Organizing for Success in Clinical Analytics (Module 5)

Setting Scope & Goals

  • Governance and Staffing

  • Building a Technical Platform

  • ROI & Sustainability

Successful use of analytics improves healthcare organization performance and requires a thoughtful approach to setting the scope and objectives of the analytics effort, to staffing the analytics team and to building the technical platform.  A balanced approach to measuring short and long term ROI is important for the sustainability of the effort.

Setting Scope & Goals

The most successful efforts in clinical business intelligence (CBI) take a unified approach where clinical and financial goals are pursued together under a consistent process for using data to improve performance. Organizations committed to using data to support management decisions will have consistent performance metrics in place at every level of management. Metrics measure progress towards goals and are used to hold executives and managers accountable for results.

Metrics for specific performance improvement projects will drill down into more detailed measures than those used for management accountability.  However, they must tie back to higher-level performance measures to ensure that the projects move the dial on things that really matter. There will be individual projects that focus on clinical details and others that focus primarily on cost or revenue. All improvement projects need to be evaluated in terms of their impacts on the organization’s top-level scorecard goals, including quality and efficiency. 

Consistent data sources and measurement methodologies should be used for accountability metrics and for measuring the impacts of both clinical and financial improvement projects. Otherwise, the validity and value of performance improvement projects will be hard to prove.

For example, when making a business case for a quality improvement project, financial impacts should be vetted using methods the finance team has confidence in – rather than using a clinician’s ad hoc estimate of the size of the opportunity.  This need for consistent measurement and strong alignment with organizational goals has major implications for staff organization for the analytics effort and for selecting the right technologies.

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Governance and Staffing

A business intelligence (BI) governance committee should be formed to manage the overall effort. This central authority provides direction and oversight to all clinical and BI projects.  In addition to an individual with day-to-day BI management responsibility, senior executives from IT, finance, clinical operations, informatics and clinical process improvement should be included. A physician leader such as the Chief Medical Officer (CMO) or Chief Medical Information Officer (CMIO) should also participate.

The BI committee reports directly to an executive steering committee that sets high-level goals and priorities for the BI effort and assigns to it the appropriate level of resources. Because BI projects encompass activities and responsibilities including the formulation and implementation of changes in business and clinical processes and are not limited to purely technical matters, the governance of BI initiatives should not be buried inside the IT organization. They should be much more directly visible and accountable to the executive committee.  Project teams in clinical analytics include members from the core BI staff as well as other member with expertise in the particular area of focus.

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Building a Technical Platform

It is important for CBI to establish a ‘single source of truth’ that provides trusted, comprehensive performance information. There doesn’t need to be one physical database that includes every number that the management team will ever use, but it does require that there be a unified set of processes for acquiring, integrating and enhancing data that produces consistent information the management team can trust and rely on. In practice this means the vast majority of performance measurement information should flow into a centralized enterprise data warehouse (EDW). Smaller, more focused data marts are should pull their data from the EDW or – at the very least – use consistent processes for cleansing and enhancing data and for defining common measures.   

Implementing consistent processes for acquiring, integrating and enhancing data is difficult to accomplish without the standardization of a common set of software tools used across all BI projects. Successful BI teams will select a small number of compatible software tools as the core of their BI technical platform for all new BI initiatives.  They will work over time to migrate any legacy systems to that common platform as well.  But in the area of information delivery and presentation, having a few different types of tools for different types of end users is often a good idea.

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ROI & Sustainability

Building up a robust organizational capability for using data to drive performance requires a significant multi-year commitment of:

  • Energy
  • Focus
  • Money
  • Other resources. 

Without a thoughtful approach, it can be easy to squander money and time on large scale technical tasks without achieving the desired quality and efficiency outcomes. However, not making the required investment in the right kind of staff and technical resources leads to fragmented efforts that may show short term gains but don’t build up the sustainable expertise to leverage past successes into even results in the future results.

Balancing the short term and long term is essential.

The most successful approach is to work towards  clear long term goals, such as a comprehensive EDW, while selecting and implementing a series of focused performance improvement projects that yield tangible results in a relatively short time frame. 

For example, a health system in the process of building out an EDW that starts with the hospital and grows to include data from physician offices and other settings should have at least one performance improvement project associated with each stage of the expansion of the EDW scope. An early project using clinical data in the hospital might focus on reducing the incidence of infections associated with urinary catheters, demonstrating the value of the EDW and reinforcing the importance of extending it to other areas.

As the EDW expands to include data from primary care office visits, a project focused on diabetic patient populations could demonstrate value by measuring and improving the percentage of patients with healthy clinical indicators, such as consistent blood glucose levels.  Demonstrable success with focused short-term projects can sustain organizational support for the longer term BI initiative.

  • The benefits of developing BI capabilities will ultimately be measured in the cumulative effects of a long series of performance improvement projects enabled by BI tools, processes and staff. 

The benefits of these projects can rightly be attributed to the investments in BI that enabled them, but it is important to keep in mind that there are many other costs of performance improvement projects beyond the core BI tool and processes, including staff time in analyzing root causes, in piloting improvements and in rolling them out across the organization.  BI investments are just one essential part of a larger set of investments that executives make in committing to an organizational effort to improve performance.

  • The ROI of BI can sometimes be usefully defined in narrower terms that focus on reductions in the cost of core BI technologies and processes. This will be the case when replacing an existing tool or process with a substitute.

For example, bringing in an automated tool for data cleansing could eliminate costs associated with manual efforts to cleanse data.  A purchase decision might be justified on that basis alone. However, the indirect effects of a new tool may actually be more important, though more difficult to quantify in advance.  For example, a faster, more automated data cleansing process might allow users to access information quicker and avoid costly problems in the delivery of patient care.

  • Are we asking the wrong question? One of the most important benefits of CBI is that it provides the measurements needed to calculate the impact of changes in clinical processes. Rather than asking, “What is the ROI for clinical analytics?’” perhaps we should be asking, “How we can ever know the ROI of anything without using clinical analytics?”

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Resources

 

The book “Implementing Business Intelligence in Your Healthcare Organization”, published by HIMSS, is a valuable resource addressing organizational issues for CBI.

https://marketplace.himss.org/Store/Product-Detail?ProductId=3329

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Module 1: What is Clinical Business Intelligence (CBI)?

Module 2: The Urgent Need for Clinical Business Intelligence

Module 3: Types of Clinical Analytics

Module 4: Essential Technologies for Clinical Analytics

Module 6: Future Directions for Clinical Business Intelligence

Module 7: Opportunityies for Payers and Big Data