My name is Pat Salem, and I'm VP of Healthcare Planning & Business Intelligence at Golden Consulting. 
As a former hospital administrator and director of planning, I know firsthand how urgently healthcare organizations need to mine their data more efficiently and plan services more effectively.  In this blog, I’ll start conversations about how healthcare organizations can better access and analyze their data and, ultimately, become smarter.  Join me!

The current trend in healthcare data transparency is arming consumers with an ever-increasing amount of cost and quality outcomes data to review, interpret and digest.   Recently the Mass Health care Quality and Cost Council launched a website called “My Healthcare Options” to provide healthcare consumers with information that will help them compare hospitals for overall patient safety and patient experience measures.  Comparative cost and quality data is also available for a number of specific diagnoses, surgical procedures, and diagnostic testing performed at hospitals located in Massachusetts.

Insurance reimbursement and clinical outcome data that was once maintained internally (and strictly “confidential”) is now publicly available on this website as well as a myriad of other sites. As a result, hospital data is now under scrutiny by prospective patients and payers alike, as they analyze a hospital’s demonstrated performance on specific metrics that are compared or benchmarked against their competitors.

The growth in data transparency provides greater incentives for hospitals to closely monitor their patient safety, quality and cost data, and to strive to continuously improve their organization’s performance to remain competitive and viable.  Business Intelligence software provides the integration tools to monitor many clinical processes in a near “real time” fashion to identify variances in performance in order to take corrective action that will positively impact results. Hospital Administrators are increasingly looking to deploy management dashboards to provide them with a high-level view of their consolidated performance data and alert them to variances and actionable items.  The most successful hospitals will need to proactively manage their outcomes, instead of passively reporting the historical results. 

I was recently contacted by a hospital executive looking for a quality dashboard to monitor his hospital's key quality and patient safety data.  We identified the usual quality suspects like the CMS CORE measures, but our discussion quickly turned to the ubiquitous sources of quality data that is collected by nurses throughout the organization on clipboards and logged into their Excel spreadsheets like MD hand washing compliance.  Imagine, such a highly educated, skilled and scarce resource as a hospital nurse is needed to "observe" and report the hand washing practices of a physician!   Another hospital I know has jury-rigged their soap dispensers with gauges that measure the amount of soap dispensed, and developed mathematical algorithms to estimate the number of hand washings per MD to measure compliance with this standard.

Most hospital executives with whom I consult are struggling to get their arms around their quality and patient safety data.  Quality data is unwieldy.....and often is one of the primary reasons they begin to look for a business intelligence solution for their institution.  It usually begins with the goal of developing an automated quality dashboard or scorecard, then identifying all of the metrics or KPIs that are required.  However, once the data sources are traced back, we usually find that more than any other other functional area,  the quality data resides in numerous applications, access databases and Excel spreadsheets.  The data sources also cut across a plethora of departments and personnel.  It is often not just a matter of integrating a couple of major HIS applications or tapping into a data warehouse.  It usually means developing a roadmap for better data management and consolidation and integration into the BI portal.  Once the data is available, Universes can be developed, which then map the data fields to business terms for ad hoc reporting and dashboards.
 
So why is MD hand washing on the Executive and Board radar, you ask?  The lack of hand hygiene compliance is one of the root causes of often preventable nosocomial infections (hospital acquired).  According to the CDC, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals alone (and the eighth leading cause of death). Studies have shown that upwards of one-half of doctors don't wash their hands between visits with hospital patients.

By the way, how does your hospital monitor, measure and report their physicians' hand washing practices? 
 
1. SOURCES: Pittet, D. Annals of Internal Medicine, July 6, 2004; vol 141. Weinstein, R. Annals of Internal Medicine, July 6, 2004; vol 141. http://women.webmd.com/news/20040706/study-doctors-dont-wash-hands-enough
 
2. http://www.cdc.gov/ncidod/dhqp/hai.html

Having just completed a physician manpower study for a local community hospital here in NE, I find myself wondering how the CEO, Director of physician services, and their team of MD recruiters will use this information to develop their recruitment plan, and how changes in the underlying assumptions will be incorporated going forward, so that the manpower plan remains current and accurate. 

A hospital’s need for physicians can vary due to changes in market share, through the implementation of new programs and services, shifts in the competitive landscape, or new payer contracts — while physician supply seems to be in constant flux these days. A shortage of internal medicine physicians and numerous sub-specialists have created a very competitive market for physicians, whereas individual or even whole practices are sometimes lured away by a competitor, taking a large number of patients with them. Other physicians relocate due to the high cost of living in NE, while others retire at a growing rate.
 
Hospital executives spend an extraordinary amount of their time, as well as related cost, in carefully managing their physician resources, developing competitive physician integration strategies, measuring physician satisfaction, recruiting, and succession planning.  Hospital planning is quite a challenge!  At the crux of these efforts lies the MD manpower plan.  How will my client keep their physician plan current? How will they utilize this information in conjunction with other internal data such as physician admission, referrals, surgeries, RVU, quality, MD satisfaction, and provider profiling, as well physician revenue and expenses? 
 
I have seen it done firsthand: the answer is “with an army of analysts” and the collaborative effort of many managers and departments.  Now that I have bridged over into the wonderful world of IT and Business Intelligence, I can begin to envision a more productive process for managing all of the data required for executives in charge of overseeing their physician resources.  In fact, I have started to develop a Physician Manpower digital dashboard that would house the demand and supply data from my initial study, enable users to change some of the key underlying assumptions (such as market share and population growth), as well as update the physician profiles.  My goal is also to see it connect to current physician credentialing information, MD volume and other operational and financial data through either Crystal Reports or through a direct connection to their databases, data warehouse or data marts.

I will let you have a "sneak peak" at the dashboard if you promise to give me your feedback!  You can also view more dashboards here.

Earlier this year, Golden launched its "Hospital IT Systems Survey" aimed at providing a snapshot of hospital information systems deployed around the country. Hospitals need to be aware of what IT and business intelligence systems their peers are deploying to remain competitive, improve quality performance, increase operating efficiency, and decrease expenses.

I'll be interested to see if our results confirm, nationally, the local trend of increased interest and deployment of digital dashboards to monitor operating performance that we see by hospitals, healthcare providers, and payers.  Executives tell us that with the adoption of EMR and CPOE systems, the amount of digitized data has outstripped their data mining and analytical capabilities.  At the same time, they are struggling to respond to the growing trend in reporting transparency of quality and cost data. Market drivers such as consumerism, value-driven healthcare and pay-for-performance initiatives are thought to be fueling this reporting demand.

Our survey is still open, but I thought I'd provide some quick notes on what we've seen so far. 

Of current respondents whose organizations use balanced scorecards or performance dashboards to track metrics or key performance indicators (KPI's), only 35% of those respondents say that the data on their scorecards or dashboards is populated and updated electronically to provide real or near-real time data. 

This indicates that for the majority (65%) of these organizations, executive reporting continues to be a tedious and time-consuming manual process!  Many of our clients tell us that prior to integrating their numerous data "silos" and deploying their automated digital dashboards, they enlisted an "army of analysts" to process data extracts from IT, running queries in Access, exporting data to Excel, creating pivot tables, designing reports and graphs. The end result was a static report with data with a lag time of anywhere from 4-6 weeks. 

We also asked if the implementation of clinical IT systems within these hospitals has resulted in improvements in the quality of patient care, and nearly 80% of respondents so far have agreed.  It looks like the biggest improvements have been in more timely clinical information, diagnosis and treatment. This is great news!  That’s why we do what we do.

I'll keep you posted....  If you want to be a part of this research, you can take the survey yourself.