Healthcare leaders say they're struggling to cut costs and waste in the emergency and surgery departments. But some say the real savings are to be found through technology and the use of business intelligence.
In a recent intelligence report from HealthLeaders Media, Cost Containment Under Healthcare Rules, healthcare leaders said eliminating excess cost and waste is a top priority, but added that progress is difficult to achieve, especially within the ED and surgical services, where 65% and 48%, respectively, said it is very or moderately difficult.
They also said information technology is part of the solution.
"Operating room information management technology is one of few areas in the hospital that stands to benefit substantially from a financial standpoint with a solid return on investment in IT," said one survey respondent, the chief of staff for a small hospital. "Unlike other areas of the hospital, the operating room is most akin to a factory production line, and has the most to gain from IT implementation."
But they survey results suggest respondents lack the tools they need to reap those benefits. We asked leaders to describe how their organizations currently use information technology to guide cost efficiency programs.
Only 16% said they "have robust clinical and financial data integrated with solid business intelligence and analytical tools" to guide them. Another 67% said they have "some reliable clinical and financial data" that they use to achieve results. And 17% said they currently lack clinical and financial data for improvement.
In a roundtable discussion, healthcare executives talked about how organizations can use data to get results. Jeffrey Limbocker, chief financial officer at Our Lady of the Lake Regional Medical Center in Baton Rouge, LA, said such data can be used to measure the impact of cost containment.
"Much of the data, even on the clinical side, that we rely on is often charge-based data, and so a charge entry has to take place and then someone will pull data and rely on it, which creates obvious problems," Limbocker said. "The clinical data that many of us also use consists of chart reviews. Chart reviews are still a fairly standard way to review data as opposed to having a clinical data field in a clinical information system. What you want to do is be able to compare high-quality outcomes with financial outcomes so you can see whether the things you're doing to improve clinical quality or reduce cost are having a positive or negative impact on the other."
And yet, noted roundtable moderator Philip Betbeze, senior leadership editor for HealthLeaders Media, it is difficult to determine the true cost of providing a service and the testing, labor costs, and other costs because there are so many variables involved. "How do you begin to make sense of it?" he asked.
Charles E. Hart, MD, president and CEO of Regional Health, Inc., in Rapid City, SD, agreed it's a problem. "I just wish I knew for sure the cost to provide a service. Revenue is a little bit easier. That's dollars in the bank," he said.
"Business intelligence is defined differently by different people, but to me it's being able to put together three or four source data systems in our institutions where data from all the platforms can be seen together in a succinct format," Limbocker said. "About 10 years ago, I was very proud of creating a senior-level dashboard and departmental dashboard for all leaders across the institution, where before they were getting a stack of paper several inches thick. Well, it was still too much data for most."
The key is to determine what kind of data is really actionable, said Paul Kronenberg, MD, CEO of Crouse Hospital in Syracuse, NY. "People say information technology will give you accuracy, but it won't necessarily because something has to be entered by a person. So just because it's electronic doesn't mean it's accurate," he added.
There are some "excellent" business intelligence systems available to the healthcare industry now, said Barry Waiter, vice president of OptumInsight in Pittsburgh, PA, which sponsored the Intelligence Report. These systems enable exception reporting that allow users to start with high-level metrics and then drill down to a granular level to understand the drivers of variances. "Hopefully managers and executives will get more comfortable with business intelligence systems over time," he said.