By Alan M. Eisman

A White Paper

A Prescription for HealthcareOptimize Performance and Quality – Now

Executive Summary

Driving Success in Healthcare

Optimizing Performance With Business Intelligence Technology

The Democratization of Information

[Sidebar] Case Study

Getting Everyone on the Same Page

Obstacles to Success

Putting Electronic Records in Perspective

[Sidebar] Electronic Records Defined

Sizing Up the Cost of EMR/EHR Initiatives

Introducing the Performance Management Framework for Healthcare

A Fresh Take on Performance Management

[Sidebar] A Balanced Approach to Performance

Healthcare Success Stories

NYU Medical Center – Reducing Labor Costs

Clarian Health System – Reducing Denials and Improving Cash Flow

Jefferson Regional Medical Center – Improving Quality

A Large Teaching and Research Hospital – Increasing Revenue

Plexus Medical Group – Improving Care

Select Medical Corporation – Reducing HIS Integration Costs

Central and NW London National Health Service Foundation Trust

Information Builders Solutions for Healthcare

Integrated Health Intelligence – Pre-Packaged Modular Components

Industry Innovations

Think Big, Implement Small

Conclusion

Table of Contents

3

4

6

6

9

10

14

15

15

15

15

16

16

16

17

18

18

1

3

8

9

17

11

13

15

19

Information Builders1

Executive Summary

Every day there is a major news story on the state of healthcare. According to a Centers for Medicare and Medicaid Services (CMS) report, U.S. spending for healthcare is expected to reach $2.5 trillion in 2009, a 17.6 percent share of the economy.1 While the economic downturn has boosted spending in public health programs such as Medicaid, spending in private health insurance has slowed, the agency said. The report also predicted a steady rise in healthcare’s share of the economy through 2018. Healthcare is also a centerpiece of the Obama administration’s plans. Both parties agree that major improvements are needed even though approaches to reform vary. In The World Health Organization’s (WHO) last ranking of the world’s health systems, the United States ranked 37th – just behind Cost Rica and just ahead of Slovenia and Cuba – even though the U.S. has the best medical schools and some of the most advanced medical technology.2

The chart below reveals that healthcare in the United States costs twice as much as in other advanced countries, yet U.S. healthcare is ranked lowest in its peer group across most measures, including quality, access, and efficiency.

The Obama administration is counting on IT technology for healthcare to help turn this situation around. The 2009 federal budget and stimulus plan provides incentives and funding for Electronic Medical Record (EMR) and Electronic Health Record (EHR) initiatives. EMR is an essential ingredient to increasing data quality, streamlining business processes, and providing information access within the enterprise while EHR extends these essential assets by making electronic health information interoperable between health enterprises via standards like HL7.

1 Yahoo/Reuters, February 24, 2009.2 “Country Rankings on Overall Health System Performance,” The Commonwealth Fund, 2007.

Country Rankings

Overall Ranking (2007)

Quality Care

Right Care

Safe Care

Coordiated Care

Patient-Centered Care

Access

Efficiency

Equity

Healthy Lives

Health Expenditures per Capita 2004

3.5

4

5

4

3

3

3

4

2

1

$2,876*

5

6

6

5

6

6

5

5

5

3

$3,165

2

2.5

3

1

4

2

1

3

4

2

$3,005*

3.5

2.5

4

3

2

1

2

2

3

4.5

$2,083

1

1

2

2

1

4

4

1

1

4.5

$2,546

6

5

1

6

5

5

6

6

6

6

$6,102

Australia

Canada

Germany

New Zealand

United Kingdom

United States

*2003 data

Source: Calculated by The Commonwealth Fund based on The Commonwealth Fund 2004 International Health Policy Survey. The Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, The 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, and The Commonwealth Fund Commission on a High Performance Health System National Scorecard.

1.00 – 2.66 2.67– 4.33 4.34– 6.00

A Prescription for Healthcare2

Beyond these important EMR/EHR initiatives, are there other IT projects that can help healthcare providers maximize quality and minimize costs? In its work with many healthcare customers, Information Builders has demonstrated that there are many complementary IT initiatives that can deliver rapid return on investment (ROI). Chief among them is business intelligence (BI), a type of software that supports strategic and operational decisions even as you implement EMR.

According to a McKinsey study, “U.S. Hospitals must learn to compete on value to cope with new competitive threats and greater transparency about quality, service, and prices. For most, this effort will require nothing less than a total transformation.”3

Performance and quality are critical to the success and in some cases the very survival of healthcare organizations. In this paper we will explain how BI and performance management (PM) technology, enabled by comprehensive integration technology, hold the keys to achieving these successes.

3 “Healthcare Transforming U.S. Hospitals,” McKinsey Quarterly, June 2007.

