with the Miami office which might be takig 100 to do the same. From a maagemet perspective, EMR allows us to respod to aythig goig o i the idustry, Lisa Summers, HCA Fiacial Services Group COO, said. EMR Beefits: Greatly improved reveue, debt collectio rate ad cash flow Automated security maagemet to meet HIPAA requiremets Reduced hours spet o queries ad aalysis. Provided a cosistet look ad feel for all users Virtually elimiated paper-based reportig ED Dashboard: The Challege Suzae Stoe-Griffith, Asst. VP of Quality for HCA, was give a almost impossible quality task: all of HCA s ERs eeded to reduce wait times, shorte legths of stay, ad avoid people leavig the ER without care ad treatmet i the face of growig volumes. The aswers could be foud i the data. But the collectio ad aalysis of data was doe maually ad thus proe to iaccuracies ad icosistecies. Some facilities had better data collectio practices tha others. Decisio makers could t always be sure what they were viewig was the whole or real picture, ad so may times they could do othig else but lead partly by ituitio. But guesses ad mistakes, eve small oes, are icreasigly risky i today s fast-paced, ever more competitive health care market. The other obstacle HCA faced was time. HCA s ERs saw millios of patiets a year ad the sheer volume of data was vast ad the geographical spread of facilities posed a challege. Makig the chages that eeded to be made would require the latest BI techology, ad a overhaul of the system ad the midset of ED Directors ad hospital leadership. We eeded a real-time solutio, Stoe-Griffith said. It was ieffective to provide data oe ad a half moths old ad ask directors to make meaigful improvemets. The data also eeded to be accurate ad robust so it could serve multiple purposes. We wated to leverage the iformatio HCA already had ad pull that iformatio together i oe view so the ed user could make use of the multiple variables that drive efficiecy ad quality i a ER. If you do t uderstad what s impactig your ER, you ll do everythig you cotiue to do, ad make the same mistakes over agai, she added. At the heart of the iitiative was oe questio: How log does it take a patiet to go through the emergecy departmet process, from the time they walk through the frot door, to registratio, triage, gettig a bed, diagosis, treatmet, ad release? HCA eeded real-time metrics about patiet flow ad throughput i the ER ad all the cotributig factors, icludig facility maagemet, provider productivity ad acillary services. The aswer to this questio would drive quality, outcomes ad patiet satisfactio.

5 ED Dashboard: The Solutio After witessig the successes of HCA s fiacial ad huma resource applicatios built with arcpla Eterprise, Stoe-Griffith decided to see what beefits could be derived i a cliical applicatio for the quality services iitiative. Plaig work got started i July 2004 ad the applicatio wet live across all of HCA s ERs i Jauary The Emergecy Departmet (ED) Dashboard solutio pairs arcpla Eterprise with Hyperio Essbase ad holds 100 gigabytes of data. Iformatio is cosolidated ito Microsoft SQL Server ad loaded ito 5 differet cubes. Fiftee reports three servig executives ad four of each focusig o ER turaroud, lab work ad radiology were produced iitially. Each eables thousads of users, icludig every hospital ad divisio executive, every ED director ad Quality director. More importatly every member of the orgaizatio is lookig at the same umber for ay give time frame or metric. The iitiative had its hurdles, for istace, cleaig up the existig data stores before users could rely fully o ED Dashboard, but the solutio, which was customized to HCA s specific eeds, is wiig the respect ad acceptace of users. We have 160 ERs live o the solutio with 100-percet patiet iput ad good compliace ad accuracy, Stoe-Griffith oted. That i itself was a feat. It s also faster for our providers to click o iformatio i real-time tha for them to pull a buch of charts, she added. I ve got to believe that s meaigful as well. Built-i metrics alert users to make chages o the fly. For istace, HCA wats every ER patiet to be see by a physicia withi 45 miutes of arrival, ad stop