Performance Optimisation for Healthcare Providers ... · PDF fileGeorge Eisenberger World Wide...

1 © 2009 IBM Corporation

Building a smarter planet: Healthcare

Performance Optimisation for Healthcare ProvidersPerformance Analytics and Business Intelligence For Organisational Agility

George Eisenberger

World Wide Software Group Healthcare Architect

IBM Software Group



2 7/14/2009

Health Analytics an Emerging Focus



Health Analytics a New Wave• Globally, healthcare organisations have made substantial investments in information

systems to improve quality and operations efficiency.

• These investments will continue but now these healthcare organisations need to begin to get value and intelligence from these investments.

• This is a wide open emerging market with no end to end solution leader today

3 7/14/2009

Clinical and Business Automation

(Transactional)

Clinical ProcessTransformation and Transactional Systems

USA

2002 2003 2004 2005 2006 2007 2008 2009 2010

Japan

UK

India

China

Health Analytics

Clinical and Business Optimisation

(Integrated Infrastructure and Analytics)

2011 2012

Growing Market (Large # of analytic applications)

Market Consolidation



PAYERPROVIDER

Includes HIIG, HIF, GTS/Integrated Communications, IT Governance, Hospital

Expansion & Construction, Security, Green, Virtualisation, IBM

Systems/Storage

Core SystemsModernisation

(Claims,Payments)

Clinical and Business

Transformation

Core Business Process

Effectiveness

Enterprise Health Analytics(Analytics and Business Performance)

Quality and Business Performance

Collaborative Care

Infrastructure Effectiveness and Efficiency

Cost Effectiveness, Operational Excellence

Content, Images, Records, Forms Lifecycle Management

Data Integration

Quality & PerformancePublic Reporting

Quality StandardsDrug / Patient Safety

Chronic Disease Management

QualityOutcomes

OperationalEfficiency

Data Management

Cost EffectivenessBusiness Process Optimisation

Business Value O

utcomes

Health Integration Framework(SOA, Data Management and Business Process Framewor k)

IBM Healthcare strategic priorities and solution focus

Patient, Physician and Member Services(incl. Patient Centered Medical Home,

Health Information Exchanges)



5 7/14/2009

Health Integration Framework

Industry Relevance



Health Integration Framework – High Level

6 7/14/2009

IBM Health Integration Framework

Healthcare and Life Sciences Extensions

Key Software Group Products

Data and Process Models

Interfaces and Adapters

Tools

Portals and Portlets

Information Management Lotus Rational Tivoli WebSphere

IBM Services Assets and Delivery

IBM Solutions

Healthcare

Payer

Core Systems

Modernisation

Healthcare

Provider

Health

Analytics

Life

Sciences

Regulatory

Compliance

Business Partner Solutions

Healthcare

Payer

Claims

Adjudication

Healthcare

Provider

Clinical

Information

Systems

Life

Sciences

Drug Discovery

Optimisation

ISV Ecosystem

our healthcare provider, payer and life science solutions

Reference

Architectures

Initial focus on healthcare

provider and payer segments



• Provider and Payer Analytics• The aggregation and analysis of information across a healthcare enterprise, to improve

clinical, financial or administrative outcomes and results.

• Patient and Clinician e-Views• Using a portal-based user interface for the aggregation of information across a

healthcare enterprise, provider or payer, to create custom views depending on role and providing new services.

• Integrating the Healthcare Enterprise (HL7 ESB)• The integration, exchange, and sharing of information across a healthcare

organisation. This can involve the integration of multiple systems within a single hospital, or within an integrated delivery network.

• Health Information Exchange (HIE)• The exchange, sharing and usage of information across multiple healthcare

organisations, region, or community of interest.