Information Builders3

There are four primary drivers of success in any healthcare organization:

Financial strength■■

Clinical effectiveness, safety, and quality■■

Operational effectiveness and efficiency ■■

Growth ■■

Let’s look at these drivers in turn. Managing financial performance involves monitoring dozens of operational variables. Tracking these variables in conjunction with the revenue cycle is important to ensure accountability, manage costs, and remain viable. In a tough economy it is critical to manage costs relative to budget and accountability in a highly granular way.

Running an efficient and effective operation is paramount to achieving high levels of patient satisfaction, ensuring service quality, and optimizing utilization of resources (beds, medical technology, labs, staff, OR, ER etc.).

Achieving high quality as measured by clinical outcomes and patient safety is fundamental to the mission of healthcare. Clinical outcomes are increasingly being measured and monitored not only by the government, but also by payers and the public through Web sites like Hospital Compare (www.hospitalcompare.hhs.gov). Pay-for-performance (P4P) programs are expanding and P4P is no longer a buzzword. There are now substantial opportunities to earn bonuses and avoid penalties. This area, which originally encompassed only a handful of Physician Quality Reporting Initiative (PQRI) measures, has expanded to 153 measures in 2009. The measures cover many clinical categories with particular emphasis on chronic illnesses such as diabetes, cancer, and asthma. While this will create tremendous incentive to focus on areas with real potential for improvement, the data collection, accountability, reporting, and analysis requirements are daunting.

Growth is imperative because to be competitive in the various service areas a provider must achieve a certain critical mass. Reaching the right volume enables healthcare institutions to accrue the benefits of the experience curve and be viewed as credible. Certain volumes are also required to spread the cost of modern facilities and cutting-edge medical technology. Growth is both a cause and effect of a sound strategy, financial strength, patient satisfaction, and a reputation for clinical excellence based on quality ratings.

Healthcare organizations need a way to bridge the gap between the promise of EMR and the eventual reality. The solution is to use relatively inexpensive, best-of-breed technologies that leverage existing information assets and can simply plug in to a hospital’s existing infrastructure to provide an extensible data model for organizing clinical data and formulating, managing, and reporting on the growing list of essential metrics. Not only does this approach ensure the lowest cost and shortest time to value, it also future proofs these investments. The business imperatives of these initiatives are as follows:

Managing performance at all levels: service lines, departments, physicians, employees ■■

Improving patient safety and clinical outcomes■■

Maximizing operations: facilities, technology, and patient satisfaction■■

Driving Success in Healthcare

A Prescription for Healthcare4

Reducing costs: labor, supplies, and revenue cycle■■

Driving growth with new revenue opportunities■■

Optimizing Performance With Business Intelligence TechnologyTo maximize hospital performance, business intelligence solutions must be available across the organization from both a strategic and an operational perspective. Objectives and initiatives should be described in cause-and-effect chains called strategy maps and then cascaded throughout the organization so each participant understands how they will be measured and how their contributions relate to overall goals.

Once this architecture is in place, personalized dashboards can be created that alert workers to trends and problems as they occur. These users can drill down to uncover the root causes of various performance problems. Meanwhile, managers can analyze effectiveness over time to further refine strategies and put initiatives, also known as gap projects, in place that are directed at improving performance. This is called operational performance management and leads to performance improvements due to improved alignment. There is truth in the adage, “What gets measured gets done.”

Operational BI involves extending actionable business information to many different types of employees throughout the enterprise. It improves business performance by providing workers with actionable information so they can make better decisions. The need for this type of pervasive intelligence has become progressively more important. According to a Brookings Institution study, only 15 percent of a typical company’s market value is made up of tangible assets. Historically this number was much higher (it was 62 percent in 1982).4 This is partly because the value in most companies has shifted from the efficient use of tangible assets to the effective and efficient use of human, organization, and information capital. This shift validates the need to embed real-time information into operational processes for front-line workers across the enterprise. Once workers are equipped with this knowledge, they can reduce errors, increase efficiency, improve service, and make more knowledgeable, evidence-based clinical decisions.

The Democratization of InformationAchieving a high-performance healthcare enterprise requires an environment where performance and operational information is shared by everyone who needs it in a transparent manner. Government agencies, insurers, and P4P initiatives require healthcare providers to maintain transparency and accountability. Transparency creates an environment of trust that empowers all stakeholders to collaborate in a proactive way to solve operational problems while constantly striving for more innovative ways to improve performance and achieve value. The old axiom that “knowledge is power” must be revised for the highly interdependent world of healthcare to “knowledge is power only when it is shared.”

4 Lev, Baruch. “Intangibles,” Brookings Institution Press, 2001.

Information Builders5

In his book, How, Dov Seidman quantifies the value of trust through communication by citing the results of a survey by professors Jeffrey H. Dyer of the Marriott School at Brigham Young University and Wujin Chu of the College of Business Administration at Seoul National University.5 “Dyer and Chu surveyed almost 350 buyer/supplier relationships involving eight automakers in the United States, Japan, and South Korea and found a direct and dramatic relationship between trust and transaction costs,” he writes. “The least trusted buyer incurred procurement costs six times higher than the most trusted: same parts, same sorts of transactions. These additional costs came from added resources that went into the selection, negotiation, and compliance costs of executing deals. Dyer and Chu point to Nobel Prize-winning economist Douglas C. North’s findings that these sorts of transaction costs account for more than a third of all business activity and that the least-trusted companies were the least profitable.”