lights (gree, yellow, red) give providers a status so they ca make adjustmets to hit that 45-miute goal. Now we are data-drive ad aalytic, said Stoe-Griffith. It gives us ifiite ways to look at our ERs. ED Dashboard: The Beefits ED Dashboard has give all of HCA s providers, medical directors, executives, quality improvemet team ad eve its board members a cetral poit of access to form a clearer picture of what s happeig i their ER s. The solutio is used daily to track patiet flow whe various physicias work. Each provider is easily called up by ame ad sorted by volume, average time spet with patiets, day of week ad patiet populatio, etc. to determie if providers are creatig a differece. This sets up a very differet type of coversatio with medical directors. Opiios are data-drive, ot subjective. For istace, ER site assessmets, which look at aythig from provider productivity to bed maagemet, to the effect of acillary services o flow ad turaroud of CT exams ad MRIs play a importat role i the allocatio of resources. The staff of oe ER may feel a ew facility is i order, but is it really eeded? Such decisios are made that much easier ad more covicigly with all the data i had. Ad ED Dashboard tells HCA leadership where to sped the dollars ad focus eergies. I kow ow that I ca use this to pait a picture of how a ER rus before I set foot i the door for a assessmet, Stoe-Griffith said. Our capital/desig ad plaig folks are already usig the solutio to make determiatios about capital ivestmets. The beefits for patiets are also great. The solutio aides provider s abilities to evaluate patiets with high risk cliical presetatios to esure they get to the ext level of care correctly ad i a more timely maer. It s about the right treatmet the first time, ad their perceptio of timeliess ad wait time, Stoe-Griffith said. ED Beefits: Shorteed the time eeded for registratio ad treatmet of ER patiets Alerted users to affect process chage o the fly Helped set best practice procedures across all ER facilities Processes withi the ER are easily moitored ad tweaked ad these best practices shared across the HCA eterprise. The ED Dashboard provides a real-time toolkit to aalyze your patiet flow. You have a costat pulse of quality of service i the ER. I additio, the tool eables ay facility to bechmark agaist others that have commo attributes other tha shear volume. This allows a director to fid solutios ad share success with greater speed, ad we all lear expoetially. Eabled effective allocatio of resources

6 Lookig Ahead: The arcpla Eterprise-based solutio s flexibility ad scalability is provig a boo for HCA. Other iitiatives usig arcpla are reapig similar beefits i other departmets, ad the platform is expected to play a leadig role i a ew outpatiet services strategy to improve operatioal performace. I the moths ahead, HCA is plaig ew ehacemets to EMR to meet its future eeds. We have o doubt EMR will cotiue to evolve to meet iteral ad exteral challeges, Huddlesto said. We have already ehaced the dashboard based o ed user feedback. Work is uderway to add ehacemets, ad a third phase is plaed to exted the applicatio.there is also discussio about extedig this applicatio to the surgerical area. The log-term goal is to eable iformatio to be shared automatically without the eed of huma data etry, creatig a oe-stop metric, aalytic ad bechmarkig tool. I do t thik metrics are goig away, if aythig they are goig to be drivers of performace, Stoe-Griffith said. I see this solutio, which is very flexible, beig able to support the chagig eeds of data. Cotact arcpla Iformatio Services GmbH Düsseldorf Elisabeth-Selbert-Str Lagefeld Deutschlad phoe +49 (2173) fax +49 (2173) ifo@arcpla.com web arcpla UK Ltd Great West Road Betford TW8 9HH Großbritaie phoe +44 (208) fax +44 (208) arcplauk@arcpla.com web arcpla, Ic. (USA) Philadelphia 1055 Westlakes Drive Suite 175 Berwy, PA USA phoe +1 (610) fax +1 (610) cotact@arcpla.com web arcpla Schweiz GmbH Bahhofstr Zug Schweiz phoe +41 (41) fax +41 (41) ifo@arcpla.com web HCA, Ic. Oe Park Plaza Nashville, TN phoe +1 (615) web Copyright October 2006 arcpla, Ic. arcpla ad dyasight are trademarks of arcpla, Ic.