Description
The healthcare industry’s new world Every year hundreds of people find themselves lost in the wilderness while working, playing, hiking, hunting, camping or travelling.
SCOTT WANLESS AND THOMAS LUDWIG
Business Intelligence and Analytics
for Healthcare Organizations
IN ASSOCIATION WITH PUBLISHED BY
Business Intelligence and Analytics for Healthcare Organizations
is published by Ark Group
UK/EUROPE OFFICE
Ark Conferences Ltd
Paulton House
8 Shepherdess Walk
London N1 7LB
United Kingdom
Tel +44 (0)207 549 2500
Fax +44 (0)20 7324 2373
[email protected]
NORTH AMERICA OFFICE
Ark Group Inc
4408 N. Rockwood Drive
Suite 150
Peoria IL 61614
United States
Tel +1 309 495 2853
Fax +1 309 495 2858
[email protected]
ASIA/PACIFIC OFFICE
Ark Group Australia Pty Ltd
Main Level
83 Walker Street
North Sydney NSW 2060
Australia
Tel +61 1300 550 662
Fax +61 1300 550 663
[email protected]
Editor
Evie Serventi
[email protected]
Head of content
Anna Shaw
[email protected]
Managing director
Jennifer Guy
[email protected]
UK/Europe marketing enquiries
Robyn Macé
[email protected]
US marketing enquiries
Daniel Smallwood
[email protected]
Asia/Pacific marketing enquiries
Steve Oesterreich
[email protected]
ISBN: 978-1-907787-57-7 (hard copy)
978-1-907787-58-4 (PDF)
Copyright
The copyright of all material appearing within
this publication is reserved by the author and
Ark Conferences 2011. It may not be reproduced,
duplicated or copied by any means without the
prior written consent of the publisher.
ARK1641
SCOTT WANLESS AND THOMAS LUDWIG
Business Intelligence and Analytics
for Healthcare Organizations
IN ASSOCIATION WITH PUBLISHED BY
Contents
III
Contents
Executive summary .............................................................................................................IX
The healthcare industry's new world ........................................................................................IX
About the authors ............................................................................................................XIII
Acknowledgements ...........................................................................................................XV
Part One – Bridging the gap between healthcare informatics and BI
Chapter 1: Challenges facing the healthcare industry ......................................................... 1
Increased demand for services ............................................................................................... 2
Resource shortages ............................................................................................................... 3
Compliance requirements ...................................................................................................... 4
Financial pressures… ............................................................................................................ 5
Vertical and horizontal integration .......................................................................................... 6
Chapter 2: Key decisions in healthcare organizations ......................................................... 9
Increased demand for services ............................................................................................... 9
Resource shortages ............................................................................................................. 13
Compliance requirements .................................................................................................... 13
Financial pressures .............................................................................................................. 13
Vertical and horizontal integration ........................................................................................ 16
Chapter 3: Business intelligence and data warehousing ................................................... 23
Driving sector business with BI ............................................................................................. 23
Insurance ........................................................................................................................... 23
Investment .......................................................................................................................... 24
Manufacturing .................................................................................................................... 24
Retail ................................................................................................................................. 25
Utility organization .............................................................................................................. 26
Public sector ....................................................................................................................... 26
Analytics ............................................................................................................................. 27
Chapter 4: Healthcare informatics .................................................................................... 31
Specialization in healthcare informatics ................................................................................ 32
IV
Contents
Reducing administration to a utility role ................................................................................ 33
Emerging healthcare informatics topics ................................................................................. 34
Chapter 5: The common denominator – Analytical questions ............................................ 35
Clinical analytical questions ................................................................................................. 35
Operational analytical questions .......................................................................................... 38
Financial analytical questions ............................................................................................... 41
Chapter 6: Business intelligence architecture .................................................................... 47
Industry-standard data warehouse architecture ...................................................................... 47
Component one – Operational systems ................................................................................ 47
Component two – Data repository ........................................................................................ 48
Component three – Analytical applications ........................................................................... 49
Chapter 7: Responsibilities of key decision-makers ........................................................... 51
Chief medical officer ........................................................................................................... 51
Chief quality officer ............................................................................................................. 52
Chief research officer .......................................................................................................... 52
Chief financial officer .......................................................................................................... 53
Chief operations officer ....................................................................................................... 53
Chief marketing officer ........................................................................................................ 53
Chief information officer ...................................................................................................... 54
Marrying BI and informatics ................................................................................................. 54
Part Two: Implementing BI for clinical, financial and operational success
Chapter 8: Business intelligence applications for clinical success ....................................... 59
Business process efficiency ................................................................................................... 59
Patient registries .................................................................................................................. 60
Outcomes analysis .............................................................................................................. 64
Quality program reporting… ............................................................................................... 64
Care team support .............................................................................................................. 68
Patient safety and risk management reporting and analysis… ................................................. 71
Patient satisfaction ............................................................................................................... 75
Chapter 9: Business intelligence applications for financial success .................................... 79
Demand data slicing ........................................................................................................... 79
Types of demand data ......................................................................................................... 80
Revenue cycle management ................................................................................................. 81
Pay for performance ............................................................................................................ 84
The payoff of P4P ............................................................................................................... 87
Reusable compliance reporting ............................................................................................ 88
The growing challenge of compliance demands .................................................................... 88
Business Intelligence and Analytics for Healthcare Organizations
V
Chapter 10: Business intelligence applications for operational success .............................. 91