Better alignment and sharing of goals – bolstered by the availability of relevant information – enables stakeholders to work together to close the gap between strategy and operations. Once you provide everyone with performance management and operational BI, you can achieve this type of strategic business intelligence. Then, everyone in the organization can make decisions that align with corporate strategies and goals.

A properly configured performance management framework provides a secure, role-based environment for managing metrics, defining strategies, and creating scorecards. When deployed to managers and stakeholders throughout the organization, this type of technology helps managers align business goals with operational processes. The graphic below depicts how tight integration of BI and PM functions can improve decision-making and positively impact performance.

s

5 Seidmen, Dov, “How: Why How We Do Anything Means Everything . . . in Business (and in Life),” John Wiley and Sons, 2007.

s

s

s

s

s

s

s

How Business Intelligence Should Work

A Prescription for Healthcare6

Of course, when it comes to making information useful and actionable, different users have different needs. For example executives and administrators need scorecards and dashboards with key performance metrics so they can make data-driven decisions to identify underperforming areas, spot trends, and justify changes in budget, staffing levels, and resource utilization. Managers need to monitor emergency department and operating room activity to make schedule and staffing adjustments when there are delays or spikes in demand. Analysts need to slice-and-dice information across systems for efficient planning and forecasting. They can mine this data for hidden relationships that yield insight through visual correlation and then use predictive analysis to identify unanticipated problems and opportunities.. Doctors, nurses, and support staff need self-service dashboards that provide clinical information at the point of care.

Case StudyPoudre Valley Healthcare (PVHC) offers a great example of how a healthcare provider can leverage the power of information. In 2008 PVHC was recognized as a 2008 InformationWeek top IT innovator, the winner of the 2008 Ventana BI Excellence Award, and recently named one of only three 2008 Malcolm Baldridge Award winners.

PVHC began implementing Information Builders’ BI technology in 2008.

Getting Everyone on the Same PageGetting various stakeholders with different perspectives to act in harmony to support the broad goals and strategies of the organization is a continual challenge. As we’ve seen, a performance management framework helps foster a culture of accountability in which each stakeholder has accurate information to support the organization’s goals in every department. But driving success has less to do with technology than it does with implementing the goals, initiatives, and cultural changes to support each organization’s strategy. Healthcare providers need an information framework to support the right measurements, incentives, and processes for each stakeholder based on their roles and areas of accountability.

EMR/EHR initiatives have tremendous potential, but you can only reach that potential in increments. Often these initiatives are executed one department and one process at a time as part of a cohesive, overall plan. In most cases, short-term projects with incremental goals yield the greatest benefits.

“We have spent years implementing clinical and financial systems to

process data, but we missed the boat in one key area: transitioning

information into knowledge, and then using that knowledge to

instigate positive change.”

-Russ Branzell, CIO of PVHC

Information Builders7

But how do you know if you are on the right path? Are you sure everyone understands their roles in these initiatives? Healthcare providers have very complex organizations, which means enterprise goals and strategies must be applied to many interdependent areas such us physical units (nursing, OR, ED), ancillary functions (radiology, labs, and pharmacy), service lines (cardiology, orthopedics, and neurology) and administrative functions (admitting and patient accounting).

Healthcare providers are organizationally complex and so are their IT infrastructures, which often include dozens of disparate systems. BI applications must draw from these systems to enable organizational decision-making. For example the revenue cycle relies on ADT, insurance contract information, accurate HIM coding, charge capture from multiple clinical systems, and other data.

Information Sharing for Healthcare Enterprise Integration and Business Intelligence

A Prescription for Healthcare8

News Flash: IT Applications Lack Decision Support According to the National Research Council, even healthcare IT leaders fall short in providing decision support and problem-solving capabilities.6 Clinical systems lack decision support. Data is primarily used to comply with regulations and defend against lawsuits, rather than improve care. Valuable time and energy is spent managing data instead of understanding patient needs.

One challenge facing healthcare providers and executives is selecting key performance indicators (KPIs) that support strategic priorities. Without implementing a comprehensive framework for managing performance there is no real way of incorporating operational effectiveness and efficiency into an institution’s overall goals. Developing key performance indicators and regularly monitoring progress is vital to an organization’s continued health. KPIs give a competitive edge to institutions by allowing them to monitor effectiveness across the continuum of care. Implementing a robust, reliable solution to track real-time measures yields concise and efficient management, which are the building blocks for performance improvement, revenue return, and quality control.

