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Posts Tagged ‘business intelligence’

What will it take to decrease nursing home readmissions? #HIMSS14

HIE, clinical data, quality measures, financial and claims data along with healthcare analytics – what does it take to decrease readmission rates in nursing homes?

There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?

It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”

home_care_nursingThe American Health Care Association (AHCA), the largest association representing skilled nursing care centers in the country, reports that every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Of readmissions, one fourth are skilled nursing care patients, receiving post-acute care (recuperative or rehabilitative services).

According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447). Read the rest of this post »

Why business intelligence isn’t the end game for health analytics

A few years ago, I transplanted my family from the south to Washington DC.  I love the Capital, for its history, its influence, but we quickly realized we had left Mayberry and arrived on Jupiter.  Horns honked and people moved around briskly.  Maybe it was us – our naiveté — or maybe it was the community we had arrived in.  But we quickly realized: “If you order french fries, you get french fries.” And only french fries. Months of dining out were spent, only to find that our presumed “condiments” were not standard with our order.  We would have to ask for them and specify the quantity.  French Fries and 2 ketchups, please.

Careful.Well I clicked my heels three times and eventually moved us back to our Mayberry.  It’s been three years and my son and I will still giggle together when we order french fries and see someone going out of his or her way to offer ketchup.  And when we say “Yes, Please”, we get several packets.

Consulting in Healthcare is no different. We’ve grown accustomed to the “build to spec” approach.  You get exactly what you asked for.

I’m thankful to be a part of Perficient and the Oracle Healthcare Business Intelligence team.  We share a common philosophy – understand what the customer wants to achieve, coach and advise available options, design and deliver a solution that fulfills their NOW problem and simultaneously prepared them for the next 5 years.  It’s not just a report – it’s Healthcare Analytics. Read the rest of this post »

Analyzing the healthcare industry tipping point using Therbligs

Do you remember therbligs from your Operations Management class? 

The word therblig was the creation of Frank Bunker Gilbreth and Lillian Moller Gilbreth, American industrial psychologists who invented the field of time and motion study. It is a reversal of the name Gilbreth, with ‘th’ transposed. Therbligs are 18 kinds of elemental motions used in the study of motion economy in the workplace. A workplace task is analyzed by recording each of the therblig units for a process, with the results used for optimization of manual labor by eliminating unneeded movements. (Wikipedia)

shutterstock_128890124I remember, and it was a lifetime ago.  But then again, the Gilbreth’s were turn-of-the-century industrial psychologists who invented the field of time and motion study.  I consider them the founding parents of Industrial Engineering.

So why are we talking about therbligs in Healthcare?

Ah, young Jedi, the time has come to learn our lessons much the same way that the industrial giants like Ford, Carnegie Steel and General Electric learned 100 years ago during Teddy Roosevelt’s administration.  These early lessons became the standards of the mid-century boom in manufacturing and production output.

So the healthcare technology space has finally gotten to its tipping point.  In order to survive, the healthcare industry will need to invest in Industrial Engineering principles and it will need to do product line, service line, episodic, acute and outpatient time and motion studies.

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A healthcare treasure map leading to a single data warehouse

I’ve waited 20 years for my Treasure Map.  Yes, a map with hidden passages, remote islands and an “X” to mark the spot.  As kids, some of us hunted in our yards looking for buried treasures.  Kids today use smart phone apps for activities like “Geocaching” to explore public and urban spaces.  What do we use in Healthcare?

The single place to put a healthcareMany of us desire a chest full of clinical outcomes, protocol conformity, activity based costing, provider scorecard, genomic studies, Pharmacogenomic markers, Adverse Event analysis, and coordination of care analytics.

But lately, we have been lost – adrift at sea, hopping from one raft to another, and from one stranded island to the next more barren island.  We’ve bought point solutions that offered the holy grail for a niche activity, all while knowing the vendor or the quick fix would evaporate before we had achieved broad-based adoption.

Oh, I’ve been there – tasked with implementing the pet project for a clinical director or department chair.  I’ve no sooner got the data in and one cycle of analysis out, than the provider champion would change their focus and the solution implemented didn’t transfer to the next project. (Sigh.) Read the rest of this post »

Can you predict my future? Predictive analytics at #HIMSS14

While my interest is always in the convergence of technology like the Internet of Things and healthcare IT, the role of sensors in managing health and wellness is just exploding. 

“The most popular device functionality in the wearable tech market is heart rate monitoring, with nearly 12 million such devices shipped in 2013. Pedometers and activity trackers accounted for a combined 16 million shipments over the same period.” (According to a report released Thursday by ABI Research)

- Source: New report shows smartwatches and AR glasses have their work cut out.

the role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.

