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Staying on Top: Using BI to Improve Quality of Care

October 10, 2013
by Gabriel Perna
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In order to stay atop the mountain, you have to constantly compare yourself to others.

That’s the mentality at the Medical University of South Carolina (MUSC), an academic health center in Charleston, S.C. which has a 709-bed inpatient medical center, various specialty centers, a separate site facility, and a children’s hospital. MUSC has created a culture of business intelligence (BI) to do just that—stay on top.

The number one hospital in South Carolina according to US News and World Report’s famous rankings, MUSC puts the proof in the proverbial pudding: two specific BI platforms used to drill down on quality metrics from an organizational and physician perspective. This allows the hospital to compare itself to other leading medical centers on quality metrics.

One platform is through its association with the United Health Consortium (UHC), an alliance of 118 academic medical centers and 299 of their affiliated hospitals. According to Amy Wilson, director of enterprise analytics at MUSC, every month the provider sends its billing data for hospitalizations (diagnosis, procedure codes, demographics) to UHC.  UHC uses historical data from all of the participating hospitals to calibrate risk-adjustment models.  UHC then applies those models to MUSC’s monthly submissions.  

For instance, if a patient has particular set of comorbidities, the UHC BI platform determines how much care for that patient should cost, as well as what his or her length-of-stay and what his or her mortality risk should be. Other metrics include readmissions and patient safety indicators. MUSC uses that information to benchmark against the UHC estimates and other organizations. 

Amy Wilson

Sitting on top of that BI platform is another one from the Falls Church, Va.-based Harris Healthcare. This platform is more distinctly focused on physician and patient profiling, says Wilson. “We’re looking at many metrics by physician, including readmission rates, resource utilization, and risk-adjusted outcomes such as length of stay, cost, and mortality,” she adds.

There are many distinct elements of this platform, which can capture documentation and coding information on diagnosis-related group (DRG) reimbursement. Various practitioners like Phyllis "PJ" Floyd, R.N., the director of health information services & clinical documentation improvement at MUSC, began to use the Harris platform on her own for this purpose.  She understood its impact and started breaking down the DRG data to see where various issues were occurring in the realm of care.

Soon after, Floyd became an active user of the platform and those in the analytics group, such as Wilson, began to notice her name frequently pop up in the system. They asked her to partner and act as a sort of liaison between the clinical and analytics sides.

“What we do is we use the BI system, and we go out to different specialties; maybe it’s CT surgery, neurosurgery, or pediatrics, and use it to compare data on various metrics,” Floyd says. “We try to determine if it’s a quality-of-care issue or if it’s just a data issue, in terms of capture of right verbiage in the medical record.”

For her role, Floyd says, she helps clinicians understand how the system fits into operations, in terms of coding and documentation. According to Wilson, it’s all part of a multi-part collaborative between CDI, physicians, and analytics teams that is essential to the success of BI in the organization. “[Floyd] sits in between the coders and the physicians, and says, ‘Dr. so and so, you need to write this, so the coders can do that,’ and then we, the data people, do the leg work to try and be smarter about how we look for the opportunities,” says Wilson.

Phyllis "PJ" Floyd, R.N.

As a large medical center, opportunities are abound. Floyd said she was going to meet with oncology to see what kinds of issues can be addressed through the BI. This is one of the areas MUSC hasn’t gotten into yet with the BI platforms, she says.

The various stakeholders of this initiative are ultimately looking at the same goal: improving the quality of care. This is where that comparative element comes into place, and indeed, Wilson says one of the organization’s goals is to be a Top 25 hospital as measured by UHC.

 According to Floyd, MUSC is trying to see what those organization are doing that it could do better. It uses benchmarks on readmissions, length-of-stay, cost-index, and patient safety metrics. Already, MUSC has used the BI platforms to improve severity of illness by and risk of mortality. While these metrics certainly affect reimbursement, she says, the technology goes beyond that.

“The reality is that reimbursement drives a lot of what we do, but I think more importantly nowadays, our mantra is ‘quality.’ Because we’re a non-profit referral center, we want to improve what we do and have better patient outcomes, and the best way to do that is to compare yourself to other places and see where they’ve had success,” Floyd says.