Unlike other industries, the clinical side of health care is based on interpretations of care practices that change over time. And while health care institutions compete for customers, there is no one set of product or service standards as would come with a new refrigerator because the patient is in fact the product shared among many providers.
We generate and use data like any other industry, but health care does not lend itself to the use of discrete data because the outcomes are necessarily fuzzy and ongoing, says Dick Gibson, M.D., the CIO at Legacy Health, an integrated network of six hospitals with research and other facilities in Portland, Oregon. Airlines have seats, schedules and know if you landed on time. In health care, we know youre alive but the big money goes to broad sets of descriptive terms around patient care that are very qualitative. For BI and performance management to have meaning, these terms need to be unified and reconciled in their definition and accuracy.
The challenges of data quality are multiplied by the number of codes and procedures managed in systems for lab results, pharmacy, check-in and other processes. Even within a single institution, the lack of standards, or ironically, the fact there are far too many, creates huge data quality and integration challenges.
But its a challenge providers must meet, both in response to consumer demand and regulatory interest in keeping down costs. Thats why information systems are increasingly required to bring a compliant and cohesive view to inpatient and outpatient facilities, right down to the bedside of the patient at the point of care. The approaches to meeting this challenge vary by hospital, with some opting for a single-vendor approach while others turn to multiple software partners. The evolution of provider software companies offers an interesting comparison to other industries, which have adopted enterprise resource planning tools only to find the tools lacking. Nonetheless, the data warehouse in the clinical setting is here to stay.
Two Views of BI
Business intelligence can be described as a process that leads to better decision-making. In its original and ongoing mission, a business analyst selects and extracts historical data from one or many databases. The analyst then structures and loads the data into a single repository (a data mart or data warehouse). Analytical and visual tools are then applied to perform trending and comparative studies that, sliced in different ways, create reports to measure performance and uncover opportunities for improvement.
In contemporary form, BI also takes an operational approach that gathers near real-time data to support ongoing processes. These include sales, marketing and customer interactions. Operational BI is more process oriented than the data warehouse model and is associated with key performance indicators, dashboards and scorecards that support performance management.
In the clinical world, health care providers have tuned operational workflows to fit processes from admission and treatment to checkout with a flexibility other industries might envy. A visitor to an emergency room or someone admitted for an inpatient or outpatient treatment might well regard the event as orderly and procedural.
Whether or not this appearance is true, the actual management and reconciliation of data that flows through admissions, doctor notes, labs and pharmacies becomes a huge challenge to implementing BI. And data complexity provides only a partial explanation of why the industry is a relative late-comer to the BI strategies employed in other economic sectors.
While current budgets are tight everywhere, the health care sector has traditionally been an IT spending laggard. Without accounting for scale, a 2009 Gartner Research note predicts that the financial services industry will spend more than six dollars on IT for every equivalent dollar spent by health care this year. But according to figures from HIMSS, the Healthcare Information and Management Systems Society, this under spending may change. Spending, which now sits at approximately 2 percent of total revenue, is expected to grow at a compounded rate of 7.5 percent through 2014. A 2008 snapshot of health institutions conducted by IDC subsidiary Health Industry Insights found that less than 20 percent had instituted an enterprise data warehouse. The study also found that more than 30 percent were planning to do so.
Despite the uneven spending on IT, health care as an industry aspires to the vision of a digital hospital with consolidated electronic records, but this does not describe the state of work under way. Its a step-wise approach to the vision. Many institutions are still turning from paper to discrete software applications that might cover a single workflow, such as processing new patient admissions or facilitating orders for lab tests.
For CIOs, maintaining the vision of the digital enterprise requires tenacity. In 1999 when Indranil Ganguly arrived as CIO at CentraState Healthcare System, a 271-bed acute care and outpatient facility in New Jersey, clinical data was being captured electronically, but not in a way that supported decision-making. When I and a couple of others joined the organization we saw technology that was simply as a surrogate for paper. It was not adding value, and maybe was impeding value by making it more onerous to retrieve information.
Some of CentraStates discrete applications offered light reporting and bits of clinical and BI value, but at a very low level. What Ganguly chose was to rip and replace isolated or weakly connected applications with a more unified platform from Siemens Medical Solutions that helps integrate data from multiple operational processes.
CentraState is hardly alone in this regard: One of the most obvious trends in health care information systems is that hospitals and integrated care networks are widely replacing older applications and connections with newer platforms. An expectation is that new technologies will also take over much of the data quality and integration heavy lifting, in part to fuel BI reporting and performance management. At Legacy Health, Gibson has torn out an expensive platform that was still under construction and replaced it with software from Epic Systems Corp. The new rollout connects the emergency department, critical care, physician office billing, hospital billing, hospital and clinical operations across Legacys facilities.