Increasing speed and efficiency ............................................................................................ 91
The value of lean initiative support ....................................................................................... 92
Lean increases capacity ....................................................................................................... 93
Business intelligence improves lean ...................................................................................... 94
Making healthcare convenient ............................................................................................. 95
Improving service timing ...................................................................................................... 98
Predictive analytics .............................................................................................................. 99
Predictive analytics requirements ........................................................................................ 101
Spending story analysis ...................................................................................................... 102
Chapter 11: Business intelligence applications for enterprise-wide success ..................... 105
Emerging business structures – Health provider cooperatives ................................................ 105
Emerging offerings – Service line management ................................................................... 107
Emerging practices – Promoting EHR adoption using analytics .............................................. 109
Improving the ROIs of EHRs ............................................................................................... 110
Emerging patient needs – Chronic condition surveillance ..................................................... 112
Levels of chronic condition surveillance ............................................................................... 112
Emerging competitors – Medical tourism ............................................................................ 115
Medical tourism proponents .............................................................................................. 117
Emerging business models – Retail clinics ........................................................................... 120
Retail clinic analytics ......................................................................................................... 121
Part Three – The journey
Chapter 12: Selling the concept of BI in your organization ............................................. 127
The importance of executive sponsorship ............................................................................ 127
Timing is key .................................................................................................................... 127
Essential elements in selling the BI concept ......................................................................... 128
Essential roles in selling the BI concept ............................................................................... 130
The basic selling process ................................................................................................... 132
Chapter 13: Business intelligence project roadmap ........................................................ 133
Business intelligence assessment ........................................................................................ 133
Planning stage .................................................................................................................. 135
Requirements gathering stage ............................................................................................ 135
Design stage .................................................................................................................... 137
Development/construction/build stage ................................................................................ 137
Testing and data validation stage ....................................................................................... 138
Implementation stage ........................................................................................................ 138
Training stage ................................................................................................................... 139
Warranty support stage ..................................................................................................... 139
Business intelligence application marketing ......................................................................... 139
Chapter 14: Growing the organization's BI capabilities from a business perspective ........ 141
Marketing the BI application .............................................................................................. 141
Developing a sustainable strategic plan .............................................................................. 144
A vision for the BI capability as a whole and the impact on the organization ......................... 146
Vision .............................................................................................................................. 147
Ears ................................................................................................................................. 148
Relentless service experimentation ...................................................................................... 148
Comprehensive event-response planning ............................................................................ 148
Many levels of BI .............................................................................................................. 148
Conclusions ..................................................................................................................... 149
Part Four: Case studies
Case study 1: Advocate Health Care, Oakbrook, Illinois ................................................. 153
Enterprise-wide balanced scorecard ................................................................................... 153
Marrying organizational objectives and goals with technology .............................................. 153
Case study 2: Denver Health, Denver, Colorado ............................................................. 155
Integration boosts continuity of care ................................................................................... 155
Data warehouse evolution ................................................................................................. 155
Electronic quality scorecard project .................................................................................... 155
Overcoming challenges ..................................................................................................... 156
More efficient and customized patient care ......................................................................... 157
Case study 3: Good Hope Hospital, Birmingham, United Kingdom ................................ 159
Using BI and analytics to improve service delivery ............................................................... 159
Financial challenges .......................................................................................................... 160
Computer simulations are key ............................................................................................ 160
Case study 4: Scott & White Healthcare, Department of Surgery, Temple, Texas .............. 161
Developing a customized dashboard tool ........................................................................... 161
Successful problem-solving during the piloting stage ........................................................... 161
Case study 5: Upstate Neurology Consultants, Albany, New York ................................... 163
Centralizing data with BI to boost efficiency ........................................................................ 163
Case study 6: United States Air Force ............................................................................. 165
The advantages of a single electronic health record ............................................................ 165
A fresh approach to data analysis ...................................................................................... 166
Case study 7: Wisconsin Collaborative for Healthcare Quality, Wisconsin ....................... 167
United approach improves performance measures .............................................................. 167
Improving data collection .................................................................................................. 167
Overcoming challenges ..................................................................................................... 168
VI
Contents
Business Intelligence and Analytics for Healthcare Organizations
VII
Case study 8: Advocate Health Care, Oakbrook, Illinios ................................................. 169
A physician report card supports clinical integration ............................................................ 169
Steps to develop a customized report card .......................................................................... 170
Further reading .............................................................................................................. 171
Index ............................................................................................................................. 173
IX
The healthcare industry’s new world
Every year hundreds of people find
themselves lost in the wilderness while
working, playing, hiking, hunting, camping
or travelling. These people suffer greatly
from cold, thirst, hunger, exhaustion and
fear. They find that the rules are different in
the wild than in civilization, the challenges
are greater, everyday tasks are harder and
the threats are scarier. Some perish.