According to industry studies, the typical enterprise only uses 20 percent of its data and only provides business intelligence capabilities to 20 percent of its employees. Deluged with data and saddled with disconnected, closed systems, healthcare organizations are even further behind. In this setting it can be a life-and-death problem: most healthcare employees are knowledge workers, so having accurate, actionable information is extremely important. It’s also a business problem: even small improvements in labor productivity, clinical efficiency, insurance denials, supply chain management, and medical technology utilization can result in millions of dollars in annual savings.

What are the ramifications of not providing business users with actionable information? Another preventable medical error, another missed chance to improve a clinical practice, another unbilled charge, another insurance denial, another unhappy patient, another physician lost – the list is endless.

The time is ripe for change. Massive government initiatives based on the federal stimulus plan all position healthcare information technology as the key to improving quality and reducing costs.

Obstacles to Success

6 Goedert, Joseph, “Applications Lack Decision Support,” Health Data Management, March 1, 2009.

Information Builders9

EMR and EHR are hugely important to today’s healthcare industry. Electronic records solve two classes of problems. The first class involves streamlining business processes through better-integrated information systems. These solutions reduce costs by eliminating manual processes and fall into two general categories:

1. Solutions to automate business processes within an organization. This class is commonly referred to as Business Process Automation (BPA) and provides the following types of benefits:

Delivering real-time lab results■■

Reducing administrative costs■■

Reducing errors■■

Streamlining healthcare operations■■

2. Solutions that automate processes between organizations. This class is commonly referred to as Business-to-Business (B2B) and provides the following types of benefits:

Cash flow with payers■■

Supply chain efficiency ■■

Health agency communications■■

Information sharing among provider organizations■■

BI technology addresses a second class of opportunities by providing tools to improve decision-making. Here the role of EMR/EHR is less direct and the benefits are more difficult to measure. While the promise of electronic records is to allow for better quality information with easier access, the information is only organized by individual patient encounters and episodes. To further leverage the value from these records, patient data needs to be aggregated and combined with other clinical, financial, and administrative information. Then dashboards can be leveraged for powerful insight into reducing costs, increasing efficiency, and improving quality.

Electronic Records DefinedThe National Alliance for Health Information Technology (NAHIT) has produced the following definitions for EMR and EHR:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization that is involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one healthcare organization and is managed and consulted by licensed clinicians and staff involved in the individual’s healthcare.

Putting Electronic Records in Perspective

A Prescription for Healthcare10

Sizing Up the Cost of EMR/EHR InitiativesMost EMR/EHR efforts represent massive undertakings. The biggest challenges are not even technical or financial even though some projects are being delayed in 2009 due to severe drops in revenue and available capital. The bigger challenges are cultural and legal, stemming from the competing interests of patients, hospitals, doctors, and payers. Compelling benefits and massive federal programs and incentives will help move these projects forward but the effort will suffer many fits and starts. It may be years before providers see a return on these massive projects.

A good comparison is the adoption and evolution of enterprise resource planning (ERP) systems in commercial enterprises, which rivaled EMR/EHR in hype, high cost, and long lead times. ERP systems also replaced disconnected systems with tightly integrated applications to streamline business processes and provide higher real-time quality information. But ERP implementations often struggled with huge time and cost overruns. Much of the potential has yet to be realized even in manufacturing where best practices from efforts like Six Sigma, TQM, and Lean have matured over 50 years. This has been largely due to weak decision support and relatively closed architectures for inter-company process integration. In the world of healthcare, where there are fewer best practices and many entrenched special interests, reaching consensus and moving forward may prove much more difficult.

Yet healthcare organizations must address these challenges if they are to survive and prosper. Improving quality and patient outcomes, reducing costs, and increasing revenue opportunities are essential, and these issues must be addressed now. While electronic medical records may eventually deliver tangible returns, waiting for the promised benefits is like waiting for a brain surgeon to arrive to treat a serious head injury.

Information Builders11

The Information Builders Performance Management Framework for Healthcare (PMF) is a complete off-the-shelf solution for the healthcare industry. It makes strategic management goals a reality through real-time information sharing, collaboration, alerts, and analysis.

PMF for Healthcare provides a secure role-based end-user environment for managing metrics, defining strategies, and creating scorecards for various operating groups throughout the healthcare enterprise. The solution’s templates provide high-level strategy maps tied to quality of care and profitability. It includes operational scorecards – such as revenue cycle and predefined healthcare-specific metrics – including length of stay, HIM-coding quality, readmits, and insurance denials.

