Wonder Why BI implementations fail?

Take a look!

http://www.youtube.com/watch?v=78FJBDKSYPY

ACO Series, Part I

So, people have been (I hate saying "people", it's like saying "they say...". My first question is, "Who are the famed "they"? In this case, who are these "people"? But for the purposes of this post, I can't take names, so "people" ) have been asking me about ACOs and the role of analytics in it. I read a recent study done by American Hospital Association and McManis consulting titled "Activities and Costs to Develop an Accountable Care Organization". If you haven't read it, it is a good read. In the report, they break it down into four major categories:

1. Network Development and Management

2. Care Coordination, Quality Improvement & Utilization Management

3. Clinical Information Systems and, my favorite

4. Data Analytics.

Now, it is interesting that they broke out Data Analytics as a separate entity. In my humble opinion, Data Analytics has implications in all three of the other areas. For example, the stated definition of ACOs is: "intended to manage the health of a defined population and to be held accountable and reimbursed based on measurable improvements in quality and patient satisfaction, plus reductions in costs". Sound familiar? If you have been reading my blogs for the last two years, you would have heard these two terms repeatedly:

1. Improving Quality of Care

2. Reducing cost of care

And why do I think Analytics has implications in all three? Well, let's put it this way. You don't throw money at something and hope that it sticks do you? If you answered yes, well...you are reading the wrong blog, but if you didn't, then read on.

Let's take a look at section 1 of the study, Network development and management. The study details about 9 activities that you have to do to achieve the goals of this section. I am not going to go into details of all of them. But let's examine a couple.

* Recruiting/acquiring primary care professionals, right-sizing practices

Great goal. But how do you achieve this? Do you want to acquire every PCP that is associated with you? Probably not. You want to acquire the "best" ones. You criteria for defining the "best" might differ from your neighbor's, but you still want to acquire the best and drop off the dead weight. (Remember the fact that you are trying to "reduce costs" through this activity). So how do you know who is your best target for acquisition? Historical data of course! So, define the metrics which allow you to define your "best case scenario", run those metrics against your historical data and see who pops up at the top! You might be surprised. If I were a betting man, I would bet a dollar on it!

* Compensating physician leaders

Uh oh! Yes, I went there. This is a touchy subject. Well, the question is, how do you define a "leader"? Is it the physician who can do 40 surgeries, play 18 holes of golf, take the kids to soccer practice and have dinner with the family all in a day? Could be. It could also be the physician who has the least infection rates. It could also be the physician with a 100% patient satisfaction rate. So now we have a combination of metrics (weighted, of course to come up with the definition of a "leader"). Again, run these metrics against your historical data ( you do have historical data as much you think you may not), and see who pops up at the top. Again, I will bet a dollar that you might be surprised.

So you see, analytics is not a separate "reporting only" solution. You can use it to make intelligent decisions. But if you are reading this blog and haven't slept yet, you already knew that. That is why I think analytics has implications in all three of the major categories in achieving a true ACO.

ACO Series Part II: Care Coordination, Quality Improvement and Utilization Management

Coming soon to a blog near you.

Plug and Play Business Intelligence?

As I was speaking to a potential client recently, I realized that someone had tried to sell her BI in a box. Even with our appliance Integra, I would not dare call it a plug and play solution. Why? There is so much that needs to happen before you get useful information out of your BI initiative. Out of the box, Integra includes the following:

· The ETL (extract, transform and load) software required to connect and integrate data.

· A semantic dictionary of healthcare terms for mapping source data to target data

· A data warehouse (customizable to house EMR, financial and other data).

· Pre-loaded metrics

· A fully integrated BI reporting solution.

· Pre-built reports.

· The hardware to house all this.

And you still wouldn't call that BI in a box, you ask? Absolutely not! And here is why. Even with all of this functionality built in, there is one thing missing. No prizes for guessing what it is. What is missing is “YOUR" data! Guess what, without that, the greatest BI in a box solution won't be of much use to you.

So let's take a look at what needs to happen before this becomes the BI 'Solution' that works for YOUR organization.

· Implementation Planning – During this initial phase the following will occur:

o Gather full set of reporting requirements.

o Gather testing requirements.

o Gather production deployment requirements.

o Identification of systems of record (SOR) and the tables/fields needed to satisfy the end reporting requirements.

o Mapping documents for each SOR are created. These documents include:

§ Source field name, data type and format.

§ Target field name, data type and format.

§ Cleansing requirements for each field.

§ Business logic needed to translate from source to target.

o Create development, testing and implementation plans for the next phases of this project.