“The role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.”

You can’t turn anywhere without reading about the latest running gadgets, fitness bands, Bluetooth blood pressure cuffs, etc.  In the inevitable rush to wearable computing, one key idea can get lost: what are we doing with all of that data? 

The data produced by these devices and sensors has to be interpreted and turned into information that is actionable.  The fitness band that looks at your goal of 10,000 steps, sees that you are at 8,000 steps right after dinner and encourages you for one final walk around the neighborhood, will ultimately win out over all others.  In order to pull off that trick, we need analytics and, sometimes, predictive analytics.

Just as the sensors are working in the background without us even taking notice, the role of analytics, especially healthcare analytics, should be to inform, encourage and drive healthcare consumers to improve our behaviors or decisions without being intrusive.  The goal of healthcare analytics or informatics should be to create an environment for the healthcare consumer that makes life better, easier and more enjoyable.

An example is when the running app sees your pace slowing down towards the end of a run, then it kicks in a song with a faster pace to help you finish strong.  Today those apps require you to recognize that situation and take action of pressing a button.  It’s all there but it’s not automated.  What we need is that invisible intelligence that recognizes the situation and then takes action to assist us.

The Role of AnalyticsAt HIMSS 2014, we will be seeing this jump in interest in predictive analytics as it applies to healthcare, especially two distinct types of predictive analytics.

  1. One type is the traditional forecasting model of advanced analytics that trends past information to predict future states.
  2. The second type of predictive analytics is statistical models that encompass multiple feeds or variables to predict a future outcome.  This modeling is rapidly moving past the arena of data scientists who create the models and is moving more within the grasp of smart business analysts.  These models can predict your longevity based on multiple factors like your BMI, blood sugar readings for diabetics and other factors from your medical history.

Of course, we want to be able to predict health outcomes, especially when faced with several choices for changing our behaviors or lifestyle.  It will be exciting to see how healthcare application vendors are addressing this important next step in analytics.

The use of predictive analytics could really change the nature of a patient engagement with your doctor.  How will we react when we see the outcome of our current lifestyle?  Will we shut off Netflix bingeing and head to the gym? See you at HIMSS 2014 to find out!  Stop by Perficient’s booth #2035 and tell us what you found out!

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Database inferencing to get to trusted healthcare data

A health insurance client of mine recently embarked on an initiative to truly have “trusted data” in its Enterprise Data Warehouse so that business leaders could make decisions based on accurate data.  However, how can one truly know if your data is trustable??   In addition to having solid controls in place (e.g., unique indexes on the primary AND natural key), it is also necessary to measure how the data compares to defined quality rulesWithout this measurement, trusted data is a hope – not an assured reality. 

shutterstock_71078161To enable this measurement, I designed a repository for storing

  • configurable data quality rules,
  • metadata about data structures to be measured,
  • and the results of data quality measurements.

I experienced the need to be able to perform a degree of “inferencing” in the relational database (DB2) being used for this repository.  Normally one thinks of inferencing as the domain of semantic modeling and semantic web technologies like RDF, OWL, SPARQL, Pellet, etc. – and these are indeed very powerful technologies that I have written about elsewhere.  However, using semantic web technologies wasn’t a possibility for this system.

Read the rest of this post »

5 Reasons Big Data Improves Personalization of Medicine

I enjoyed an article today in IT Business Edge about the ways that Big Data is improving outcomes. We hear that all the time, right? But what does it really mean? Why does more (and better) patient data lead to improved healthcare for all? When business intelligence is leveraged properly to deliver insights to healthcare providers, we see the following:

  1. 5_waysLearning what we never knew before: 

    “Allowing for previously unknown factors involved in disease to be discovered and utilized as drug targets or disease biomarkers.”

  2. Comparing data points from various sources to individualize treatment plans, improving outcomes. 

    “We are able to align and compare multiple data points from various sources, tailoring individualized treatment plans for each patient.”

  3. A move from subjective interpretation to objective diagnosis.A coworker of mine said to me yesterday, “Can you imagine when our kids are older? They’ll be laughing at our stories of how doctors once said to us, ‘Based on your symptoms, I think you have [X disease].’”

    She’s right. Diagnoses vary from physician to physician based on his or her background and experience. Not any more! As this article states, we’re facing a “datafication” of patient samples.