With PMF for Healthcare, business users can access, analyze, and drill through reports to a wealth of information to uncover root-cause issues and identify targeted improvement initiatives. Business strategies can be measured and tracked and owners can be automatically linked to their business objectives. This proven solution allows senior managers to create goals, strategies, and initiatives and then align and communicate these objectives to other workers throughout the organization. The framework extends hundreds of scorecards based on an integrated set of strategies and a packaged data model. This approach ensures that there is one trusted and auditable source for the underlying measures and associated business rules:

Hospital and system-wide scorecards■■

Departmental scorecards (nursing units, OR, and ED)■■

Service-line scorecards■■

Ancillary service scorecards■■

Physician scorecards■■

X-Functional scorecards (revenue cycle and quality)■■

PMF for Healthcare is built on a mature data integration framework from iWay Software, an Information Builders division. iWay can access more than 300 information assets including databases, applications, documents (HIPAA, HL7, PHIN, LOINC, etc.), and source measures. These KPIs, along with each provider’s dimensional structure, are loaded into PMF to optimize system performance and maintain historical data for trending and predictive analysis. This comprehensive data set allows providers to track progress and analyze information by different dimensions (service line, department, etc.). Measures such as Press Gainey scores are input directly into the framework. Additionally, benchmark data as well as plans from budgeting applications can be imported from CMS, JCAHO, Medicaid P4P, and other systems for comparative analysis.

Unlike most scorecard products, which were developed independent of the underlying BI technology, PMF for Healthcare was built hand in hand with WebFOCUS, one of the world’s leading BI platforms. The result is a well-integrated performance management platform that is useful to all stakeholders, including executives, managers, clinicians, and partners.

For example, strategy maps describe how organizational objectives can be achieved by organizing goals and metrics into cause-and-effect relationships, relating improvement initiatives to goals, and cascading scorecards and goals throughout the organization.

Introducing the Performance Management Framework for Healthcare

A Prescription for Healthcare12

Most managers understand the value of formalizing the performance management process but they are stymied by manual, spreadsheet-driven processes and data that is not truly integrated, trusted, or auditable. These approaches make it difficult to synchronize strategies, goals, and initiatives – let alone to promote new behaviors that lead to improved performance.

This screen capture shows a typical hospital level strategy map with the overall hospital mission (strategic theme) described and objectives arranged in cause and effect relationships across four user-defined perspectives: growth, quality, operations, and finance. By dragging and dropping goals related to pre-defined measures and organizational owners onto the palate, business users can create any number of strategy maps.

Information Builders13

Information Builders’ healthcare solutions go beyond earlier performance management initiatives, which only manage performance retrospectively. This rearview mirror approach is primarily focused on financial measures or lagging indicators of performance. Leading indicators of performance need to be managed by looking ahead through dashboards at operational, quality, and service-oriented measures that ultimately improve financial performance and growth. Information Builders supplies scorecards for key operational functions in conjunction with a data model that supplies over one hundred and fifty healthcare metrics, presented through dozens of function-specific dashboards and reporting templates. This mature, industry-specific BI solution helps each department manage the operational processes that improve performance on a daily basis. This allows each department to make more knowledgeable and timely decisions without losing sight of the broader strategies and goals, as illustrated below.

Even automated performance management applications do not typically integrate with the BI functions required to support operational processes for improved decision-making. This lack of true pervasive PM/BI does not provide context between corporate goals, strategies, and operational decisions. As W. Edwards Deming said, “Measurement without the opportunity to improve is harassment!”7

Most PM products do not integrate analytic functions with dashboards and scorecards. This lack of integration inhibits the natural data discovery process that leads to true insight, which in turn leads to better decisions. PM that is not integrated with mature BI functionality also requires greater administration and does not easily scale beyond a few power users, limiting the potential for better decision-making.

A Fresh Take on Performance Management

Pervasive PM and BI – Because Everyone Makes Decisions

7 Paladino, Bob, “Five Key Principles of Corporate Performance Management,” John Wiley and Sons, 2007.

s

s

s

s

A Prescription for Healthcare14

A Balanced Approach to PerformanceAccording to David Norton, who along with Robert Kaplan first developed the Balanced Scorecard Methodology, nine out of ten firms fail to execute their strategies. This is not due to too few strategies, too few metrics, or too few tools. It is largely due to management’s inability to make the strategies operational by aligning and cascading goals throughout the organization and providing tools to support the operational decision making required to execute strategies.

The Wrong Way (specialized tools and more data silos) creates multiple versions of the truth for various operating units, departments, and service lines. The information used for real-time decisions is disconnected from strategies and there is lots of telephone ad hoc, administrative, and IT support.

The Right Way (pervasive performance management and business intelligence) provides personalized intuitive dashboards and operational decision support in the context of goals and strategies. It enables healthcare organizations to establish a culture of accountability, empowerment, and collaboration. The optimal use of information to support decisions actually becomes the new operational process, appropriately supporting the goals and priorities. As a result, the strategy gap is eliminated.

Information Builders15

The following are examples of healthcare organizations that have implemented Information Builders’ BI and PM solutions in two to six months and typically achieved a 500 percent ROI within one year. These implementations leveraged existing systems, databases, and applications.

