Health care business intelligence in a clinical setting

This tip discusses clinical uses of business intelligence systems including quality reporting, claims analysis, evidence-based medicine and patient registry analysis.

When faced with meaningful use requirements, as well as mandates from the Centers for Medicare and Medicaid Services,

the Centers for Disease Control and Prevention and other regulatory bodies, hospitals must constantly evaluate and review their data to ensure compliance and quality of care. For health care, business intelligence (BI) is an important investment.

There are several areas in the clinical setting that can benefit from the use of BI tools and data analysis. (A separate tip explains how health care organizations can use BI for evidence-based decision making  pertaining to financial performance, productivity and customer service. There is also a separate tip that covers common data analysis methods, which help C-level executives and physicians alike make key decisions.)

For some time now, health plans have implemented pay-for-performance (P4P) programs to give providers an incentive, usually monetary, to improve quality of care. In addition, many health plans have made this information available to patients. This is an example of health care business intelligence being applied to claims data submitted to payers and then utilized to generate ranking and score cards. This information does ultimately influence a patient's care decisions, not to mention reimbursement levels for physicians.

The best way to describe the effect that evidence-based medicine can have on patient outcomes is to cite the example from Evidence-Based Medicine: How to Practice and Teach EBM. The book's authors described the story of flecainide. This medication was widely accepted as a successful heart attack treatment until physicians reviewed patient outcomes over an extended time period and concluded that flecainide was killing more patients than it was saving. In short, access to patient information pertaining to specific treatments can save lives.

A powerful application of health care business intelligence is the analysis of data available within different patient registries.

For evidence-based medicine to succeed, information must be shared and analyzed. This allows researchers to apply BI to efficiently identify specific patterns and trends in patient's responses to certain treatments and then publish their findings in order to improve care.

Another powerful application of health care business intelligence is the analysis of data available within different patient registries, which contain information about patients with common conditions.  Whether it is a renal registry, tumor registry or chronic care management registry, the information therein can be analyzed once it has been collected in order to identify quality improvements from specific treatments. Patient registries can also be used to review overall patient population trends over time and respond to specific treatment models accordingly.

For many eligible hospitals, receiving money from the Electronic Health Record (EHR) Incentive Programs requires reporting on meaningful use hospital quality measures. In some cases the information may be available through a hospital information system or certified EHR system; however, in order for an organization to monitor its progress in addressing quality measures over time, BI tools will be needed.  Aside from meaningful use, other quality measures that hospitals must address are listed by the National Committee for Quality Assurance (NCQA), the Physician Quality Reporting System (PQRS) and The Joint Commission. 

Finally, BI would be a crucial component for any accountable care organization, as those groups will need to identify, measure and provide insight into the effectiveness of the collaborative care model, including how well the group and individual physicians are performing within the ACO. BI would also serve as the basis for reporting on the as-yet-undefined quality measures that will quantify the success of collaborative care.

Reda Chouffani is the co-founder and vice president of development at Biz Technology Solutions Inc. Let us know what you think about the story; email editor@searchhealthit.com.

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This was first published in October 2011

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