    “A vast quantity of knowledge that can be statistically analyzed and quickly reviewed by multiple clinicians for solid diagnosis”

  4. Better – and faster – decisions about treatment as a result of more and better patient data
    “Clinicians can systematically extract more information from each patient without requiring multiple rounds of testing.”
  5.  More accurate diagnosis and more appropriate spending on treatments due to reproducible testing”Consistently reproducible test results are possible between clinicians and doctors for more accurate diagnosis and appropriate spending on therapy options.”

Identity and the Internet of Things – Lessons for Healthcare

Attending Dreamforce in San Francisco last month, I was reminded of an article I read in All Things Digital about the role of Identity and the Internet of Things.  Apparently Marc Benioff, salesforce.com’s CEO, mentioned during a presentation at the Bank of America Merrill Lynch 2013 Technology Conference,  that Phillips, the electronics company long known for staple consumer products like TVs, cameras and audio equipment, was working on a new toothbrush. The toothbrush under development was not just any ordinary toothbrush but included GPS, Wi-Fi and “realtime” feedback on how a person brushes their teeth.  Voila, no more lying to your dentist – self-quantification will rat you out with your own data.

While the concept of “The Internet of Things” like the high-tech toothbrush isn’t new, salesforce.com’s forward thinking CEO was previewing a new trend — connected devices are becoming inextricably tied to identity.  Just like my registration email at Dreamforce using a barcode to speed check-in and attendance at sessions.  My identity Internet-Of-Thingswas tied to a “thing” in the Internet of Things.  Lots of my personal devices are internet-enabled as well, connecting my identity to how far I walk for exercise, where I travel, what hotels I stay at, etc.  In the world of social, devices like the smartphone, activity tracking wristbands, etc. are creating comprehensive profiles of our “real” behaviors like brushing our teeth.

It doesn’t take a big leap to understand the impact of connecting my identity and devices on managing my health or lifestyle.  You can easily imagine a healthcare plan, like Geico does on cars, offering a discounted health plan in exchange for your comprehensive lifestyle profile, or at least lower deductibles for positive behaviors, including taking your medications on time.  The challenge will be making certain that your identity is truly linked to your proper information in healthcare systems and there are clear safeguards in place.  As the article in All Things Digital states

“And to be clear, trust-based relationships with users means that privacy must be accounted for and the right controls must be in place before businesses start collecting and using this data. With the proper opt-in/out privacy controls in place, identity-defining traits like hometown, religious beliefs, relationships status, likes, activities and social graph can be available to marketers and used to drive hyper-relevant marketing campaigns.”

As the list of connected “things” in our lives grows and uses our identity to tie our behavior profile to our healthcare management, the pressure will be increased for outstanding master data management by healthcare providers and healthcare plans.  It is amazingly difficult for healthcare companies to conquer enterprise-level master patient indexes to resolve your one identity and create a combined view of your medical history.  While your smartphone revolves around your Facebook username and password, Twitter log-ins, etc. to know you, the fragmented healthcare system must piece together that you go by your middle name, use a nickname or don’t really know your actual Social Security Number.

Master Data Management and Identity Management for healthcare is literally a matter of life and death, especially for people with medication allergies, chronic conditions like diabetes and people with medical implants like pacemakers.  Dick Chaney took the extreme step of firewalling his wireless connection on his pacemaker, for example, to block terrorists from attacking him based on his device and identity.  While we enjoy the idea of our exercise wrist band taking to our smart thermostat to cool down the house after a run, we need to understand the broader implication of this degree of connectivity into our own safety as patients.

You may laugh the next time that the hospital asks you your name for the umpteenth time or marks the site of your surgery with a marker, but identity matters in healthcare and as that industry becomes more connected like your devices, make sure that your information is correct, up to date and is “real.”  It could literally save your life.

Two Keys to Success for Healthcare

Healthcare reform, ACA, Business Intelligence, Enterprise Portals, predictive analytics, pay for performance, the Triple Aim, total cost of care, patient safety….these, and many more,  are the buzzwords in healthcare and medicine these days.  Install this system, connect that system, run these reports, use this “intelligent program”… Do you ever wonder if we can solve all of these problems with just technology?

As a clinically oriented physician working in a technology world, I need to take a step back and look at behaviors and workflow.  How can we mentor the next generation of physicians, nurses and allied health professionals, teach them skills and foster their curiosity while encouraging them to be technologically savvy? I believe there are two twisted stethescopecritical keys to success: critical thinking and decision support.  Both are crucial and neither should exist without the other.  Here’s why.

