In today's hospital environment, improving operational efficiency, both financially and to ensure patient safety has never been more important. Today's challenging financial climate and increasing focus on transparency for reimbursement and reporting from both payers and the government are driving hospitals to do the most they with what they have. Most agree that means utilizing data more efficiently.
But in hospitals, that data is all over the place. The hospital norm is many disparate systems that feed hospital IT; identifying key performance metrics that hospitals can easily track, and then using those metrics for improvements is a challenge. And though many forms of business intelligence (BI) have long been utilized in the financial area for financial reporting, integrating that information with the clinical side is the name of the game today. In addition to the typical financial indicators, like length of stay, the data can be reused to monitor patient safety for adverse drug reactions or events such as nosocomial infections, or for measures like time from medication order to administration.
“Hospitals, whether they're 200 beds or 400 beds, often have lots of silos,” says Greg Walton, CIO of 400-bed El Camino Hospital in Mountain View, Calif. “It's very difficult to talk to a physician without continual data. So the real desire here is to tackle the clinical side.”
Mike Davis, vice president at Chicago-based HIMSS Analytics, agrees. “I think the key to BI for all hospitals is how we create an environment where we can look at the financial and clinical data together and understand the impact and relationships between them.”
According to Sue Schade, a pioneer in the use of business intelligence at Boston-based Brigham and Women's Hospital, hospitals should be using BI for directional and strategic planning and decision making. In the “Balanced Scorecard” BI project at Brigham, Schade says she took the textbook view of a balanced scorecard approach — quality, operations, finance, the customer view, and the employee view.
And in a time of thin or evaporating margins, BI can help the executive team make the tough decisions. “A lot of people are using BI to figure out where their true markets are,” says Davis. “‘Which services are profitable, which do we expand and which do we cut?’ Hospitals should all be doing that kind of thing today.”
Many are using a wide variety of tools — from simple spreadsheets to extensive data warehouses. “What I see is a lot of people starting to create environments where they have databases that they're downloading,” Davis says. “When you talk about the very sophisticated hospitals, they have a database they dump all this data into and then use for BI.”
That's what Schade has been doing at Brigham, using Cary, N.C.-based SAS. “We probably have about 80 different data feeds into our balanced scorecard data warehouse.” It's so effective, she says, because of its transparency. “From an end-user perspective, they don't see all those feeds — what they see is the reporting capability, like one-stop shopping.”
Davis says he believes smaller hospitals lacking a BI server or data warehouse can do the same thing with Redmond, Wash.-based Microsoft's Access or Excel. “It's just a matter of how you get the data into that environment and what are the tool sets available to utilize it,” he says. “Even if you're using Excel for small hospitals, there are a lot of things you can do with that data.”
And though Access and Excel can be useful, a newer Microsoft product may be promising to deliver the next level of BI. At El Camino, Walton has just implemented Microsoft Amalga, a unified, system-wide platform that aggregates and enables the analysis of data across the organization. Using Amalga in conjunction with Sharepointe (which most organizations already have) is, Walton believes, a solution that holds much promise.
“I think the sleeper for organizations (and the) big surprise will be Sharepointe,” he says. “The combination of Amalga and Sharepointe is going to deliver a knockout punch to a lot of these problems that we've faced for a long time.” Walton says he is extremely bullish on the solution because the tools look familiar to the end user. “The philosophy to this whole strategy is to put the power into the hands of the end user,” he says. “That's where breaking down the silos should make an enormous difference in the quality of the work that these folks are able to do.”
Enterprise-wide IT solutions like Amalga can be solutions to what most say is the main problem in implementing a BI strategy. “This is where the ugly word interoperability comes back in,” Davis says, “getting that data out of one system and into another environment in order to analyze, trend and evaluate it on a timely basis.”
But with so many enterprise IT vendors touting BI tools as part of their systems, why aren't more hospitals utilizing them? Not so fast, Walton says — there's one big drawback: “They're built into their enterprise system, and there's the rub,” he says.
Schade says in addition an efficient IT solution, another problem hospitals face in implementing a BI strategy is organizational. “They can try to champion it, but they won't be successful if they don't have someone else in the leadership team outside of IS working with them as a champion,” she says.
Schade says she believes that smaller hospitals without data warehouses or solutions can still begin to get a strategy in place. “Ultimately you're going to need to do this,” she says, adding that goes for all hospitals, both large and small. “In a smaller situation I think Access could be workable,” she says. A good place to begin? “Every organization has people doing reporting and metrics, so that's where you start.”
In light of the current economy
Traditionally, Schade says, it's hard to determine ROI for business intelligence. “We have been asked over the years, ‘Where's your ROI?’” Though difficult to measure, she says, there are definitely positive financial implications. “An example is when we reduce length of stay by even a fraction of a day; there is ultimately a financial impact to that. If we're reduced overall average LOS, then we're ultimately able to bring in more patients and more patient days.”
In light of today's economy however, financial challenges can restrict choices. Enterprise BI solutions like Redwood Shores, Calif.-based Oracle are often too pricey for smaller hospitals. And though most agree BI makes sense financially, the cost of purchasing and maintaining a data warehouse is compounded by the need for staff to maintain it. “The problem with the economy today is that if they don't have the skill sets available on staff, they are not going to be able to bring people in to do it,” Davis says.
He suggests that in these tough economic times, CIOs look at the processes they already have tools to measure, use them to establish what the impact can be, and then go back and get the budget for next year. “For the smaller hospitals, this is going to be a tougher challenge,” he says.
Walton agrees that the real problem in implementing a BI solution is not the technology, but rather the budgetary constraints hospitals are facing. “It's not that people don't get technology in hospitals, they do,” he says. “But it's an extremely capital-intensive sector of our economy and that constantly causes hospitals to choose between a cyber knife or a new BI system. Hospitals have to make the decision on where they put their capital dollars.”
And any BI funding decision, most say, needs to come from the C-suite. Schade says executive leadership must be on board and behind any BI project for the funding to happen. “They first need to say it's important to do this, and then IS needs to work with them to make it happen and enable it.”
But in these tough times, how can CIOs convincingly engage their executive management team and the board when every other department is trying to do the same? “You show them,” Davis says. “Pick a problem and if you can measure the metrics you can improve it. Use the success in that to say, ‘If we have better tools here's what we can do.’”
Whether it's using Excel or Access, Davis says, demonstrating the results can pave the way for future projects. “Do it, show them what the impact is and then you say, ‘If you want us to do more, then we need to budget for tools to upgrade the environment.’”
Hospitals without data warehouses can begin by using Access or Excel.
CIOs shouldn't necessarily rely on enterprise vendor solutions for BI.
BI commitment needs to come from the C-suite.
To begin a BI initiative, CIOs should first engage any departments doing quality reporting.
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Healthcare Informatics 2009 February;25(14):47-49