Despite this, the resources they need
exist in abundance and are actually readily
available. The problem is that most people
simply do not recognize these resources as
the shelter, water, food, medicines, tools and
weapons they need. Furthermore, they do
not recognize their own internal strengths
– the skills, knowledge and resourcefulness
they could use to protect themselves, to
survive and even to rescue themselves.
Healthcare provider organizations today
find they are entering a new wilderness of
their own with new rules, pressures, threats
and new opportunities. Patients, payers
and purchasers of healthcare services have
become more demanding and more critical.
Volume that was thought to be impervious
to recession has plunged. Former partners
and allies have now become competitors
and foes. Care delivery models that have
always been rock solid are now obsolete
and the new models replacing them
are confusing and counter to the ways
hospitals, doctors, medical groups and
ancillary service providers are compensated.
Accountability and transparency are king
and government regulations are crushing.
Budgets are slashed, reimbursement is
deteriorating and revenue or public funding
is depressed. Meanwhile, capital for
growth, change and expansion has all but
dried up and what is available requires
much higher levels of justification and risk
mitigation planning.
Many of these providers worldwide will
suffer greatly. Some will merge to protect
themselves and others will contract; some
will sell out altogether and some will perish.
And yet, these organizations universally
have a tremendous supply of the very
resources they need to adapt, survive,
thrive, rescue themselves and even lead
the changes they are experiencing. But
many simply do not recognize their existing
resources including people, processes
and technologies, as well as the analytical
mindset, knowledge and resourcefulness
needed to succeed.
One key difference between the winners
and losers is their propensity for analysis
and for using their analytical capabilities
to improve clinical quality, operational
efficiency and financial strength. The
differentiator is how they use the data they
already own to become smarter, stronger
and faster, being business intelligence (BI),
analytics and informatics.
This Ark Group report is intended to help
healthcare organizations understand BI and
its benefits from a strategic and business
perspective particular to the healthcare
industry, by providing examples of BI
Executive summary
X
applications for improving clinical, financial
and operational success. And it provides
a roadmap for organizations to follow to
implement and maximise BI. Crucial aspects
covered include:
Achieving executive sponsorship; ?
Nurturing vital conversations between ?
business leaders and IT managers; and
Ensuring the project remains ?
business-driven.
This report is directed at c-level executives
in healthcare provider organizations
including hospitals, medical groups,
clinic organizations, specialty physician
companies, as well as public health and
government-based healthcare enterprises.
Health information exchanges, quality
standards organizations, payers, public
health organizations, healthcare purchasing
groups and patient advocacy groups will
also find insight and practical advice for
guiding their analytical efforts.
This report is based on over 260
interviews with doctors, nurses, executives,
informaticists, project managers, analysts
and policy-makers across a wide spectrum
of healthcare providers of varying
sizes, shapes and stages of analytical
development. Also, the authors each
bring over 30 years‘ experience and have
combined backgrounds in nursing, clinical
operations and practice management,
front-line clinical experience, public health,
primary care management, financial
management, technology development,
process improvement facilitation; and of
course, BI, data warehouse, informatics and
analytics development.
This report is presented in four sections:
Part One – Bridging the gap between ?
healthcare informatics and BI;
Part Two – Implementing BI and ?
analytics for clinical, financial and
operational success;
Part Three – The journey; and ?
Part Four – Case studies. ?
In-depth and informative case studies include:
Upstate Neurology Consultants, Albany, ?
New York – Specialty physician practice;
Wisconsin Collaborative for Healthcare ?
Quality, Madison, Wisconsin – A voluntary
consortium of 27 healthcare organizations;
Advocate Health Care, Oakbrook, ?
Illinois – Integrated health care system;
Good Hope Hospital, Birmingham, ?
UK – Member of the National Health
Service (NHS);
Scott & White Healthcare, Temple, ?
Texas – Integrated health system;
Denver Health, Denver, Colorado – ?
A safety net institution that integrates
acute hospital and emergency care
with public and community health
services; and
United States Air Force Medical ?
Operations Agency, San Antonio, Texas
– Supports healthcare operations for 75
medical treatment facilities.
Part One bridges the gap between
healthcare informatics and BI. Informatics is
familiar to most healthcare providers,
but is seen as a specialized discipline
practiced by only a few in the organization.
Business intelligence is unfamiliar to most of
these same providers. This section describes
both and is intended to show decision-
makers that their organization already has
analytical resources and methods at its
disposal and explains how to supercharge
them using BI, data warehousing and
analytics methodologies. Concept and topics
addressed in Part One include:
Executive summary
Business Intelligence and Analytics for Healthcare Organizations
XI
Chapter 1 – Challenges facing the ?
healthcare industry describes major
trends such as increased demand,
resource shortages, compliance
requirements, financial pressures and
vertical and horizontal integration;
Chapter 2 – Key decisions in healthcare ?
organizations cover initiatives to increase
revenue and reimbursement, improve
care, streamline operations, reduce
waste and cost, ensure quality and
safety and integrate systems, processes
and information;
Chapter 3 – Business intelligence ?
and data warehousing steps outside
healthcare to look at how other industries
are using BI and data warehousing for
business success, including insurance,
retail, manufacturing, utilities and the
public sector;
Chapter 4 – Healthcare informatics ?
brings us back to the roots of analytical
information usage in healthcare and shows
how the field has grown and matured;
Chapter 5 – The common denominator ?
