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ICD-10 deadlines are looming; the Affordable Care Act is impacting the current state and future scope of healthcare; and transitioning from paper-based systems to electronic health records is still consuming a significant amount of time and budget for internal healthcare IT departments. With so many mission-critical initiatives to focus on, it is a challenge to merely maintain the status quo, let alone be forward-thinking. So where do business intelligence initiatives, which require niche expertise and resources, fit in today’s budget- and resource-strapped healthcare IT landscape?
Healthcare organizations are traditionally focused on two primary goals: improving the quality of patient care and reducing overall organizational costs. As a whole, the healthcare industry is moving from paper-based processes to utilizing information technology (IT) to record, track and transfer information. The massive amounts of data that organizations collect, including first-party data (e.g., patient information, appointment details, diagnostics as well as financials) and third-party data (e.g., insurance provider information and claims), can be leveraged to meet these goals using business intelligence (BI).
Organizations invest in BI systems to capture and analyze their data so it can be used to make smart business decisions based on accurate, up-to-date information. BI can help providers improve the quality of patient care by mitigating outbreaks through real-time disease surveillance and collecting health-related data that can both help develop new treatment insights as well as support immediate adjustments to patient care. BI can also help organizations cut costs and improve operational efficiencies; for example, systems can track staff recertification needs and connect treatments to specific outcomes, which can inspire best practices information. Using BI, hospitals can also identify new wellness and business opportunities, set and monitor performance goals, and pinpoint areas in need of quality or revenue improvements. Benefits of these boosts are reduced readmission rates, more transparent healthcare costs and achieved pay-for-performance standards—which, ultimately, enrich an organization’s bottom line.
While many other industries have successfully adopted and implemented BI systems over the past few years, the healthcare sector has instead focused on meeting time-sensitive compliance and regulatory deadlines. Since BI systems require a tremendous commitment themselves—and often hit myriad technical, cultural and financial challenges along the way—TEKsystems partnered with Healthcare Informatics to better understand where, when, why and how BI systems are currently being employed in the healthcare sector. In November 2013, we surveyed more than 250 clinical and HIT leaders in the Healthcare Informatics community, the majority of them self-identifying as providers, about BI investments, goals, pain points and partners.
For the past two years, IT leaders have named BI the No.1 trend or technology that will have the biggest impact on their organization.1 However, BI’s growing reach has not yet solidified its place in healthcare: more than half (58 percent) of all healthcare organizations have yet to implement a BI system. This segment is comprised of 36 percent that simply do not have a BI system, 15 percent that do not have a system but plan to implement one in the next 12 to 24 months and 7 percent that have a BI system but have yet to implement it. Only 42 percent have both implemented and currently use a BI system.
Organizations utilizing BI are leveraging these systems to gain insight into various segments of their business. Over two-thirds of respondents said they utilize or expect to utilize BI in IT, finance, operations and clinical care. More than half have also used BI for compliance and nearly one-third have used it for human resources. The scope of BI use in healthcare shows that the industry appreciates the value of BI-based decisions across the entire organization
The market for BI in healthcare is fairly wide open. Organizations are using a multitude of BI systems to meet their data needs. While there are about five vendors that represent nearly half of all systems in use, each account for a similar percentage of market share. Even though there may not be a clear market leader in healthcare BI systems, HIT leaders overwhelming agree that the systems they do want should have comprehensive reporting options. More than three quarters (76 percent) want pre-built, custom and ad-hoc reporting. Given that BI remains a fairly new concept in healthcare, having a system flexible enough to meet all of these needs, including analytical paradigms that may not have been imagined yet, is critical to ensuring that organizations are getting the most out of a rather significant IT investment.
Healthcare IT leaders have several goals when it comes to how they will use the information acquired through their BI system. Nevertheless, nearly half of respondents (48 percent) agree that they want to improve data availability and completeness. Excellent data warehousing technologies can ensure data availability, meaning that data gathered is able to be duplicated and found during both normal and abnormal situations. Data completeness assures that all the data required to accurately meet the needs of the organization is available in the source system’s data resource. The focus on available, complete, quality data leads to healthcare’s biggest IT challenges: figuring out data complexities and finding the skilled resources to do so.
Although implementing BI in healthcare comes with a multitude of challenges, healthcare IT leaders name data complexities (34 percent) and a lack of resources/skills (32 percent) as the biggest challenges to reaching their BI goals.
The data complexities organizations face include diverse data types, a lack of standards for data entry and multiple types of systems producing data from first-party and third-party systems; most of which are electronic, yet some are still paper-based. While the large number of systems increases the amount of data collected, it also introduces problems when the information can’t easily be shared and compared across systems, which is necessary to create robust, insightful reports.
IT leaders also note a lack of standardized data structure and standards both internally and externally, which further challenge report accuracy and interoperability. Another concern is analysis requirements and the associated level of complexity. Organizations aren’t aware of what information is most necessary to gather and compare, or how to do it. If organizations don’t overcome these challenges, the data collected won’t be maximized and thus will yield minimal return on investment.