NYU Medical Center – Reducing Labor CostsNYU streamlined and consolidated measurement and reporting into a central area to manage performance of the entire organization. Typically labor represents as much as 50 percent of a hospital’s total costs. One NYU BI project involved deploying a Labor Productivity Management System using WebFOCUS to deliver fast, easy access to high-quality data based on Relative Value Units (which compute time, effort, and technical skills). NYU formerly used Microsoft Excel reports for this purpose but they did not provide the detail or data integrity needed for department managers to make staffing adjustments related to skill mix, vacation schedules, and overtime. This application helped NYU reduce the FTE/AOB (Available Occupied Beds) ratio from 5.95 to 5.75, a 3.4 percent improvement.

Clarian Health System – Reducing Denials and Improving Cash FlowClarian Health, the largest healthcare provider in the Midwest, is consistently cited as one of the top healthcare organizations in the U.S. This organization standardized on iWay for B2B and application integration projects based on an expected $10 million ROI from improving cash flow and reducing denials. The Clarian Revenue Cycle Services division uses iWay’s HIPAA solution to automatically request information on claims past a certain date and process the information they receive back. That reduces phone calls and administration costs, avoids manual entry of individual queries, improves business agility, and eliminates inefficiencies. David Burton, executive director of IT for Clarian Revenue Cycle, said, “The first project was completed four weeks early and under budget. The second project had 80 percent reusability from the first project, which is key. It gives us a great ROI with the speed and security of knowing it works.”

Jefferson Regional Medical Center – Improving QualityJefferson generates reports for standard quality measures and compares the results to industry benchmarks including JCAHO, CMS Hospital Compare, Medicaid P4P, Premier, and State. Improving quality is particularly challenging at JRMC and other “Safety Net Hospitals” with a high percentage of low-income patients, many without private insurance. WebFOCUS provides timely and accurate data and feedback to users to boost accountability, improve clinical outcomes, and reduce medical errors. Jefferson has improved quality substantially to achieve annual awards from the State of Arkansas of approximately $350,000.

A Large Teaching and Research Hospital – Increasing RevenueUsing WebFOCUS, a large teaching and research hospital discovered it had undercharged patients and payers by $4.5 million. WebFOCUS allowed them to pull data from multiple sources, conduct payment variance queries, and look for outliers. Last year, the hospital recovered $2.5 million in

Healthcare Success Stories

A Prescription for Healthcare16

revenue from insurers who underpaid patient bills. “In addition to using WebFOCUS to identify underpayments, we also use it across the hospital for departmental reporting,” said the hospital’s director of DSS. “We wanted a system that allowed non-technical users to access and bring data to meetings without needing the IT department to pull the reports. WebFOCUS made this possible by allowing users to easily create drill-down reports containing visual analytics and color coding, and push key information out to other users via commonly used formats such as Excel.”

Plexus Medical Group – Improving CareNetherlands-based Plexus used WebFOCUS to create a nationwide system that delivers information about costs, reimbursements, treatment success rates, and many other key performance indicators. The BI-as-a-service solution, called Pi, helps providers analyze the quality and efficiency of their primary processes and then compares these results to national benchmarks. Hospitals using Pi have reduced costs up to 10 percent of annual budgets, thanks to insight derived from the system. “All healthcare organizations strive to provide high-quality care for an equitable price. But how do these organizations know if they are achieving this goal without precise measures,” asked Erik-Jan Vlieger, senior consultant at Plexus Medical Group. “We’re using BI to give administrators and physicians a level of visibility into their facilities and processes that was formerly difficult to achieve, to improve the quality and value of their services.”

Select Medical Corporation – Reducing HIS Integration CostsSelect Medical Corporation is a leading provider of specialty healthcare. It operates more than 100 long-term acute care facilities and approximately 1,100 outpatient rehabilitation clinics. The challenge was to integrate accounting transactions from ancillary systems into the existing Select Medical Infrastructure. Select deployed iWay as part of a service-oriented architecture (SOA) to integrate accounting transactions with many types of clinical information systems at multiple facilities. This approach turned out to be far less costly than the point-to-point integration solution required by a proprietary HMS system vendor. Now Select is able to quickly and cost effectively integrate its information systems as they expand and change.

Central and NW London National Health Service Foundation Trust (CNWL)CNWL manages more than 100 healthcare sites across nine boroughs in London. They needed to measure performance and make process improvements to improve patient care. CNWL’s WebFOCUS- and iWay-based solution gathers key performance information in real time from disparate sources – gathering details from multiple organizations, including Primary Care Trusts, the Department of Health, and patients themselves – to give NHS Foundation Trust managers and 3,400 staff a holistic view of its performance. This includes the ability to access, drill down, and analyze data relating to specific areas of the Trust. The solution will automatically measure data against all key targets to enable process improvements both at an operational and strategic level.

