In his 2008 book The Big Switch, Nicholas Carr draws lots of comparisons between electricity and information technology. When the United States began generating electricity, it came from a thousand sources and there was no electricity-sharing grid. Worse, different power sources were generating different kinds of power, with varying voltages, amperages, and protocols (think direct current versus alternating current).
Eventually, through the rough-and-tumble of capitalism and some heavy-handed government meddling, the country converged on a single power system for the public electricity grid, and a variety of other industry standards governing electrical use in everything from cars to lithium batteries. That process took a few decades. To this day, as lightning strikes prove, electric devices are at risk from variations in that system. A whole network of uninterruptible power supplies—more ubiquitous than you might realize—now has to supplement the system.
The process of standardizing and safeguarding information will probably end up taking longer. The inputs are all over the place. The outputs can be wildly different from each other. That much parallels the story of industrialized electricity.
In healthcare, doctors are the primary generators of information. Movements toward accountable care, value-based purchasing, and patient-centered medical homes are efforts to standardize the generation of that information. Without standardization, the kind of data analysis I described in the September HealthLeaders magazine cover story is difficult, if not impossible. In the forthcoming December issue, I'll delve into this issue further in an article I am currently writing about the role that online order sets play in this standardization.
In the course of researching the analytics cover story, I talked to more healthcare provider organizations about this standardization challenge than I was able to quote. One such organization is Mountain States Health Alliance, a 13-hospital system in east Tennessee and southwest Virginia.
Like many other providers, Mountain States is forming an accountable care organization. As such, the organization has to quickly identify major changes in admissions, patient days, length of stay, case mix index, and payer mix. "We're developing a very robust data governance structure, to where we're talking about access to data, turning data from just information into actual knowledge, so we don't have 50 people in the organization trying to get to the same number in different ways," says Logan Pigg, director of finance at MSHA.
Arriving at a "single version of the truth" from all of these data sources has enabled MSHA to detect surgical volume moving from inpatient to outpatient, Pigg says. "These shifts can really affect your bottom line," he says.
"It takes business analytics, digging into the details to figure out why the revenue isn't there, and why it legitimately isn't there," says Pigg. A traditional inpatient surgical DRG might get $20,000, but the same type of procedure done on an outpatient basis may only bring in $10,000.
As a result, MSHA has started shifting more low-margin surgeries out of its tertiary hospital, 445-bed Johnson City Medical Center, and into its clinics and surgery centers.
"We're going to have to find the lowest-cost settings to care for patients. We're not going to transfer patients to our tertiary hospital just because we have vacancy," Pigg says.
One thing is constant across the different providers I've talked to about analytics. You need a whole toolbox, not just one tool. MSHA uses a bunch: Siemens Soarian (EMR and data warehouse), Avantas Smart Square (scheduling software with demand forecasting), SCC Soft Computer's SoftLab (laboratory management), Surgical Information Systems (OR management) and others, Pigg says.
The combination of these tools can advise MSHA how to adjust its mix of labor, which can account for 50% of overall operating expenses, Pigg says.
Going forward, though, those standalone tools will be continually reevaluated by management in order to bring clinical and financial reporting together into a shared data structure, Pigg says. This will bring a whole new meaning to that goal of CIOs, "a single version of the truth."
"We're starting to see a lot of different organizations, either through GPOs—group purchasing organizations—or integrated networks, where people are really starting to develop standard definitions for a lot of things," Pigg says. "As we go even farther down the road of one unified medical record, we will have a true definition of what a readmission is. I'm hearing more and more conversation about that."
Truly, it takes a lot to build an interoperable data grid. Just ask the electric companies.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.