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CASE STUDY - Hospital Finds Cure for Information Overload Syndrome

Commentary by Morie Mehyou, Assistant Vice President of IM and Decision Support, Jefferson Regional Medical Center

Today’s hospitals maintain an immense amount of information that must be carefully stored, managed, analyzed, and exchanged. In addition to administrative data on hospital operations, many types of patient information are entered and maintained electronically. Hospitals must streamline the flow of information—both internally and externally—even as they comply with HIPAA requirements and HL7 standards.

Maximizing reimbursements, analyzing payer mixes, tracking admissions trends, and monitoring staff productivity are all functions of having accurate information, delivered to the right place at the right time. That’s why Jefferson Regional Medical Center depends on business intelligence (BI) technology from Information Builders to streamline data management and reporting activities throughout the enterprise.

“The amount of information in your average hospital can be overwhelming,” admits Morie Mehyou, an assistant vice president of IM and decision support at Jefferson Regional Medical Center. “The challenge for clinicians and administrators is to quickly hone in on specific information.”

As the fourth largest hospital in Arkansas, Jefferson Regional serves more than 280,000 residents in 11 counties. Licensed for 471 beds and with an average daily census of about 240 patients, the hospital employs more than 2,000 people and offers a complete range of medical services.

Treating Information Management Ailments

WebFOCUS has become an integral part of the hospital’s management activities, with 75 departments now using the business intelligence software on a daily basis. “Virtually all operational data from every department—from materials management to pharmaceuticals— is now accessible via a self-service reporting environment,” says Mehyou.

An accountant by training, Mehyou is no stranger to the demands for precise, auditable information. Yet before WebFOCUS came on the scene in the late 1990s, he says getting information in a timely fashion was often a hit-and-miss prospect. Most of the hospital information systems offered standard reports, but it was difficult to obtain precisely what each user needed. That meant lots of custom reporting, which dominated the available hours of the IT staff.

About that time, executive vice president Tom Harbuck asked Mehyou to develop an internal reporting system through which his staff could access information on demand— without asking IT pros for assistance. “Our managers wanted a better way to measure productivity by department,” recalls Harbuck. “With WebFOCUS, we accepted that challenge head-on.”

Resident in Training

Mehyou had experience with Information Builders’ FOCUS reporting environment on an AS/400 computer, so learning Web- FOCUS was easy. He began by creating reports for the finance department, including departmental financial statements, income statements, accounts payable reports, balance sheets, and budget reports. He went on to develop revenue, HR, and productivitybenchmarking reports—more than 150 in all, most of which are now accessible via the corporate intranet.

To give users maximum control over this information, Jefferson Regional constructed a parameterized, self-service environment that organizes reports into three primary groups: financial reports for the finance department, productivity reports for department managers, and bed management reports for hospital administrators and a few doctors. Today, this reporting system is an integral part of the hospital’s daily management activities. “We have leveraged WebFOCUS for a huge number of BI projects, such as to monitor physician deficiencies, for corporate education test scoring, and as part of our open chart review process,” Mehyou notes. “WebFOCUS helps us tabulate deficiencies, so physicians always know where they stand. For example, it tells us which patients are missing documentation, for how long, and in what areas. WebFOCUS has enabled us to provide a much more accurate and timely report relating to deficiencies.”

Meanwhile, department managers have learned to use WebFOCUS to generate productivity reports, extending back several years, which are useful for benchmarking and comparisons. “Managers might want to know, for example, how many hours it took to provide care for a certain number of patients, or how many tests they performed during a certain period,” explains Mehyou. “WebFOCUS allows them to summarize this information over any time period. It is a very flexible environment.”

Other reports have been created for diagnosisrelated groups (DRGs)—the three-digit codes that describe patient conditions, from heart attacks to hypertension. Reimbursement rates are often set according to these codes, and hospitals get paid a predefined amount for each DRG. “Sometimes a number of procedures are bundled into one rate, and complicated formulas are used,” Mehyou says. “Our hospital administrators need to make sure each diagnosis is correct, the charges are justified, and that they are billing appropriately to maximize reimbursements.”

Extensive data analysis is performed every month using many FOCUS and WebFOCUS reports. “Everybody wants to see a different slice of the information,” continues Mehyou. “Some people want to see test results. Others are interested in your medical history. Still others need to know the length of your visit, review your bill, or perform statistical analysis. WebFOCUS makes it easy for these users to change parameters so they can obtain the information they need.”

Hospital personnel log into the WebFOCUS environment through a secure Web portal accessible via any Web browser. Once they enter the correct department number, they are presented with a graphical environment that directs them to the information they need. For example, department managers can review statements to make sure they were charged for the correct supplies. Other basic information includes pay reports and productivity reports. “Users can drill down to the details as required, or sort the information by user, pay period, or charge level,” Mehyou says. “Everything is protected by user and role, and the system is fully compliant with HIPAA requirements governing privacy of information.”

IT Vital Signs

To create this user-friendly reporting environment, Jefferson Regional integrated WebFOCUS with a McKesson HBOC clinical information system on an AS/400 computer. WebFOCUS accesses other AS/400 packages, such as Payroll, OR, and related business functions. These packaged applications store data in a DB2/400 relational database, which WebFOCUS can access directly. Other critical information is stored in Microsoft SQL Server data marts. “We like the way WebFOCUS can easily combine two or more types of data into the same report,” says Mehyou. “For example, we might access the AS/400 database to create a summary report for the radiology department, then compare that information to a national benchmark, which is derived from a different kind of database entirely. WebFOCUS combines information on the fly to create a cohesive presentation.”

Eventually, Jefferson Regional would like to build BI dashboards for managers, senior managers board members, and other constituencies within the hospital. “More and more patient data is now maintained electronically—everything from vital signs to medications to test results to billing information,” says Mehyou. “Much of it is stored in a clinical application system that is easy to sort and summarize with WebFOCUS. Now that we have the proper reporting tools, we can deliver information to our chief of staff with confidence.”

For example, the hospital uses an Eclipsys Clinical Application System, which gathers many types of clinical information, such as periodic vital signs. “There are myriad data points on each admitted patient,” says Mehyou. “Ultimately, we hope to use WebFOCUS to mine this data.”

WebFOCUS has paid for itself in measurable productivity gains. For example, the labor and delivery department was operating above the 50th percentile in cost-per-delivery, on a national basis. Careful analysis of spending patterns helped the hospital reduce these costs. “We’re now in the 36th percentile, thanks to better knowledge of costs,” Mehyou says. “That’s a 28 percent improvement in productivity.”

In the face of numerous industry reports that accuse health care organizations of runaway spending and rising costs—with no noticeable improvement in quality of care—these measurable performance gains are a source of pride for Jefferson Regional. “Providing good care is our primary objective, but of course we want to do that within the bounds of what is reasonable and financially responsible,” Mehyou concludes. “WebFOCUS gives us the insight we need to create a more efficient operation. For the amount of money we have spent to purchase and maintain the software—and the ease with which we can create reports—it is one of the best technology investments the hospital has made. The cost is minimal, and the return has been phenomenal.”

This article originally appeared in the issue of .

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