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May 6, 2010: TDWI Flashpoint – Business Intelligence in Healthcare: The Time for Fundamental Redesign Has Never Been Better

In this issue of TDWI FlashPoint, Carol Newcomb argues that now is the best time for healthcare organizations to design a sound, reliable BI infrastructure based on best practices.

BI in Healthcare: The Time for Fundamental Redesign Has Never Been Better

Carol Newcomb, Baseline Consulting

The federal government is providing billions of dollars in ARRA grants to healthcare organizations to automate and integrate information systems. Hurrah to that! Before you leap, though, consider the awesome opportunity you have to design a sound, integrated, and reliable information enterprise based on BI best practices. Funding is available. You don’t need to repeat the blunders that got healthcare into the technology mess it’s in today. If you do it correctly--and now is the moment--would you add yet another application on top of the existing patchwork quilt of technologies currently driving your operations?

Even if electronic health record (EHR) vendors claim their systems are extensive and integrated on one platform across registration, billing, pharmacy, inpatient, surgery, ER, ambulatory, and so on, ask yourself how difficult it will be to report on Sally Jones’s total cost of care if her hip implant goes bad; whether Mr. White’s infection while he was in the ICU was due to an allergy, poor hand-washing, or unclean IV tubing; or if the pharmacy’s mistake in distributing Coumadin in the wrong dosage contributed to $400,000 overruns in the cost of Mrs. Brown’s preapproved hospital visit.

How many different places will you need to go for answers to these questions? How many different hardware and software platforms does the information reside on? When you’re through with your EHR implementation, how much work will it take to generate meaningful reports at an enterprise level? These are the challenges that most healthcare organizations face today, and they call for a strategic and deliberate plan to do BI right.

Let’s talk about best practices in BI, starting with the typical healthcare organization’s technical infrastructure.

  • How many interfaces does your IT department maintain?
  • How much time is invested in “keeping the lights on”?
  • How many standalone applications do you have under one organizational roof?
  • Does anybody maintain an inventory or portfolio of the different systems?
  • Do you have an enterprise server?
  • How many programming languages and DBAs do you employ?
  • Can anybody in your organization draw one logical data model that represents the entire business?
  • Who maintains a centralized physical data model? How many physical data models exist?
  • In how many different places are business requirements, data requirements, or functional requirements stored?
  • Do you have a data dictionary that end users can access?
  • Do you have agreed-upon definitions?
  • How do you handle master data such as patients, physicians, employees, service codes, and diagnosis and billing codes?
  • Do you have any master data hubs?
  • Do you have any data governance efforts under way to resolve conflicts in data usage and develop centralized and enforceable policies for visibility, data capture, and data sharing?
  • What types of systematic data quality activities are under way to root out data issues?
  • How are issues escalated and resolved within the organization?

BI best practices recommend that the fundamental approach to managing data and the delivery of data within your healthcare organization starts at the enterprise level. If you need to “roll data up” instead of drilling down to detail, this is your first clue that your strategy needs to change. Solid BI infrastructure can provide the following:

  • Reduced time to collect, scrub, and deliver data for quality assurance, compliance and accreditation activities, billing, credentialing, clinical reporting, and more
  • Fewer reports to manage staffing, productivity, purchasing, and recruitment activities
  • Repeatable, reliable results
  • Trusted data
  • Faster resolution of data quality and governance issues
  • A scalable, organized solution for a multitude of data provisioning demands
  • Enterprise-level data to support both operational and strategic decision making

If you think this investment in BI will take too long, derail other systems development or implementation activities, or even cost too much, think again. We are all guilty of short-term thinking, and patching things together only results in patchwork systems that are messy and expensive to maintain. Five years down the road, wouldn’t you rather say, “We spent $5 million on laying the groundwork for a scalable enterprise platform that integrates finance, human resources, legal, clinical and administrative reporting needs with data that we understand and that we can trust” instead of “We spent $5 million on our current EHR, and now we have two hospitals that use it but we still need to bring three more on board”? There may never be a better opportunity to prepare for the future.

Carol Newcomb is a senior consultant for Baseline Consulting. She has an MHSA from the University of Michigan and extensive background in health services data management. Her current work is focused on data governance in a variety of industries.


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