7 7/14/2009

HIF Solution Focus



IBM’s Foundation Tools and Runtime Landscape

BUSINESS AND TECHNICAL METADATA

INDUSTRY CONTENT

MDM

WORKBENCH

DATASTAGE / QUALITYSTAGE INFOSPHERE WAREHOUSE

RATIONAL DATA

ARCHITECT FASTTRACK

METADATA

WORKBENCH

BUSINESS

GLOSSARY

INFORMATION

ANALYZER

InfoSphere Foundation Tools

MDM SERVERS

Core measures / Workbench

Quality Reporting

Patient Safety

Dashboard

Diabetes Management

Operations and KPI

Dashboard

User Interface

Cognos BI

DB2 and Balanced Warehouse

Data Layer

WebSphere Application/Portal ServerWebSphere Portlet Factory

Clinical Systems

DataIntegrationLevel

BI Level

GBSSWG Services

InfoSphereCDW

Metadata

BusinessGlossary

Datastage

QualityStage

WSTX+HL7

Adapters

Siemens GP Apps McKesson

Governance

Analytics for patient throughput and access

Identify, track, analyse report by disease for population studies

Track, analyse, report adverse drug events, other events

IBM has assembled a strong base of capabilities an d partners to create end-to-end, differentiated offerings around Enterprise Healthca re Analytics



Health Care Industry Data Models and Architecture



� Fully integrated Dev. Platform� Server + Clinical Data Warehouse

+Solution Templates + Tools + Dashboard

� Solution’s unique features:� Create longitudinal record from

inpatient, outpatient, specialty and ambulatory care setting

� Patient record De-Id and Re-Id � Data validation 900+ Programs � Medical vocabulary mapping� MPI mapping� Cohort screening� Analysis of whole organisation down

to physician and patients

IBM Clinical Data Warehouse (CDW) Platform

BalancedWarehouse

Server

Clinical DataWarehouse

InfosphereWarehouse

Edition

CognosData Mining& Analytics



IBM Clinical Data Warehouse Delivers

• The Value Proposition:– A full feature clinical analytics development platform that is uniquely

available for on-premise installation and can be in a production state within weeks. It is designed to meet a wide array of clinical and operational needs while integrating seamlessly into a provider’s healthcare IT environment.

• CDW Clinical Solution Templates: – Fast deployment of powerful, clinical ad-hoc query environments– Rapid development of disease profile solutions that provide population

based analysis with the ability to drill through to the patient or encounter detail

– The ability to turn information into actionable insights for Physicians, Medical Directors and Patient Quality advocates



The Value of Enterprise Healthcare Analytics with the IBM Clinical Data Warehouse

• Start with proven technology – The value of mass customisation

• Obtain additional value from your considerable CIS investment bycreating a corporate data asset

• Population-level analysis, not just survey data ties process changes to patient outcomes

• Support evidence-based practices

• Provide new tools to providers to improve treatment

• Monitor and manage operations on a more timely basis: Operational in as little as 16 weeks



Mapping –

Validation -

Norm

alization

Data Sources

Consolidate Clinical Data AcrossEntire Organisation Into‘Single Enterprise Trust’

Disease Cubes

Hospital

Hospital

Clinic

Clinic

Analysis

Operations

Sep

arat

e S

yste

ms

& S

iloed

Dat

aHealthcare Analytics Architecture

C3 C2 C1

X

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Y

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C3 C2 C1

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A

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AC3 C2 C1

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C3 C2 C1

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AC3 C2 C1

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Analytic E

nvironment

IBM / CDW

LocalVocabulary

Dashboard

PatientSafety

OutcomesAnalysis

Quality Improvement

PhysicianPerformance

QualityImprovement

Car

e &

Ops

Im

prov

emen

t

ComplianceMonitoring

C3 C2 C1

X

X

Y

X

X

Y

X

X

8

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5

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1

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B

B

A

B

A

A

A

C3 C2 C1

X

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Y

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Y

X

X

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B

B

B

A

B

A

A

AC3 C2 C1

X

X

Y

X

X

Y

X

X

8

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5

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1

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B

B

A

B

A

A

A

C3 C2 C1

X

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Y

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NormalisedVocabulary

MEDITECH



Enterprise Analysis Use CasesDomains Use Case Subject Areas

Exploratory Analysis Exploratory Analysis

Cohort IdentificationCohort Identification

Patient Flow / Capacity ManagementPatient Flow / Capacity Management

Service Line MeasurementService Line Measurement

Business AnalysisBusiness Analysis

Identify Variations in Healthcare DeliveryIdentify Variations in Healthcare Delivery

