Safety & Quality Pay Off

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By Sanjaya Kumar, MD

Safe, high-quality care is an imperative in the evolution of health care. Everyone involved in the care process, from patients to providers to payors agree on this point.

No matter what payment system, billing process or reimbursement policy is implemented, top-notch care is becoming the focus. At the core of a superior care environment is a consistent experience based on best practices and actionable knowledge.

Yet, as the entire industry is rapidly moving from process to outcomes-based metrics, most health care executives and senior staff are still ill equipped to make prudent decisions that help improve care while ensuring their efforts are operationally and fiscally sound.

Today providers make these decisions using a combination of partial data, past experience and trial and error. However, with technological advancement, better methods of decision-making are coming to the forefront. If implemented appropriately, these methods can rapidly change the paradigm of care and the overall performance of the health care enterprise.

One main barrier to this is that performance-enhancing, actionable knowledge resides within silos of data scattered throughout the health care IT environment. Integration of this information through business intelligence systems will enable health care executives to more effectively direct resources to improve patient safety and care based on hard evidence.

Out of Functional Silos, Integration of Clinical and Financial MetricsToday, clinically relevant data can more easily be associated with financial metrics. For example, pressure ulcers have always been considered a drain on resources, but proving this was cumbersome. Software enables patient populations to be easily separated into different cohorts (e.g., various stages of pressure ulcers). Likewise, analytics built into software enables length of stay (LOS) and costs incurred by each group to be analyzed.

The differences between the groups are typically wide, with extended stays and higher costs associated with those who have stage III and IV pressure ulcers. And if these are acquired while in the hospital, Medicare reimbursement is at risk. This of course is in addition to the burden on the patient, many of whom must subsequently be cared for in a rehab or skilled nursing facility.

There are many other examples of how integrated data can clarify and "prove up" where and to what extent investments in patient safety and quality should be allocated. High-risk, problem-prone activities, as well as those that are covered under accreditation standards, can be used as variables in the prioritization process. Research can also support decision-making regarding investment decisions.

An analysis of insurance claims data completed by the consulting firm Milliman for the Schaumburg, IL-based Society of Actuaries (SOA) revealed that five common medical errors accounted for 55 percent of total medical error costs in 2008:

• Pressure ulcers, $3.86 billion ($10,288 total cost per error)
  
• Postoperative infections, $3.66 billion ($14,548 per error)
  
• Mechanical complications of devices, implants, or grafts, $1.13 billion ($18,771 per error)
  
• Postlaminectomy syndrome, $1.12 billion ($9,863 per error)
  
• Hemorrhages complicating a procedure, $960 million (12,272 per error)

Access to cross-domain, interrelated information on demand, with presentation in a context that makes sense based on the decision-maker's roles and responsibilities, is critical to supporting executive decision-making, the launch of improvement goals and the measurement of results. Analytics and reporting support teams as they delve into the processes and systems that need to be revised or redesigned.

In addition, the quality effort must be applied consistently across the entire organization to allow performance improvement to be measured enterprise-wide and across all domains.

Understanding the Technological FundamentalsHealthcare executives have long dealt with large budgets for IT systems, software and hardware. Today's newer technologies will support not just an individual organization, but also the healthcare continuum. To be prepared to review and evaluate these technologies, leaders must be have a basic understanding of the following concepts:

• Cloud computing: this term refers to hosted services over the Internet and is broadly divided into three categories: platform-as-a-service (PaaS), infrastructure-as-a-service (IaaS), and software-as-a-service (SaaS). Among many advantages, these services provide access to a wide variety of service options and applications, the latest advanced application developments at a fraction of the cost of in-house development, and hosting on the most advanced platforms with the greatest computing power.

• Integration and its complexities: With cloud computing services and their new, flexible and highly sophisticated technologies, the time-consuming and expensive task of integrating data across multiple tasks becomes considerably easier. This scheme provides match data types for the business owner with a map in place across all data types.

• Role-based application architecture: Operating on the many-to-many principle, this architecture distributes data to many individuals from multiple sources. Each individual develops specific profiles with data access and permissions. To monitor metrics important to their role across clinical, operational and financial domains, users have the ability to customize their environment. This empowers and guides healthcare executives to make the most financially prudent and clinically sound decisions.

Next Steps for a Creating Clinical Business Intelligence EnvironmentNavigating the ever-changing tides of the health care environment and making driving a profitable, high-quality end result is not an easy task. Yet health care organizations have the data required to optimize performance and manage a financially and operationally efficient enterprise. As health care providers look to harness the power of business intelligence there are some key factors that deserve consideration. They include:

1. Start with the end in mind. Setting a concrete vision for how a health care organization plans to implement and use a business intelligence system is critical to its success. Lack of vision will lead to numerous missteps and poor investment decisions.
   
2. Choose the right technology platform. Health care providers need to review their environment and make sure the technology supports the overall vision. Technology for technology's sake will not yield the results desired from a business intelligence and decision support system.
   
3. Drive cultural change. Ultimately, business intelligence solutions are used by staff to make critical decisions. Health care organizations need to ensure their organizations are prepared to take action with this knowledge. Clarity of roles and responsibilities and a supportive environment that encourages responsibility and accountability accelerate adoption and usage of this newfound intelligence.
   
4. Implement checks and balances. Any decision support system needs constant monitoring to validate the use of the system and the decisions being made. Business intelligence is not a magic bullet to solve all your organizational issues. It is a systematic means of making informed decisions that should be monitored in terms of financial and clinical outcomes.
   
5. Expect to fine-tune as you go. Implementing a business intelligence system is the start of a journey. Once the initial implementation takes place, health care providers will see a hundred other areas where business intelligence can be applied. They should expect this and make sure the technology used has the ability adapt and evolve with the needs of the organization.

Health care is at a crossroads. The intersections are safe, high-quality care, efficient operations and financially prudent decisions. Business intelligence, the technology, people and processes deployed will determine the level of organizational success in this endeavor. Every day health care providers wait to get moving is another day where profits and quality care are at risk.

Resources
1. Davis, C. (2010). Medical errors: Pressure ulcers and postop infections