Lack of Available and Skilled Resources
To help make sense of data complexities and ultimately attain the ROI they desire, organizations require the right people. For BI implementations, the roles in highest demand are solution architects, data analysts and data scientists. These highly skilled IT professionals not only need the technical capabilities, they also need the healthcare experience to understand the nuances of the industry.
That is most likely why healthcare organizations are looking first within their organization for data-related skill sets. However, they’re coming up short; over 60 percent identify either a lack of in-house experts or a lack of available internal resources due to other higher-priority programs. These other initiatives, such as ICD-10 conversion or ACA compliance, have larger budgets and are usually connected to financial incentives or penalties, giving them higher priority. The lack of skilled resources—or available ones—to assist with BI implementation is holding organizations back.
In looking at the state of the healthcare BI market—its scope, use and goals—two clear themes emerge. First, organizations see the value of BI and want to make the most out of their systems. They recognize and anticipate, however, the many issues surrounding data, including concerns regarding having usable, quality data available to their systems. Second, many organizations are clearly apprehensive about having adequate resources on hand, both in terms of staff and budget, to make the most of their data and BI investments.
Over two-thirds of healthcare organizations are looking to external partners to help them address these challenges. Interestingly, their partner preference varies by healthcare organization type. Medical clinics / group practices / ambulatory care centers are most likely to partner with IT services vendors (58 percent). Hospitals are most likely to partner with healthcare services vendors (53 percent), and integrated delivery systems are most likely to partner with software vendors (49 percent). With no clear-cut preference, a healthcare IT provider with consulting, assessment and workforce management capabilities may make for the best BI implementation partner.
Pre-implementation assessments can help organizations figure out their data complexity challenges so they can meet their end goals. Skilled providers are able to conduct detailed assessments to help make this possible. Assessments can include defining the company vision, aligning processes, integrating first- and third-party data, identifying key metrics and data points, performing gap analyses, and developing a customized implementation process that can help the organization achieve optimal results from their BI systems.
By partnering with these providers, organizations can understand both their current data needs, as well as their future goals. With so much data coming in, these experienced partners can help prioritize data needs and accurately plan for resource and budget requirements. Also, they can help identify the technologies that best align to that organization’s specific needs and goals—traditional tools that offer high-quality, pre-built options, as well as newer, more agile solutions. Either way, a skilled HIT partner can design a solution best for the organization. By getting a better understanding of their needs and priorities—before investing—healthcare organizations can feel confident with a more defined course of action that will help reduce costs and optimize their current infrastructure.
While many organizations report a lack of skilled resources for BI implementation, they do understand that there are a fair number of qualified IT staffers available outside their organizations, recognizing that finding staff with implementation skill sets—e.g., a qualified business analyst or data analyst—is only “moderately difficult.” Quality data architects are perceived as “very difficult” to find, while project managers are only “somewhat difficult.” It would seem that healthcare organizations face a bigger challenge in allocating the resources to hire the right people to help implement BI systems than in not finding people to bring on board at all.
Organizations are approaching these challenges in a variety of ways. More than 40 percent of HIT leaders seek consultation from outside vendors, while 36 percent use a software vendor to meet resource needs. Some hire permanent staff or contingent labor to help support implementation (35 percent) while a small number plan to or are fully outsourcing BI implementation (8 percent). It is important to note that most times organizations aren’t using only one course of action; they are utilizing a combination of these resources to meet their overall goals. Less than one-third manage everything in-house (32 percent). Ideally, organizations are looking for partners who can do it all—offer the high-level expertise to design a customized approach for their BI implementation, provide them with skilled resources to carry out the implementation, as well as support and train end users post-implementation
Healthcare organizations clearly see the value of such systems in leveraging analytics for better business decisions. They want systems that can do it all, so that they have accurate information to both improve the quality of care and cut costs across the organization. But while the potential value of BI is clearly evident, organizations are also well aware of the challenges inherent to such big system implementations. Time and time again, concerns about data quality and stretched resources are expressed, suggesting that while organizations have big hopes for BI, they are apprehensive about the fiscal, technical and cultural issues that too often accompany it.
To help deal with those issues, healthcare organizations require—and are actively seeking—dedicated HIT providers that can do it all. They want HIT staffing and services partners that have reliable experience with these challenges and can assist in anystage of their BI initiatives (e.g., consulting, assessments, planning and/or implementation). BI initiatives often ask for significant upfront investment, and if healthcare organizations are paying, they don’t want to be boxed-in to solutions—they want flexibility. This agility extends from the technologies they can work in, as well as the number and skill sets of resources they can provide, so they can scale and match the exact needs of that particular healthcare organization.
Health Informatics conducted a survey of clinical and healthcare IT leaders across the United States. Of the more than 250 leaders surveyed, 79 percent of respondents work for a healthcare provider organization. The other respondents included healthcare/IT consulting firms (11 percent), public health (6 percent), physician organizations (3 percent)and pharmacy/lab/imaging centers (1 percent).
12014 IT Annual Forecast, TEKsystems