Quality & Best PracticesQuality & Best Practices

Outcomes Management; e.g. diabetes, surgicalOutcomes Management; e.g. diabetes, surgical

Safety & SurveillanceSafety & Surveillance

Clinical Trial Study Design Clinical Trial Study Design

Patient RecruitmentPatient Recruitment

Clinical Use Cases

Clinical Use Cases

Business Use CasesBusiness

Use Cases

Research Use CasesResearch Use Cases

CDW



15

OLAP

Delivery of trusted information through IBM CDW

• Unlocking data from– Databases– Repositories– Spreadsheets– Application silos – Sensor Networks

• Bringing it all together in a meaningful way– Information Integration – ETL, CDC, Replication, Federation

• Improving its Quality– Cleansing, standardising, enriching, semantic reconciliation– Controlled Vocabularies

• Getting to one version of the truth– Master Data Management (EMPI), Data Warehouse

• Delivering it where needed– Information Integration, Business Dashboards, SOA

SOURCE SYSTEMS

DATAMARTS

INFORMATION INTEGRATION

WAREHOUSE

REPORTS

MASTERDATA

Dashboards

CIS

HR

GL/AR

CDW

EMPI



High Level Data Model for Clinical & Operational Data

PatientCharacteristics� Age� Gender� Race� Geography

ICD-9/CPT� Diagnosis� Procedure� DRG (inpatient)� Date/time

stamp� Encounter link

Pharmacy� Days Supply� Refill #� Ordering MD� Dose/Strength� Route� NDC

Laboratory� Orders & Results� Microbiology

Encounter� Admit info� Discharge info� CCR� Dept, Facility ID� CPT Codes

Provider� Specialty/Sub� Admit/Attend� Cons/Order� Prescribing� Procedural

Insurance� All Payers� Plan ID

Medical Devices� Mfg. Name� Model, type� Serial number� Implant date

Financial� UB Data� 1500 Data� CPT Codes� Facility ID

G/L and HR� Productive FTE

Nursing Notes� Height, weight� Blood pressure� Temp., HR, RR

Facility Details� Inpatient� Outpatient� Geography� Urban/Rural� Department

Pathology

Clinical Data Model

C3C2C1

X

X

Y

X

X

Y

X

X

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B

B

A

B

A

A

A

C3C2C1

X

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Y

X

X

Y

X

X

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A

A

C3C2C1

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Y

X

X

Y

X

X

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B

B

A

B

A

A

A

C3C2C1

X

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Y

X

X

Y

X

X

8

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B

B

A

B

A

A

A C3C2C1

X

X

Y

X

X

Y

X

X

8

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B

B

A

B

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A

A

C3C2C1

X

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Y

X

X

Y

X

X

8

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B

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C3C2C1

X

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Y

X

X

Y

X

X

8

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C3C2C1

X

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X

Y

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B

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A

A

A

EMR� Problem list� Med list� Allergies� Chief complaint

Imaging studies



Emerging Healthcare Analytics Requires Longitudinal Patient-Centric Data Combining Primary and Acute Care

Primary Care(Physician

Office, Pharmacy)

Acute Care(Emergency,

Inpatient, Outpatient)

TimeA Patient’s Longitudinal Medical Record



Evidence-based Analysis Supporting Improvements to Financial and Clinical Performance

• Practice Pattern Analysis– Analyses physician practice patterns. Conduct comparative analysis

to identify performance best practices

• Clinical Cost Decision Support– Measures and views clinical performance across multiple

perspectives to optimise resource utilisation, cost effectiveness, and evidence-based decision-making

• Early Disease/Condition Management– Uses predictive modeling techniques to identify high-risk patients and

to proactively intervene and optimise care across populations



Example Provider Analytic Use Cases

• Patient Demographics Analysis• Patient Readmission Analysis• Disease Management: clinical alert creation• Chronic Disease Management: personal diabetes report card• Chronic Disease Management: self care patient reminders• Chronic Care Education Program: patient referrals• Patient Safety: adverse drug events• Outcomes Analysis: best practice identification• Treatment Strategies • Regulatory Analytics & Compliance• Quality Improvement: Analysis & Reporting• National Comparative Benchmarking• Episode Analysis: Program Evaluation• Physician Performance: MD profile/scorecard• Pay for Performance• Financials by Disease or Service• Resource Utilisation• LOB Revenue Analysis