– analytical questions emphasizes the
most important component of either BI
or informatics capabilities, which is the
analytical question and how healthcare
organizations can use informatics to
adopt BI;
Chapter 6 – Business intelligence ?
architecture describes the industry-
standard architecture for developing BI
and data warehousing, in order to set
the stage for subsequent chapters on
specific applications; and
Chapter 7 – Decision-makers in ?
healthcare organizations walk down
the executive halls to see what types of
analytical questions are important to
chief medical officers, chief financial
officers, chief operating officers and
many more.
Part Two offers 20 key types of BI
applications that are being implemented
and used by healthcare provider
organizations to achieve clinical,
operational, financial and enterprise-
wide success:
Chapter 8 – Business intelligence ?
applications for clinical success
demonstrates how healthcare
organizations can become smarter
clinically and describes seven
applications such as patient registries,
outcomes analysis, quality program
reporting, patient safety and risk
management analytics, etc;
Chapter 9 – Business intelligence ?
applications for financial success
describes applications used to become
stronger financially, including demand
data slicing, revenue cycle management,
pay for performance (P4P) analytics and
reusable compliance reporting;
Chapter 10 – Business intelligence ?
applications for operational success
offers applications used to become
faster operationally, such as lean
initiative support, service innovation,
predictive analytics and spending story
analysis; and
Chapter 11 – Business intelligence ?
applications for enterprise-wide
success describes applications used
to move from old business models
to new, emerging models such as
cooperatives, medical tourism and retail
clinics; and describes how to improve
the organization through promoting
electronic health records (EHRs), chronic
conditions surveillance and advanced
service line management.
Part Three describes the journey from
introduction of the concept of BI into
XII
your organization, through design,
construction and implementation of the
capabilities and finally, how to grow and
evolve those capabilities:
Chapter 12 – Selling the concept of BI ?
in your organization provides a roadmap
of the process for championing BI in
the healthcare enterprise by discussing
essential concepts, roles and processes
in this selling effort;
Chapter 13 – Business intelligence ?
project roadmap briefly describes
the industry-standard methodology
for developing and implementing a
healthcare BI application; and
Chapter 14 – Growing the organization’s ?
BI capabilities from a business perspective
concludes the report by showing the
reader how to market the application to
the business, how to develop a strategy
for long-term success and a vision for the
BI capability as a whole; and analyzes its
impact on the organization.
This report will give readers a good
understanding of how to use BI, informatics
and analytics capabilities so their
organizations can survive and thrive in the
new healthcare industry ‘wilderness’ that is
emerging. Readers will have a firm grasp of
the concepts, examples, roadmaps as well
as a vision needed to put BI into play to
make their respective organization smarter,
stronger and faster.
Executive summary
XIII
Scott Wanless
Scott Wanless is the healthcare business intelligence practice lead for Resource Management
Professionals (www.yourrmp.com) and an industry researcher, consultant and business analyst
in the healthcare business intelligence field. He has more than 30 years’ experience in business
intelligence strategic planning, informatics and analytics development, financial management,
economic development and process improvement. His vast industry experience spans healthcare
providers, hospitals, long-term care, primary care and specialty physician practices, healthcare
payers, laboratory research, retail pharmacy and optical, insurance, financial services, banking,
manufacturing; and state and local governments. Scott can be reached at [email protected].
Thomas A. Ludwig, RN, MBA, FACMPE
Tom Ludwig is president and CEO of Forward Healthcare Solutions, LLC, a consulting firm that
specializes in working with physician practices (www.forwardhealthcaresolutions.com). Having worked
in the medical environment for 35 years, Tom started his career as a Navy Corpsman and also
worked as a medical assistant and as a staff nurse. His 20-plus years’ experience as an administrator
have been in roles from front-line manager to program director to chief operations officer. He is a
member of the Medical Group Management Association and the American College of Medical
Practice Executives (ACMPE) and currently serves on the ACMPE Board of Directors. Tom is a
Board certified medical practice executive and a fellow in the American College of Medical
Practice Executives. Tom can be reached at [email protected].
About the authors
XV
Acknowledgements
Scott Wanless
Many thanks to the hundreds of people who provided expertise and thought on the future of a better
healthcare world through business intelligence and analytics; and for demonstrating the courage to
act today to bring this future about.
Specific thanks to the many people who have helped to get this message out over the years,
including Evie Serventi of the Ark Group, Ron Powell, Jean Schauer and Mary Jo Nott of the
BeyeNetwork; and Satish Kavirajan of The Center for Business Innovation.
Additional thanks to my parents for teaching me at a young age to think analytically and apply
this thinking to real-world situations. And of course, special thanks to my wife Laura and my sons
Erik, Andy and Ethan for their help to turn this project into a mission.
Tom Ludwig
I would like to thank my friends at the Wisconsin Primary Health Care Association, as well as my
FQHC colleagues for pushing me to learn more about this topic. I would also like to thank the
individuals who contributed to the case studies, for you and your organizations are leading the way.