Critical thinking is an essential tool for physicians.  Physicians who have this innate ability are often the most successful at diagnosing and treating their patients well. It is part art and part skill but ultimately, it affects patient safety and wellness.  I was pleased to see that medical school curriculums are now focusing on this as a fundamental skill. According to the recent Wall Street Journal article, “The Biggest Mistake Doctors Make,” the program at Dalhousie University “aims to help trainees step back and examine how biases may affect their thinking. Developed by Pat Croskerry, a physician known for his research on the role of cognitive error in diagnosis, it uses a list of 50 different types of bias that may lead to diagnostic error”.  Couple this with technology driven decision support at the point of care, which assists but never negates clinical judgment, and you have a winning combination.  These basic building blocks allow clinicians to concentrate on their craft: diagnosing and treating patients safely and effectively.

Healthcare reform is necessary but it does not have to undermine the knowledge and experience of our clinicians.  Adding technology, such as Natural Language Processing (NLP), real time decision support, predictive analytics, patient entered data via portals, mobile healthcare management apps and yes, even Watson, can only enhance and advance healthcare, streamline treatment and decrease costs.  Simple?  Let me know your thoughts!

Healthcare Analytics for the Patient Centered Medical Home

The patient centered medical home (PCMH) emphasizes care coordination and communication between various healthcare delivery systems. This coordinated care system can lead to better quality healthcare delivery as well as a better patient experience – but in order to achieve these benefits, providers must be able to see and interpret data from across the many entities the patient interacts with.

Leveraging clinical data from EMRs, HIEs and patient devices allows organizations to:

  • Enhance access and continuity
  • Identify and manage patient populations
  • Plan and manage care
  • Provide self-care support and resources
  • Track and coordinate care
  • Measure and improve performance

Join us October 29th for the webinar “Make the Most of Your ACO with Healthcare Analytics.”  You will learn how Oracle Enterprise Health Analytics (EHA), coupled with Oracle Business Intelligence and Oracle WebCenter, fulfills the ACO mandate for a patient centered medical home.

Click here to register for the webinar.

The Business Intelligence of Healthcare

Numerous industries incorporate core concepts and methodologies of business intelligence to capture and review processed information, develop trending metrics, implement projective analyses, and transform raw data to strategic information to enhance organizational operations. The core opportunity within the healthcare industry that will benefit all aspects of the organization is establishing high standards of care for patient quality and overall healthcare delivery system performance. The integration of hospital-leftbusiness intelligence has the ability to improve standards by implementing methodologies for the maintenance of current healthcare delivery systems while introducing innovative processes that will enable continual improvement.

The foundational categories that are required to integrate an effective business intelligence system will include the capture and data transfer from raw input data files into data that can be incorporated into analytic review, reporting, and graphing presentations to render future goals and strategy. Additionally, pre-defined goals must be established to focus on core competencies and objectives. In maintaining quality and performance, a quality parameter may include accurate diagnoses and follow-up treatment for an ER visit with a mapped performance indicator being time to service and subsequent ER revisits. The incoming ER visit submissions can be aggregated to present data sets to project risk assessment for future ER visits or missed diagnoses. The core methodologies of business intelligence can be utilized to improve on clinical and business aspects of healthcare systems with planning and determined goals.

Are you really listening to your patients?

If the pressure to obtain and implement Customer Relationship Management software by healthcare organizations is any indication, decision makers are recognizing the increasing importance of consumer knowledge in the race to improve patient satisfaction scores.  Indeed, today, patient insights can lead healthcare organizations to their best opportunities for growth and restoration of profitability far more accurately than that marketing presentation in the boardroom.  The increasingly reluctant spending by healthcare consumers needs to be better understood because a healthy healthcare delivery system depends on it.  The challenge is that healthcare consumer interactions are not typically structured information that is easily analyzed to be acted upon, but are increasingly emails, phone conversations, web-based chat support and other unstructured information.

Increasingly, outbound direct mail or telemarketing is simply not getting results for healthcare marketing departments.  The focus needs to shift to creating a great consumer experience on the inbound approach as an alternative. Doesn’t everyone enjoy doing business with a company that is easy to find and obtain what you are looking iStock_DoctorPatientfor?  You don’t have to look far for proof of this idea.  No longer able to differentiate on brand reputation, leading companies instead are focusing on the consumer experience—the all-important feelings that consumers develop about a company and its products or services across all touch points—as the key opportunity to break from their competition and regain lost revenue from programs like hospital value based purchasing. Outside of healthcare, the evidence of this new emphasis is found in the emergence of the “chief consumer officer” (CCO) role across the Fortune 1000 community.  Companies such as United Airlines, Samsung and Chrysler have all implemented chief consumer officers as part of their executive suites.  Should healthcare plans and providers consider this key competitive move too?

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