Actionable Analytics for Management

Valley Community Hospital

Powered by:



21 7/14/2009

Ability to see how Cross River Diabetes Clinic is trending on all NCQA measures can be displayed as well



Sample Dashboard

7/14/2009



Top 10 Procedures Performed

23 7/14/2009



Health Care Provider Reference Architecture

7/14/2009



A Progress Report:Leveraging the Web Presence with Clinical and Patie nt Portals

Tony Bosselait

World Wide Software Group Healthcare Executive

Chief Technology Officer

IBM Software Group



Integrating silos of information across healthcare is critical to better patient care and improved performance/satisfaction

Laboratory

Radiology

PharmacyClinical records

EMR

Financial



United States Hospital EMR Adoption Progress – 03/2009

Organisations

further

along

are

doing

more

Integration

(not less)



Value expected by surveyed Clinicians:



Clinical Care Systems

Lab/Medical Records Systems

Imaging Systems

Patient Admin Systems

Financial & HR Systems

Collaboration, e-mail

e-learning - CME

Patient enabled Systems

Content (articles, manuals...)

CPOE

People Finding - expertise

Examples of clinical & patient information needs:

Patient View Clinician View

Consumer View Employee View

Pre –

Admissio

n

FormsFind a Dr.

& Schedule

Bill Payment

Change

Demographics

View

Appointments

Common

Portal

Clinical Systems Access

HR Self Service

Secure

Chat

QualityDashboards

Get

Results

JobInfo

Get Medical

Info

CE/CME

Learning



PORTALPLATFORM

[Why] A Single Portal Platform and Framework [Borrowed from Trillium:]

PatientsPatients ProvidersProviders

EmployeesEmployees

Portal software connects all stakeholders enabling communication, collaboration, process efficiency, orchestration and workflow opti misation and information

sharing.

90 % of content & multipleportlets re-used

50 % of development time

Resourcingincremental from originalinvestments



Other Examples of Healthcare Portals

Memorial HealthSystem

Duke MedicalUniv. of TexasCancer Therapy &Research Center

Mayo Clinic

Richardson RegionalMedical Center

CatholicHealthcareWest

OttawaHospital

TrilliumHealthCentre



An Enterprise Portal for Patients, Employees and Physicians

Enterprise Portal Framework

Common Infrastructure

Enterprise Portal FrameworkEnterprise Portal Framework

Common InfrastructureCommon Infrastructure

PatientsPatientsPatients EmployeesEmployeesEmployees PhysiciansPhysiciansPhysicians



Demonstration of the Clinical Portal:



General Practitioner (Hospitalist) Census View



General Practitioner (Hospitalist) Portal Page



Surgeon’s view – same portlets - personalised



Proactive Alert View – Core Measures example



Obstacles to Portal Implementations

Source: Healthcare Informatics Feb 2009



Key to success: Use ‘Launch and learn’ to maximise benefits:S

trat

egic

Bus

ines

s an

dT

echn

olog

ical

Val

ue

Time

PHASE n

SolutionMicro Design

Build

Pilot

Deploy &Improve

Extended PortalSolution

Micro Design

Build

Pilot

Deploy &Improve

Extended Portal

SolutionMicro Design

Build

Pilot

Deploy &Improve

Extended Portal

SolutionMacro / Micro

Design

Build

Pilot

Deploy &Improve

Basic Portal

InitiateAssessment &

Strategy

Phase 1 Implementation• Bills on line• Payment• Scheduling

Phase 1 Phase 2 Phase 3

Phase 2 Implementation• Labs• PHR

Example Approach: Multi-Phase, Iterative Rollout Strategy

Physicians Nurses Employees Patients…

“Never eat more than you can lift”



40 7/14/2009

Thank You

Q & A

Performance Optimisation for Healthcare Providers ... · PDF fileGeorge Eisenberger World Wide...

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