Last of all, special thanks go to my wife Lisa and my sons Frederic and Evan for their
encouragement and support.
doc_105028038.pdf
The healthcare industry’s new world Every year hundreds of people find themselves lost in the wilderness while working, playing, hiking, hunting, camping or travelling.
SCOTT WANLESS AND THOMAS LUDWIG
Business Intelligence and Analytics
for Healthcare Organizations
IN ASSOCIATION WITH PUBLISHED BY
Business Intelligence and Analytics for Healthcare Organizations
is published by Ark Group
UK/EUROPE OFFICE
Ark Conferences Ltd
Paulton House
8 Shepherdess Walk
London N1 7LB
United Kingdom
Tel +44 (0)207 549 2500
Fax +44 (0)20 7324 2373
[email protected]
NORTH AMERICA OFFICE
Ark Group Inc
4408 N. Rockwood Drive
Suite 150
Peoria IL 61614
United States
Tel +1 309 495 2853
Fax +1 309 495 2858
[email protected]
ASIA/PACIFIC OFFICE
Ark Group Australia Pty Ltd
Main Level
83 Walker Street
North Sydney NSW 2060
Australia
Tel +61 1300 550 662
Fax +61 1300 550 663
[email protected]
Editor
Evie Serventi
[email protected]
Head of content
Anna Shaw
[email protected]
Managing director
Jennifer Guy
[email protected]
UK/Europe marketing enquiries
Robyn Macé
[email protected]
US marketing enquiries
Daniel Smallwood
[email protected]
Asia/Pacific marketing enquiries
Steve Oesterreich
[email protected]
ISBN: 978-1-907787-57-7 (hard copy)
978-1-907787-58-4 (PDF)
Copyright
The copyright of all material appearing within
this publication is reserved by the author and
Ark Conferences 2011. It may not be reproduced,
duplicated or copied by any means without the
prior written consent of the publisher.
ARK1641
SCOTT WANLESS AND THOMAS LUDWIG
Business Intelligence and Analytics
for Healthcare Organizations
IN ASSOCIATION WITH PUBLISHED BY
Contents
III
Contents
Executive summary .............................................................................................................IX
The healthcare industry's new world ........................................................................................IX
About the authors ............................................................................................................XIII
Acknowledgements ...........................................................................................................XV
Part One – Bridging the gap between healthcare informatics and BI
Chapter 1: Challenges facing the healthcare industry ......................................................... 1
Increased demand for services ............................................................................................... 2
Resource shortages ............................................................................................................... 3
Compliance requirements ...................................................................................................... 4
Financial pressures… ............................................................................................................ 5
Vertical and horizontal integration .......................................................................................... 6
Chapter 2: Key decisions in healthcare organizations ......................................................... 9
Increased demand for services ............................................................................................... 9
Resource shortages ............................................................................................................. 13
Compliance requirements .................................................................................................... 13
Financial pressures .............................................................................................................. 13
Vertical and horizontal integration ........................................................................................ 16
Chapter 3: Business intelligence and data warehousing ................................................... 23
Driving sector business with BI ............................................................................................. 23
Insurance ........................................................................................................................... 23
Investment .......................................................................................................................... 24
Manufacturing .................................................................................................................... 24
Retail ................................................................................................................................. 25
Utility organization .............................................................................................................. 26
Public sector ....................................................................................................................... 26
Analytics ............................................................................................................................. 27
Chapter 4: Healthcare informatics .................................................................................... 31
Specialization in healthcare informatics ................................................................................ 32
IV
Contents
Reducing administration to a utility role ................................................................................ 33
Emerging healthcare informatics topics ................................................................................. 34
Chapter 5: The common denominator – Analytical questions ............................................ 35
Clinical analytical questions ................................................................................................. 35
Operational analytical questions .......................................................................................... 38
Financial analytical questions ............................................................................................... 41
Chapter 6: Business intelligence architecture .................................................................... 47
Industry-standard data warehouse architecture ...................................................................... 47
Component one – Operational systems ................................................................................ 47
Component two – Data repository ........................................................................................ 48
Component three – Analytical applications ........................................................................... 49
Chapter 7: Responsibilities of key decision-makers ........................................................... 51
Chief medical officer ........................................................................................................... 51
Chief quality officer ............................................................................................................. 52
Chief research officer .......................................................................................................... 52
Chief financial officer .......................................................................................................... 53
Chief operations officer ....................................................................................................... 53
Chief marketing officer ........................................................................................................ 53
Chief information officer ...................................................................................................... 54
Marrying BI and informatics ................................................................................................. 54
Part Two: Implementing BI for clinical, financial and operational success
Chapter 8: Business intelligence applications for clinical success ....................................... 59
Business process efficiency ................................................................................................... 59
Patient registries .................................................................................................................. 60
Outcomes analysis .............................................................................................................. 64
Quality program reporting… ............................................................................................... 64
Care team support .............................................................................................................. 68
Patient safety and risk management reporting and analysis… ................................................. 71
Patient satisfaction ............................................................................................................... 75
Chapter 9: Business intelligence applications for financial success .................................... 79
Demand data slicing ........................................................................................................... 79
Types of demand data ......................................................................................................... 80
Revenue cycle management ................................................................................................. 81
Pay for performance ............................................................................................................ 84
The payoff of P4P ............................................................................................................... 87
Reusable compliance reporting ............................................................................................ 88
The growing challenge of compliance demands .................................................................... 88
Business Intelligence and Analytics for Healthcare Organizations
V
