Executive decision, clinical precision

By Mike Miliard
02:51 PM

Executive information systems deliver crucial metrics to the C-suite

Managing a hospital's operations means dealing with data. Lots and lots of data. That's where executive information systems come in. And as healthcare moves towards hugely different paradigms of care delivery and reimbursement, they're only going to become more crucial to efficient operations.

An executive information system (EIS) isn't the same as business intelligence (BI).

"BI is an executive information system on steroids," says John Hoyt, executive vice president of HIMSS analytics.

Instead, the goal of such systems is to take disparate data streams and present them to the CEO in a simple, eye-catching dashboard. HIMSS describes the software as a tool that can "integrate, process and present key operational performance data to executives in an easy‐to‐learn and highly user‐friendly format."

"The entire purpose of an executive information system is to gel down all this data, the 10 or 15 or 20 operational key performance indicators," says Hoyt. "If you're a hospital CEO, every morning when you walk into the office, one of the thoughts on your mind is, 'What's the census today? I've got this 500-bed hospital, how many patients do I have in there?'"

That's just one example of what might be presented via these dashboards. Also, the numbers relayed evolve depending on the economic imperatives of healthcare. "They could be different in 2012 than they were in 2009," says Hoyt.

Other key performance indicators (KPIs) could include total patient revenue, operating margin, surgical volume, health plan operating margin, visits-per-day at ambulatory practices, length-of-stay, readmission rate, Medicare operating margin, Medicaid operating margin, commercial operating margin and so on.

Some systems measure quality indicators, as well – such as those for hospital-acquired infections. Patient satisfaction and staff satisfaction are gauged, too. Dashboards could also include "physician profiles, practice patterns, admission and dollar volume contribution rankings," the HIMSS definition notes. "It is more than just standard or customized reports generated by HIS."

Hoyt emphasizes that an executive information system doesn't generate data, but simply integrates and presents it for easy daily check-in by the C-suite. "The whole idea is to give you your color graphs," he says. "You ought to be able to look at an EIS in 15 minutes and know whether this is going to be a bad month or not. … This is not CEOs sitting down at the keyboard and writing a bunch of Excel reports every day. It's 'push a button, and up comes data.' That's the 'executiveness' of it."

Even as they gather disparate data from "multiple, multiple, multiple systems," says Hoyt, most EIS set-ups come from a single vendor. MEDITECH and McKesson are the leading vendors, at 18 and 15 percent, respectively.

EIS systems are "increasingly more difficult to implement, as organizations increasingly have more vendor systems," says Hoyt. "Let's pretend you've got an 80-bed hospital that's running everything on MEDITECH. It's pretty easy to set up."

On the other hand, if you have an 800-bed hospital with a Cerner lab and with Epic used here and MEDITECH used there, things can get challenging. "Then you have to gather data from all these sources, and do data normalization to make sure MEDITECH and Cerner are still using the same ICD-9 tables and so on," he says. "It's more complex."

Many EIS dashboards are homegrown, however. Self-developed systems account for 12 percent of those in place, according to HIMSS Analytics. After all, customizability is key, as hospitals of different sizes and types have such widely divergent needs. "An 80-bed hospital is probably not going to own a health plan," says Hoyt.

Indeed, small hospitals stand to be the some of the bigger adopters of EIS systems, going forward (see sidebar). And their implementation numbers could rise, in part, since the systems are sometimes installed as "negotiable throw-ins" to other enterprise-wide IT systems.

An EIS is "one of those things that's not that hard to develop, honestly, because the feeder systems are making the data," says Hoyt. "They just go out and pick it up and present in some pretty fashion."

Jennifer Horowitz, senior director, research at HIMSS Analytics, says that as implementations increase, the systems themselves will evolve. "As organizations are looking at things like shared savings and value-based purchasing, and they're starting to think about the different ways payment is being made, that will impact what's showing up on their dashboard."