· Customization – The actual customizations are created during this phase.

o Data for each SOR is gathered.

o Cleansing ETL processes are created for each source record.

o ETL processes are created and unit tested for each SOR.

o Reporting cube(s) are customized to support reporting requirements.

o Reports are created/customized and unit tested to requirements.

o At the end of this phase, the hardware is delivered to your site and the processes are connected to your SORs.

· Testing – Testing will be performed to the requirements which typically includes:

o Systems Integration Test (SIT) – Full nightly runs are performed and system is tested for correct technical functionality.

o User Acceptance Test (UAT) – A test bed of users are allowed to use the system to ensure requirements have been met from a business/clinical viewpoint.

· Production Deployment – The system is moved to your production environment and the system is made available to your users for consumption.

So folks, next time someone tells you that there is a plug and play solution for BI that does all of these things automagically, please call me right away! I would like to see this wondrous new thing and pay my respects. You can reach me at kishore@metaanalytix.com

Mental Health

Ok, so this is not really a blog post, but thought I'd let you know that we have now partnered with a Mental Health screening provider to provide analytics. You can read the press release here:

http://www.metaanalytix.com/upload/File/Meta%20Analytix_Medical_Outcomes_PressRelease.pdf

Accountable Care Organization - Achievable?

What is an ACO?

Here is a recent example of an ACO definition taken from a 2010 article co-authored by Elliot Fisher:

ACOs consist of providers who are jointly held accountable for achieving measured quality improvements [note that “measured quality improvements” is synonymous with report cards] and reductions in the rate of spending growth. Our definition emphasizes that these cost and quality improvements must achieve overall, per capita improvements in quality and cost, and that ACOs should have at least limited accountability for achieving these improvements while caring for a defined population of patients.

ACOs may involve a variety of provider configurations, ranging from integrated delivery systems and primary care medical groups to hospital-based systems and virtual networks of physicians such as independent practice associations. All accountable care organizations should have a strong base of primary care. Hospitals should be encouraged to participate, because improving hospital care is likely to be essential to success. But in contrast to others’ definitions, we believe that this need not be an absolute requirement for all ACOs (Mark McClellan et al., “A national strategy to put accountable care into practice,” Health Affairs 2010;29:982-990).

Hmmmm....confused enough? Well, in my ongoing quest to simplify or "Englishify" everything, I'll take a stab at it in my own way. The basic premise of an ACO is this:

1. Improve Quality of Care

2. Reduce Cost

3. We will hold you accountable for 1 and 2. Simple enough? Not so fast....

Someone once told me, "if you ask a question once, you might look dumb. But if you don't ask it, you'll stay that way". So here are the questions:

1. Who is going to hold you accountable? (Let's say CMS)

2. How are they going to hold you accountable? (Let's say they come up with measures that you have to track and report)

3. Define "defined patient populations"? (This my friends, I have no idea what it means)

So my real question is, if they do come up with the answers to the questions above and define ACOs, is it an achievable goal? The answer is, Absolutely! Improving quality of care while reducing cost of care is a very achievable goal. In fact, you should do it before they make you do it! The technology exists today. All you have to do is take one look at our KnowledgePath report and go home happy knowing that you have the technology and reporting capabilities available at your fingertips.

Informatics for Improving Quality of Care

A well designed informatics platform can not only improve profitability among healthcare providers, but allow for “Improved Quality of Care”. This white paper provides the possibilities, design considerations and thought leadership in designing and implementing scalable information architecture for Healthcare Providers to improve quality of care through research. You can download the whitepaper here: http://www.metaanalytix.com/page.php?page=33

Information Based Design - Next Gen Data Warehouses

Recently, in my webinar done jointly with expressor, I was asked a question: "Is the best practice for deploying warehouses a "single, enterprise wide warehouse" or a warehouse with different data marts for each line of business?" My answer was "it depends on the client". Very simply said. As I was talking to a colleague of mine, we knew the answer wasn't that simple and we decided to write a whitepaper about it. So here we are, with a brand new, hot off the press (or Adobe for that matter), FREE whitepaper on "Information Based Design - Next Generation Data Warehouses for Healthcare providers". Here is an excerpt from the whitepaper:

"Very large companies can afford big investments and long lead times to build out new enterprise data warehouse environments. These can be several year projects that cost tens of millions of dollars, or more. Success (based on full achievement of the initial vision) is far from guaranteed. Not uncommonly, after several years, planning for the “next generation” data warehouse begins to take root and the process begins anew… Meta Analytix and End to End solutions present a white paper on Information Based, Incremental, Data Warehouse design for those organizations with limited time and budgets."

Continue to White Paper here: http://www.metaanalytix.com/page.php?page=15