Automated systems are used by healthcare organizations to perform many tasks, but the common element all of them have is generating and collecting data. And therein lies the challenge: How does an organization use that data to its best advantage?

Makers and users of business intelligence systems say that question is at the core of what they do.
“There is a lot of intertwining between business intelligence and data analytics – it depends heavily on data aggregation,” said Jeanne O’Kelley, senior vice president of Arlington, Va.-based Vangent’s Technology Excellence Center. “It’s all about how to make sense of data.”

Together with Santa Clara, Calif.-based Sun Microsystems, Vangent participated in the recent Integrating the Healthcare Enterprise North American Connectathon and HIMSS09 Interoperability Showcase. The demonstration focused on the value of open source, standards-based technologies to facilitate critical healthcare information sharing.

As a 30-year veteran of the healthcare industry, O’Kelley says she has seen the data management evolution up close. Over the arc of three decades, she said data flow has increased exponentially with technology advancement.

“We’ve always been able to make sense of data, but now it’s at the point where there is so much that it has become impossible to manage,” she said. “We have to detect the patterns and make sense of them.”

Interoperability and open source technology represent significant leaps forward in automation capabilities for the healthcare industry, O’Kelley said, though she added that this phase is just beginning its development.

“Different organizations have different degrees of maturity,” she said. “It’s still pretty early. When your goals are to improve access and quality of healthcare while improving cost effectiveness at the same time, that’s a big job.”

Data at the Core
At a fundamental level, repurposed data is a key facilitator of provider revenue management. For the past year, Exeter, N.H.-based Core Physicians has been using a business intelligence system to aggregate data from across its network in southern New Hampshire.

As the largest primary, specialty and surgical care physician network in the region, Core Physicians includes 130 providers and 26 practice locations. Affiliates include Exeter Hospital, Synergy Health & Fitness, Rockingham VNA and Exeter Healthcare.  
Angela Parisi, director of revenue, says the business intelligence system from Duluth, Ga.-based Navicure has helped her department get “ahead of the curve.” The Navicure system dovetails with other enterprise-wide initiatives, such as electronic billing and electronic medical records.

“Our big challenge is controlling denials, with charges entered at the physician practice locations and claims processed at the centralized billing office,” she said. “What the system does for us is create a snapshot of categories for denials. There are two phases of denials – at the clearinghouse level from Navicure and at the payer level. This is helpful because we can look at the data and see what we’re doing wrong with charge entry, coding, insurance card information or demographics. We can catch those errors and educate people in the front office on the right way to capture information or enter charges so that claims will process smoothly.”

Reliable intelComputer giant IBM has been involved with business intelligence systems for many years and boosted its efforts in the field with the acquisition of Burlington, Mass.-based Cognos in November 2007. Sue Noack, global industry director for IBM Cognos, says as systems have advanced, their capabilities have more of a “performance management” aspect to them.

“We’ve defined performance management around its decision-making capability – how the provider is doing, why things are happening and what they should be doing,” she said. “It’s about having insight into your business, understanding what you’re doing well and what you can do better.”

With all the dynamic changes occurring in healthcare – namely an emphasis on cost management due to the economic recession and stimulus funds aimed at bolstering IT, electronic health records and interoperability – provider organizations need to attach greater importance to business intelligence systems, Noack said.

“We have reached a critical juncture where it’s important to understand what’s really happening and to be more agile about changing operations,” she said. “Healthcare needs to adopt performance management discipline now rather than later. In that construct, they need to look at how their business operates and how technology can assist with cost reduction, gaining efficiencies, the quality of care and alignment of clinical processes.”