Chapter 10: Business intelligence applications for operational success .............................. 91
Increasing speed and efficiency ............................................................................................ 91
The value of lean initiative support ....................................................................................... 92
Lean increases capacity ....................................................................................................... 93
Business intelligence improves lean ...................................................................................... 94
Making healthcare convenient ............................................................................................. 95
Improving service timing ...................................................................................................... 98
Predictive analytics .............................................................................................................. 99
Predictive analytics requirements ........................................................................................ 101
Spending story analysis ...................................................................................................... 102
Chapter 11: Business intelligence applications for enterprise-wide success ..................... 105
Emerging business structures – Health provider cooperatives ................................................ 105
Emerging offerings – Service line management ................................................................... 107
Emerging practices – Promoting EHR adoption using analytics .............................................. 109
Improving the ROIs of EHRs ............................................................................................... 110
Emerging patient needs – Chronic condition surveillance ..................................................... 112
Levels of chronic condition surveillance ............................................................................... 112
Emerging competitors – Medical tourism ............................................................................ 115
Medical tourism proponents .............................................................................................. 117
Emerging business models – Retail clinics ........................................................................... 120
Retail clinic analytics ......................................................................................................... 121
Part Three – The journey
Chapter 12: Selling the concept of BI in your organization ............................................. 127
The importance of executive sponsorship ............................................................................ 127
Timing is key .................................................................................................................... 127
Essential elements in selling the BI concept ......................................................................... 128
Essential roles in selling the BI concept ............................................................................... 130
The basic selling process ................................................................................................... 132
Chapter 13: Business intelligence project roadmap ........................................................ 133
Business intelligence assessment ........................................................................................ 133
Planning stage .................................................................................................................. 135
Requirements gathering stage ............................................................................................ 135
Design stage .................................................................................................................... 137
Development/construction/build stage ................................................................................ 137
Testing and data validation stage ....................................................................................... 138
Implementation stage ........................................................................................................ 138
Training stage ................................................................................................................... 139
Warranty support stage ..................................................................................................... 139
Business intelligence application marketing ......................................................................... 139
Chapter 14: Growing the organization's BI capabilities from a business perspective ........ 141
Marketing the BI application .............................................................................................. 141
Developing a sustainable strategic plan .............................................................................. 144
A vision for the BI capability as a whole and the impact on the organization ......................... 146
Vision .............................................................................................................................. 147
Ears ................................................................................................................................. 148
Relentless service experimentation ...................................................................................... 148
Comprehensive event-response planning ............................................................................ 148
Many levels of BI .............................................................................................................. 148
Conclusions ..................................................................................................................... 149
Part Four: Case studies
Case study 1: Advocate Health Care, Oakbrook, Illinois ................................................. 153
Enterprise-wide balanced scorecard ................................................................................... 153
Marrying organizational objectives and goals with technology .............................................. 153
Case study 2: Denver Health, Denver, Colorado ............................................................. 155
Integration boosts continuity of care ................................................................................... 155
Data warehouse evolution ................................................................................................. 155
Electronic quality scorecard project .................................................................................... 155
Overcoming challenges ..................................................................................................... 156
More efficient and customized patient care ......................................................................... 157
Case study 3: Good Hope Hospital, Birmingham, United Kingdom ................................ 159
Using BI and analytics to improve service delivery ............................................................... 159
Financial challenges .......................................................................................................... 160
Computer simulations are key ............................................................................................ 160
Case study 4: Scott & White Healthcare, Department of Surgery, Temple, Texas .............. 161
Developing a customized dashboard tool ........................................................................... 161
Successful problem-solving during the piloting stage ........................................................... 161
Case study 5: Upstate Neurology Consultants, Albany, New York ................................... 163
Centralizing data with BI to boost efficiency ........................................................................ 163
Case study 6: United States Air Force ............................................................................. 165
The advantages of a single electronic health record ............................................................ 165
A fresh approach to data analysis ...................................................................................... 166
Case study 7: Wisconsin Collaborative for Healthcare Quality, Wisconsin ....................... 167
United approach improves performance measures .............................................................. 167
Improving data collection .................................................................................................. 167
Overcoming challenges ..................................................................................................... 168
VI
Contents
Business Intelligence and Analytics for Healthcare Organizations
VII
Case study 8: Advocate Health Care, Oakbrook, Illinios ................................................. 169
A physician report card supports clinical integration ............................................................ 169
Steps to develop a customized report card .......................................................................... 170
Further reading .............................................................................................................. 171
Index ............................................................................................................................. 173
IX
The healthcare industry’s new world
Every year hundreds of people find
themselves lost in the wilderness while
working, playing, hiking, hunting, camping
or travelling. These people suffer greatly
from cold, thirst, hunger, exhaustion and
fear. They find that the rules are different in
the wild than in civilization, the challenges
are greater, everyday tasks are harder and
the threats are scarier. Some perish.
