Business Intelligence, often referred to as BI, is truly an emerging endeavor in health care. Many industries are fairly mature with respect to internal corporate BI, and the new, emerging technology relates to working with vast data sets to identify the market and identify customers. Data analysis and measurement facilitated by BI is what leads to better decision making within any organization.  Health care is clearly in a different position with regards to the maturity of BI tools available. This is not surprising since the tools for data collection, namely electronic health records (EHRs), are relatively new in the health care environment. 

Health Care and BI

Health care BI technology is relatively immature, and due to this immaturity, time should be taken to really understand your organization’s needs and what you want to get out of your business intelligence system. Most EHRs come with BI tools that are sold as a solid set of tools for the management of your clinic and/or integrated delivery system. The promise of this sales pitch is rarely fulfilled, so make sure you review the functionality used by reference customers and consider if the included package will meet your needs.

Common Pitfalls with BI System Implementation

One problem is poor planning at the time of the implementation. It is important to assure that the reports you need have data structured in a way that allows reporting. Another common problem is that you are unique; your health care organization is probably not like most of the clients your vendor serves. Therefore, the reports that are prepackaged do not necessarily replicate your needs well. If your vendor (or your hosting organization) specializes in meeting the needs of clinics like yours, you are much more likely to have a majority of your BI needs met with pre-packaged reporting tools.

Time Commitment and Staffing

Most clinics should expect to spend significant time working with these tools to get the reports that you desire. The majority of BI tools are fairly difficult to use and require special expertise. Plan on hiring a staff member with these specialized skills at the time you implement your EHR. To the extent you plan well, this staff can help you with the implementation and ensure that data is captured in a way that facilitates reporting.

New Rules and Vendor Selection

With the implementation of meaningful use, more reporting options and metrics are built into EHRs. This will continue to expand with Stage II rules that have now been released. These new rules have been rolling out quickly, and the vendors have been hard-pressed to meet these requirements. You should expect the measurement tools to be focused on the exact needs described in the meaningful use rules, and many vendors provide little flexibility in this area.

When working with your vendor, ensure that they are certified by the Office of the National Coordinator for Health Care Information Technology (ONC). You can look up your vendor (and their product offering) at the Certified Health IT Product List. As part of the certification process, the vendor must prove that they can produce a small set of metrics; this subset is listed on the certification page.

Where are EHRs Failing to Meet Organizational Need?

There are several areas where the EHRs are failing to meet many organizational needs:

1. No ability to capture data from outside sources. Many of the EHRs have no tools to capture data or measurements from external systems and integrate this data for reporting of metrics.  Examples include retinal exams for diabetics: these are often done outside of primary care. The data needs to be hand-entered into the EHR to get credit. Most EHR data tools do not do a good job of importing this type of data, and health information exchanges may not format the data in a way your EHR can use for reporting.
2. No ability to compare across multiple like organizations. Most vendor tools do not include a mechanism to compare your performance with like organizations. Ideally, you would be able to tell how your performance looks compared to a facility like yours on a plethora of clinical, patient satisfaction, and performance metrics. Clinics usually have to buy this functionality from a membership organization or a hosting organization and build interfaces to deliver the data to these services to compare results. A few vendors are now providing benchmarking with national standards like NCQA for clinical quality or MGMA for financial or performance measures.
3. Population Health functionality is improving in EHRs but is still not as effective as  you would expect.  Population Health is comprised of both disease management and prevention services. Few EHRs have effective automated reminder tools. As mentioned above, many of the screening services may occur outside the clinic, and processes need to be built to import or enter the data into reportable fields in the system to keep the reminders relevant and specific. Most clinics continue to use the BI tools for these functions, and many clinics purchase a third-party tool to manage this function because the internal tools are not capable of meeting these functions to their satisfaction.

Summary

BI tools, while key to any organization’s efforts to access and analyze real-time data, can be complex tools to use and support. Most EHRs have a BI tool included, but these tools may not provide the support that you expect and may not perform as well as they appear in the demonstration of the system. Many clinics augment the EHR investment with other investments in BI, especially where data from outside sources is critical to performance or population management functions. THQLink L3C provides data aggregation and analytics services to organizations looking to gain Primary Care Medical Home certification or to achieve better population management and performance benchmark functions.

About Clayton Gillett: Prior to working for THQLink, Clayton was the Executive Director the Regional Extension Center for Oregon and has held several senior leadership positions in EHR hosting companies or integrated delivery systems. He also has worked as a consultant for a large independent firm providing strategic advice, implementation assistance, and general consulting services to integrated delivery systems, MSOs, hospitals, and large group practices. 

Previous articles from the OHN series:

OHN's 12 health IT best practices, part 6: Tech support

OHN's 12 health IT best practices, part 5: Information

OHN's 12 health IT best practices, part 4: Implementation

OHN's 12 health IT best practices, part 3: A strategic checklist for connectivity

OHN's 12 health IT best practices, part 2: Collaboration.

OHN's 12 best practices for health IT, part 1: Strategy and planning