Allina moved strongly into outcome-based payment this past January, when it kicked off its initial ACO efforts as one of 32 Pioneer ACOs in the United States, even working in conjunction with a rival provider. "We couldn't get to actionable data without the integrated data warehouse," Wheeler says.
Measuring key business indicators in a healthcare system often precedes clinical business intelligence, but not always. At Memorial Sloan-Kettering Cancer Center in New York City, use of a clinical data repository began 25 years ago, while the financial operational data warehouse is less than two years old.
A single hospital with 470 beds and a number of regional facilities, Memorial Sloan-Kettering Cancer Center evolved its clinical data warehouse six years ago to be Web-enabled and HIPAA-compliant, says Patricia Skarulis, vice president of information systems and CIO.
To help take care of patients closer to their homes, patients may have surgery at Memorial Sloan-Kettering but receive radiation at a regional facility in northern New Jersey, Long Island, or Westchester County in New York. "We have a database of over a million and a quarter patients, and we have everything about them for their inpatient and outpatient cancer care," Skarulis says.
Every event that occurs with those patients is time-stamped, allowing clinical analysis to begin quickly. "We can begin to simulate what a bottleneck might be," Skarulis says.
Memorial Sloan-Kettering's newly developed business intelligence warehouse, built on IBM's Cognos and SPSS software, can drive decisions from the detail-oriented work of matching invoices and purchase orders to more mundane analysis.
With budget planning for 2013 under way, unit managers will have the ability to spot changes such as how performance in a given month compares to the same month going back two years. Predictive analytics will still require expertise. "We have several analytics groups within the institution, including advanced analytics and predictive analysis to clinical work," Skarulis says. "They have been so used to doing it for all of their clinical studies that to be able to have this database that will match up square footage and buildings with people and salaries and expenses and all of that and revenues, to have a total comprehensive picture—it will be extraordinarily useful to some of these super-analysts to be able to pull together insights for our business operations."
Jonathan Perlin, MD, is chief medical officer and president of the clinical and physician services group at HCA, a Nashville-based hospital company that includes about 163 hospitals and 109 freestanding surgery centers in 20 states and England. He notes that data can move the needle on best practices for healthcare.
"During the pandemic flu threat of a couple of years ago, we partnered with the CDC and the Department of HHS to share not just data about prescriptions for flu-related medications, but also to share something that we've been doing for a long time: anything that would indicate an increase in influenzalike illnesses, or laboratory data that would show increases in white blood cell count or other markers of infection," says Perlin, who is a former undersecretary of health for the Department of Veterans Affairs. "The ability to span multiple states, multiple markets, multiple environments, and detect trends and aggregate those data was immediately beneficial to the public health in terms of detection of potential trends in influenza."
More recently, HCA partnered with Richard Platt, MD, a hospital epidemiologist at Boston's Brigham and Women's Hospital, to help the Centers for Disease Control understand the best way to prevent MRSA infections in hospitals.