Despite this, the resources they need
exist in abundance and are actually readily
available. The problem is that most people
simply do not recognize these resources as
the shelter, water, food, medicines, tools and
weapons they need. Furthermore, they do
not recognize their own internal strengths
– the skills, knowledge and resourcefulness
they could use to protect themselves, to
survive and even to rescue themselves.
Healthcare provider organizations today
find they are entering a new wilderness of
their own with new rules, pressures, threats
and new opportunities. Patients, payers
and purchasers of healthcare services have
become more demanding and more critical.
Volume that was thought to be impervious
to recession has plunged. Former partners
and allies have now become competitors
and foes. Care delivery models that have
always been rock solid are now obsolete
and the new models replacing them
are confusing and counter to the ways
hospitals, doctors, medical groups and
ancillary service providers are compensated.
Accountability and transparency are king
and government regulations are crushing.
Budgets are slashed, reimbursement is
deteriorating and revenue or public funding
is depressed. Meanwhile, capital for
growth, change and expansion has all but
dried up and what is available requires
much higher levels of justification and risk
mitigation planning.
Many of these providers worldwide will
suffer greatly. Some will merge to protect
themselves and others will contract; some
will sell out altogether and some will perish.
And yet, these organizations universally
have a tremendous supply of the very
resources they need to adapt, survive,
thrive, rescue themselves and even lead
the changes they are experiencing. But
many simply do not recognize their existing
resources including people, processes
and technologies, as well as the analytical
mindset, knowledge and resourcefulness
needed to succeed.
One key difference between the winners
and losers is their propensity for analysis
and for using their analytical capabilities
to improve clinical quality, operational
efficiency and financial strength. The
differentiator is how they use the data they
already own to become smarter, stronger
and faster, being business intelligence (BI),
analytics and informatics.
This Ark Group report is intended to help
healthcare organizations understand BI and
its benefits from a strategic and business
perspective particular to the healthcare
industry, by providing examples of BI
Executive summary
X
applications for improving clinical, financial
and operational success. And it provides
a roadmap for organizations to follow to
implement and maximise BI. Crucial aspects
covered include:
Achieving executive sponsorship; ?
Nurturing vital conversations between ?
business leaders and IT managers; and
Ensuring the project remains ?
business-driven.
This report is directed at c-level executives
in healthcare provider organizations
including hospitals, medical groups,
clinic organizations, specialty physician
companies, as well as public health and
government-based healthcare enterprises.
Health information exchanges, quality
standards organizations, payers, public
health organizations, healthcare purchasing
groups and patient advocacy groups will
also find insight and practical advice for
guiding their analytical efforts.
This report is based on over 260
interviews with doctors, nurses, executives,
informaticists, project managers, analysts
and policy-makers across a wide spectrum
of healthcare providers of varying
sizes, shapes and stages of analytical
development. Also, the authors each
bring over 30 years‘ experience and have
combined backgrounds in nursing, clinical
operations and practice management,
front-line clinical experience, public health,
primary care management, financial
management, technology development,
process improvement facilitation; and of
course, BI, data warehouse, informatics and
analytics development.
This report is presented in four sections:
Part One – Bridging the gap between ?
healthcare informatics and BI;
Part Two – Implementing BI and ?
analytics for clinical, financial and
operational success;
Part Three – The journey; and ?
Part Four – Case studies. ?
In-depth and informative case studies include:
Upstate Neurology Consultants, Albany, ?
New York – Specialty physician practice;
Wisconsin Collaborative for Healthcare ?
Quality, Madison, Wisconsin – A voluntary
consortium of 27 healthcare organizations;
Advocate Health Care, Oakbrook, ?
Illinois – Integrated health care system;
Good Hope Hospital, Birmingham, ?
UK – Member of the National Health
Service (NHS);
Scott & White Healthcare, Temple, ?
Texas – Integrated health system;
Denver Health, Denver, Colorado – ?
A safety net institution that integrates
acute hospital and emergency care
with public and community health
services; and
United States Air Force Medical ?
Operations Agency, San Antonio, Texas
– Supports healthcare operations for 75
medical treatment facilities.
Part One bridges the gap between
healthcare informatics and BI. Informatics is
familiar to most healthcare providers,
but is seen as a specialized discipline
practiced by only a few in the organization.
Business intelligence is unfamiliar to most of
these same providers. This section describes
both and is intended to show decision-
makers that their organization already has
analytical resources and methods at its
disposal and explains how to supercharge
them using BI, data warehousing and
analytics methodologies. Concept and topics
addressed in Part One include:
Executive summary
Business Intelligence and Analytics for Healthcare Organizations
XI
Chapter 1 – Challenges facing the ?
healthcare industry describes major
trends such as increased demand,
resource shortages, compliance
requirements, financial pressures and
vertical and horizontal integration;
Chapter 2 – Key decisions in healthcare ?
organizations cover initiatives to increase
revenue and reimbursement, improve
care, streamline operations, reduce
waste and cost, ensure quality and
safety and integrate systems, processes
and information;
Chapter 3 – Business intelligence ?
and data warehousing steps outside
healthcare to look at how other industries
are using BI and data warehousing for
business success, including insurance,
retail, manufacturing, utilities and the
public sector;
Chapter 4 – Healthcare informatics ?
brings us back to the roots of analytical
information usage in healthcare and shows
how the field has grown and matured;
Chapter 5 – The common denominator ?
