As healthcare organizations utilize and understand the synergies of technology and software as it relates to improving the bottom line and efficiency of their respective organizations; I’ve
often wondered as a health care provider, what the consequences of the utilization of data derived from business intelligence platforms, as it relates to understanding what motivates physicians and other health care providers decision making process for clinical care and clinical outcomes.
Moreover, the health care industry has become increasingly complex (increased regulatory) and competitive (market share), especially during the past ten years. This is primarily due to an advance in medical technologies and therapies which have addressed a consortium of pathologies. As this positive trend in health care technologies increases, consumers should expect insurance plans, health care providers, drug companies and pharmacies to compete diligently for your [respective] health care dollar. In my opinion, this is the driving catalyst to why the utilization of Business Intelligence (BI) has gained traction in the health care community.
“Business intelligence (BI) has two different meanings related to the use of the term intelligence. The primary, less frequently, is the human intelligence capacity applied in business affairs/activities. Intelligence of Business is a new field of the investigation of the application of human cognitive faculties and artificial intelligence technologies to the management and decision support in different business problems, see ( BI as a cognitive capacity).”
The second, which is the subject of this article, relates to the intelligence as information valued for its currency and relevance. “It is expert information, knowledge and technologies efficient in the management of organizational and individual business. Therefore, in this sense, business intelligence is a broad category of applications and technologies for gathering, providing access to, and analyzing data for the purpose of helping enterprise users make better business decisions. The term implies having a comprehensive knowledge of all of the factors that affect your business. It is imperative that you have an in depth knowledge about factors such as your customers, competitors, business partners, economic environment, and internal operations to make effective and good quality business decisions. Business intelligence enables you to make these kinds of decisions.”
A specialized field of business intelligence known as competitive intelligence focuses solely on the external competitive environment. Information is gathered on the actions of competitors and decisions are made based on this information. Little if any attention is paid to gathering internal information. Companies like Strategic Performance Management (SAS), SAS Institute, Ingenix and others, have began to offer health care organizations a wide array of web-based business intelligence solutions that assist organizations with revenue cycle, clinical and performance improvement issues.
With all of the proposed benefit(s) that (BI) brings to the table; What is the hoopla with physician/administrator relationships? Why are these relationships so important?
Several studies have often cited that when hospitals and physicians work well together, patient care and the hospital’s bottom line improves overall (McGowan, 2004). But there are many challenges that can thwart this relationship. BI has this potential [unless managed by a health care provider]. McGowan (2004) mentions a strategy which alings the economic interests and share revenues of the hospital with the physician. This ultimately means transforming the overall mission and vision statements of organizations to meet this goal.
For example, in Ms. Cross article “Providers Getting Smart About Business Intelligence”; after reading the article, I was left with the impression that hospital administration [or non-clinical personnel still hold the “keys” in terms of what data elements drives performance improvement(or what data points are inclusive of the cost benefit analysis). BI vendors also cite that the application of this type of technology is endless [in terms of defining missed opportunities for improvements].
All health care organizations would like to see improved score cards [including myself]. But, when [primary stakeholders] are left out of the decision making process to pursue a technology such as this. This type of pervasive behavior, has the potential to exacerbate the strained relationship between physicians and hospitals. Allow me to explain, by taking a closer look at a particular quote from Ms. Cross’ article.
“The sweet spot of business intelligence is looking at a population, analyzing the data and seeing the trends.” Without (hopefully) mischaracterizing this quote, what exactly does this mean? Does this mean that hospitals have the flexibility to allow a platform such as this, decide on what data points are critical [without validation]? According to Ms. Cross, BI software has the capability to mine several data warehouses and can present administrators with a graphical view of pertinent information on their organization. The purpose of Outcomes research is to understand the end results of particular health care practices and interventions. “End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions—where cure is not always possible—end results include quality of life as well as mortality (AHRQ).” By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care. Subsequently, supporting improvement based initiatives in health outcomes should be a strategic goal for any health care organization.
Declining reimbursement, patient safety, staffing shortages are among some of the factors that continue to challenge the hospital/physician relationship. Now physicians are being asked to change behavior in terms of performance improvement in clinical outcomes. Physicians are already under assault for clinical autonomy (thanks to managed care) and out-of-control malpractice insurance rates.
Historically, clinicians have relied primarily on traditional biomedical measures, such as the results of laboratory tests, to determine whether a health intervention is necessary and whether it is successful. Researchers have discovered, however, that when they use only these measures, they miss many of the outcomes that matter most to patients. Hence, outcomes research also measures how people function and their experiences with care.
This additional stressor of being questioned by a BI platform of why your patients’ length of stay (LOS) exceeds parameters compared to other colleagues, perpetuates increased resistance.
AHRQ Publication No. 00-P011
Replaces AHCPR Publication No. 99-P006
Current as of March 2000
Cross, M. (August, 2006). Providers Getting Smart About Business Intelligence. Health Data Management. Vol 14:2 pp.56-61.
Outcomes Research. Fact Sheet. [Online]. AHRQ Publication No. 00-P011, March 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/outfact.htm.
McGowan, R. (2004).[Online]. Strengthening hospital-physician relationships. Health care Financial Management. Retrieved August 15, 2006 from http://findarticles.com/p/articles/mi_m3257/is_12_58/ai_n8574803