Information Builders17

PMF for Healthcare provides easy cause-and-effect analysis with drill downs to any level within its rich dimensional architecture, such as reviewing clinical service lines all the way down to DRG or physician, which may be adapted specifically to organizational hierarchies. Through secure, role-based access to real-time data, PMF for Healthcare provides the necessary alignment between business goals and operational processes. Built on Information Builders WebFOCUS enterprise business intelligence suite, PMF for Healthcare’s metrics and reports are easily customizable.

In addition, WebFOCUS provides a reusable architecture for ad hoc and parameterized reporting that meets every user’s needs by offering clinicians, physicians, nurses, business analysts, managers, and executives the ability to create, run, save, and schedule their own reports through a Web-based interface. With adapters from iWay Software, PMF for Healthcare can access all of an institution’s data sources – both clinical and financial – from disparate systems in either real time or from staged data in cubes, data marts, or warehouses.

Integrated Health Intelligence – Pre-Packaged Modular ComponentsThe Integrated Health Intelligence family of pre-built components complements PMF for Healthcare with support for strategic, financial, clinical, operations, and external (i.e. CMS, JC, and Health Department) reporting. These components are modular and can be plugged into an existing IT infrastructure. With predefined scorecards, reports, and data models, customers can rapidly deploy the solution incrementally on a departmental basis or across an entire health system to thousands of users.

Information Builders Solutions for Healthcare

A Prescription for Healthcare18

Industry Innovations Information Builders has pioneered many new technologies, such as WebFOCUS Magnify, the first combination BI/search product to index enterprise information from any source system in the same way that Google indexes public information. Search results are presented in a convenient index so users can drill directly to desired information.

In this example a clinician is researching burns related to skin cancer to understand what treatments have been used and the clinical outcomes. iWay accesses the information while respecting security and HIPAA regulations. Once the physician identifies information relevant to her search she can use WebFOCUS Active Reports to analyze the results by age group, clinical outcome, ethnicity, and other variables. Active Reports provide portable analytics to colleagues and partners whether they work in connected or disconnected mode.

Think Big, Implement SmallWhile the ideas and solutions discussed in this paper may seem ambitious, Information Builders advocates smaller projects that can be implemented in less than six months and often in as little as two to three months at an extremely competitive price. These projects complement EMR/EHR plans by integrating relevant, high-quality data. They support process-improvement initiatives that mobilize the organization to leverage EMRs. However it is important to evaluate these projects with an eye towards how they fit in to broader business and IT strategies.

Information Builders has a proven methodology that identifies high ROI initiatives related to streamlining processes and providing better information to business users. Each engagement includes a two- to three-day assessment followed by a solution proposal that outlines the findings, the proposed solution, the expected benefits, and a suggested implementation plan.

Information Builders19

The benefits of digitizing medical information are clear to most stakeholders. What is not clear is how healthcare providers can derive maximum value from these initiatives by leveraging the data in productive and intuitive ways. Providers must continue to manage costs, operate efficiently, and provide quality care. Implementing a BI environment that provides strategic, analytical, and operational information to everyone involved in the continuum of care provides the best opportunity to optimize performance and quality.

Many Information Builders customers see the advantages of partnering with a company that is independent, dedicated to BI innovation, and able to leverage legacy and emerging technologies. Headquartered in New York City, Information Builders has more than 12,000 customers and 350 business partners.

Conclusion

Worldwide Offices

Corporate Headquarters Two Penn Plaza, New York, NY 10121-2898 (212) 736-4433 Fax (212) 967-6406 DN7506147.0509 informationbuilders.com askinfo@informationbuilders.comCanadian Headquarters 150 York St., Suite 1000, Toronto, ON M5H 3S5 (416) 364-2760 Fax (416) 364-6552For International Inquiries +1(212) 736-4433

Copyright © 2009 by Information Builders. All rights reserved. [82] All products and product names mentioned in this publication are trademarks or registered trademarks of their respective companies.

Printed in the U.S.A. on recycled paper

North AmericaUnited States

■■ Atlanta,* GA (770) 395-9913■■ Baltimore, MD Professional Services:

(703) 247-5565

Boston,*■■ MA (781) 224-7660

Channels,■■ (800) 969-4636

Charlotte,■■ NC Professional Services:

(704) 494-2680

Chicago,*■■ IL (630) 971-6700

Cincinnati,*■■ OH (513) 891-2338

Dallas,*■■ TX (972) 490-1300

Denver,*■■ CO (303) 770-4440

Detroit,*■■ MI (248) 641-8820

Federal Systems,*■■ DC (703) 276-9006

Hartford,■■ CT (860) 249-7229

Houston,*■■ TX (713) 952-4800

Los Angeles,*■■ CA (310) 615-0735

Minneapolis,*■■ MN (651) 602-9100

New Jersey*■■ Sales: (973) 593-0022

New York,*■■ NY Sales: (212) 736-7928

Professional Services: (212) 736-4433, ext. 4443

Orlando,*■■ FL (407) 804-8000

Philadelphia,*■■ PA Sales: (610) 940-0790

Phoenix,■■ AZ (480) 346-1095

Pittsburgh,■■ PA Sales: (412) 494-9699

St. Louis,*■■ MO (636) 519-1411

San Jose,*■■ CA (408) 453-7600

Seattle,■■ WA (206) 624-9055

Washington,*■■ DC Sales: (703) 276-9006

Professional Services: (703) 247-5565

CanadaInformation Builders (Canada) Inc.