– analytical questions emphasizes the
most important component of either BI
or informatics capabilities, which is the
analytical question and how healthcare
organizations can use informatics to
adopt BI;
Chapter 6 – Business intelligence ?
architecture describes the industry-
standard architecture for developing BI
and data warehousing, in order to set
the stage for subsequent chapters on
specific applications; and
Chapter 7 – Decision-makers in ?
healthcare organizations walk down
the executive halls to see what types of
analytical questions are important to
chief medical officers, chief financial
officers, chief operating officers and
many more.
Part Two offers 20 key types of BI
applications that are being implemented
and used by healthcare provider
organizations to achieve clinical,
operational, financial and enterprise-
wide success:
Chapter 8 – Business intelligence ?
applications for clinical success
demonstrates how healthcare
organizations can become smarter
clinically and describes seven
applications such as patient registries,
outcomes analysis, quality program
reporting, patient safety and risk
management analytics, etc;
Chapter 9 – Business intelligence ?
applications for financial success
describes applications used to become
stronger financially, including demand
data slicing, revenue cycle management,
pay for performance (P4P) analytics and
reusable compliance reporting;
Chapter 10 – Business intelligence ?
applications for operational success
offers applications used to become
faster operationally, such as lean
initiative support, service innovation,
predictive analytics and spending story
analysis; and
Chapter 11 – Business intelligence ?
applications for enterprise-wide
success describes applications used
to move from old business models
to new, emerging models such as
cooperatives, medical tourism and retail
clinics; and describes how to improve
the organization through promoting
electronic health records (EHRs), chronic
conditions surveillance and advanced
service line management.
Part Three describes the journey from
introduction of the concept of BI into
XII
your organization, through design,
construction and implementation of the
capabilities and finally, how to grow and
evolve those capabilities:
Chapter 12 – Selling the concept of BI ?
in your organization provides a roadmap
of the process for championing BI in
the healthcare enterprise by discussing
essential concepts, roles and processes
in this selling effort;
Chapter 13 – Business intelligence ?
project roadmap briefly describes
the industry-standard methodology
for developing and implementing a
healthcare BI application; and
Chapter 14 – Growing the organization’s ?
BI capabilities from a business perspective
concludes the report by showing the
reader how to market the application to
the business, how to develop a strategy
for long-term success and a vision for the
BI capability as a whole; and analyzes its
impact on the organization.
This report will give readers a good
understanding of how to use BI, informatics
and analytics capabilities so their
organizations can survive and thrive in the
new healthcare industry ‘wilderness’ that is
emerging. Readers will have a firm grasp of
the concepts, examples, roadmaps as well
as a vision needed to put BI into play to
make their respective organization smarter,
stronger and faster.
Executive summary
XIII
Scott Wanless
Scott Wanless is the healthcare business intelligence practice lead for Resource Management
Professionals (www.yourrmp.com) and an industry researcher, consultant and business analyst
in the healthcare business intelligence field. He has more than 30 years’ experience in business
intelligence strategic planning, informatics and analytics development, financial management,
economic development and process improvement. His vast industry experience spans healthcare
providers, hospitals, long-term care, primary care and specialty physician practices, healthcare
payers, laboratory research, retail pharmacy and optical, insurance, financial services, banking,
manufacturing; and state and local governments. Scott can be reached at [email protected].
Thomas A. Ludwig, RN, MBA, FACMPE
Tom Ludwig is president and CEO of Forward Healthcare Solutions, LLC, a consulting firm that
specializes in working with physician practices (www.forwardhealthcaresolutions.com). Having worked
in the medical environment for 35 years, Tom started his career as a Navy Corpsman and also
worked as a medical assistant and as a staff nurse. His 20-plus years’ experience as an administrator
have been in roles from front-line manager to program director to chief operations officer. He is a
member of the Medical Group Management Association and the American College of Medical
Practice Executives (ACMPE) and currently serves on the ACMPE Board of Directors. Tom is a
Board certified medical practice executive and a fellow in the American College of Medical
Practice Executives. Tom can be reached at [email protected].
About the authors
XV
Acknowledgements
Scott Wanless
Many thanks to the hundreds of people who provided expertise and thought on the future of a better
healthcare world through business intelligence and analytics; and for demonstrating the courage to
act today to bring this future about.
Specific thanks to the many people who have helped to get this message out over the years,
including Evie Serventi of the Ark Group, Ron Powell, Jean Schauer and Mary Jo Nott of the
BeyeNetwork; and Satish Kavirajan of The Center for Business Innovation.
Additional thanks to my parents for teaching me at a young age to think analytically and apply
this thinking to real-world situations. And of course, special thanks to my wife Laura and my sons
Erik, Andy and Ethan for their help to turn this project into a mission.
Tom Ludwig
I would like to thank my friends at the Wisconsin Primary Health Care Association, as well as my
FQHC colleagues for pushing me to learn more about this topic. I would also like to thank the
individuals who contributed to the case studies, for you and your organizations are leading the way.
Last of all, special thanks go to my wife Lisa and my sons Frederic and Evan for their
encouragement and support.
doc_105028038.pdf