Montreal*■■ (514) 421-1555

Ottawa■■ (613) 233-0865

Toronto*■■ (416) 364-2760

Vancouver■■ (604) 688-2499

MexicoInformation Builders Mexico

Mexico City■■ 52-55-5062-0660

AustraliaInformation Builders Pty. Ltd.

Melbourne*■■ 61-3-9631-7900

Sydney*■■ 61-2-8223-0600

EuropeBelgium*■■ Information Builders Belgium

Brussels 32-2-7430240

France*■■ Information Builders France S.A.

Paris 33-14-507-6600

Germany■■ Information Builders (Deutschland)

Eschborn* 49-6196-77576-0

Netherlands*■■ Information Builders

(Netherlands) B.V.

Amsterdam 31-20-4563333

Portugal■■ Information Builders Portugal

Lisbon 351-217-217-400

Spain■■ Information Builders Iberica S.A.

Barcelona 34-93-344-32-70

Bilbao 34-94-452-50-15

Madrid* 34-91-710-22-75

Switzerland■■ Information Builders Switzerland AG

Dietlikon 41-44-839-49-49

United Kingdom*■■ Information Builders (UK) Ltd.

London 44-845-658-8484

RepresentativesAustria■■ Raiffeisen Informatik Consulting GmbH

Vienna 43-12-1136-3870

Brazil■■ InfoBuild Brazil Ltda.

São Paulo 55-11-3285-1050

China■■

InfoBuild China, Inc.

Shanghai 86-21-5080-5432

Rongji Software Technology Co., Ltd.

Beijing 86-10-5873-2031

Denmark■■ InfoBuild AB

Kista, SE 46-735-23-34-97

Egypt■■ Al-Hisn Al-Waqi (AHAW)

Riyadh, SA 996-1-4412664

Ethiopia■■ MKTY IT Services Plc

Addis Ababa 251-11-5501933

Finland■■ InfoBuild Oy

Vantaa 358-207-580-840

Greece■■ Applied Science

Athens 30-210-699-8225

Guatemala■■ IDS de Centroamerica

Guatemala City 502-2412-4212

Gulf States■■ Al-Hisn Al-Waqi (AHAW) ■ Bahrain ■ Kuwait ■ Oman ■ Qatar ■ United Arab Emirates ■ Yemen

Riyadh, SA 996-1-4412664

India*■■ InfoBuild India

Chennai 91-44-42177082

Israel■■ SRL Group Ltd.

Tel Aviv 972-3-7662030

Italy■■ NessPRO Italy S.p.A.

Genoa 39-010-64201-224

Milan 39-02-2515181

Turin 39-011-5513-211

Japan■■ K.K. Ashisuto

Osaka 81-6-6373-7113

Tokyo 81-3-5276-5863

Jordan■■ Al-Hisn Al-Waqi (AHAW)

Riyadh, SA 996-1-4412664

Malaysia■■ Elite Software Technology Sdn Bhd

Kuala Lumpur 60-3-21165682

Norway■■ InfoBuild Norway

Oslo 47-48-20-40-30

Philippines■■ Beacon Frontline Solutions, Inc.

Makati City 63-2-750-1972

Poland/Central and Eastern Europe■■ InfoBuild SP.J.

Warsaw 48-22-657-00-14

Russian Federation■■ FOBOS Plus Co., Ltd.

Moscow 7-495-124-0810

Saudi Arabia■■ Al-Hisn Al-Waqi (AHAW)

Riyadh 996-1-4412664

Singapore■■

Automatic Identification Technology Ltd.

Singapore 65-6286-2922

South Africa■■

InfoBuild South Africa (Pty.) Ltd.

Gauteng 27-83-4600800

Fujitsu Services (Pty.) Ltd.

Johannesburg 27-11-2335911

South Korea■■

Unitech Infocom Co. Ltd.

Seoul 82-2-2026-3100

UVANSYS

Seoul 82-2-832-0705

Sweden■■ InfoBuild AB

Kista 46-735-23-34-97

Taiwan■■ Galaxy Software Services

Taipei 886-2-2586-7890

Thailand■■ Datapro Computer Systems Co. Ltd.

Bangkok 662-679-1927, ext. 200

Venezuela■■ InfoServices Consulting

Caracas 58-212-763-1653

Toll-Free NumberSales, ISV, VAR, and SI Partner Information■■

(800) 969-4636

* Training facilities are located at these branches.