Doctor Practice Uses BI Tools To Improve Care

Healthcare Innovators

When discussions focus on healthcare providers doing sophisticated analysis of clinical data, academic medical centers with deep research pockets usually come to mind. Those examples include the Mayo Clinic, Cleveland Clinic, and other large prestigious, healthcare providers that have ambitious projects related to personalized medicine and other care initiatives.

But as more doctor practices across the U.S. roll out e-medical record systems to collect and manage their patient information, those smaller organizations can also tap into the power of analytics tools to glean better insight into the care they provide their patients.

That's something that's already happening at Southeast Texas Medical Associates, or SETMA. Through the use of business intelligence and analytics tools with the medical records data of thousands of patients, the mid-size doctor practice in Beaumont, Texas is improving treatment programs, reducing hospital readmissions, developing preventative care programs, and boosting staff productivity.

SETMA, with 29 primary care physicians in three locations, rolled out a NextGen EMR in 1998, which at the time required lots of customization by SETMA since there were few pre-configured templates available, said the practice's CEO Dr. James Holly. But two years ago, SETMA begun using IBM Cognos business intelligence tools to analyze data in a data mart developed for keeping extracted data from those patient records.

The tools are enabling SETMA to run real time analysis on the health and treatment trends of patients, including those with chronic illnesses like diabetes, and to audit performance of SETMA clinicians, to ensure they are providing evidence-based standards of care to patients, and adhering to best practices and other quality measure sets from a number of sources. Those quality measures include the Healthcare Effectiveness Data and Information Set (HEDIS) from the National Committee for Quality Assurance; the Centers for Medicare and Medicaid's Physician Quality Reporting Initiative, and also care benchmarks from the National Quality Forum.

The analysis has helped SETMA identify "interruptions of care" that some patients experience, enabling the practice to act quickly on resolving those issues, even to the extent of reminding diabetic patients around the holiday season that they need to be extra diligent about exercise, glucose testing, and diet as they partake in end of year celebrating, said Holly.

"Healthcare is behind the times in the use of BI," said Holley. "But everything that BI can do in other industries, it's doing for us in healthcare, leveraging points to improve care," said Holly.

SETMA is using the analysis tools to "eliminate the ethnic disparity in care," said Holly.

"How do you know the disparities till you have the ability to ask questions," he said. The analysis allows SETMA to identify issues that can play factors in patient outcomes, such as in situations when patients need to be readmitted to the hospital not long after being discharged.

According to a 2010 study by the University of California San Francisco, nearly one in five Medicare patients in the U.S. have an unplanned readmission to the hospital within 30 days of being discharged.

Healthcare Innovators

Within the first six months of using the Cognos tools, SETMA reduced hospital readmissions of its patients by 22%. SETMA was able to use the analysis tools to compare patients who did not experience readmission to those who did, taking into account patient characteristics such as age, gender, ethnicity, follow-up care received, and how soon follow up care was received once the patient left the hospital.

Using the Cognos tools to analyze patient EMR data, ICD 9 billing codes, and other information, SETMA identified patterns that showed groups of patients who are more likely than others to be readmitted, and the factors that contribute to that. SETMA saw that patients who live alone and patients in lower social economics groups were among individuals most likely to be readmitted.

For instance, patients who live alone are less likely to adhere to their follow-up care instructions while lower income patients often can't afford medications prescribed for ongoing treatment once they're out of the hospital, Holly said.

These findings prompted SETMA to institute new post-hospitalization treatment plans that include setting up immediate at-home care and interventional support services for patients who live alone, as well as the creation of a foundation to help low-income patients pay for their medications, said Holly.

SETMA spent about $500,000 on the Cognos project, said Holly. "It was expensive but the payoffs are enormous, we're just scratching the surface," he said.

There are records for 65,000 patients in the Cognos database, including records of 7,500 diabetics and 26,000 with hypertension, said Holly.

Prior to using the Cognos tools, it would take SETMA about 36 hours to run daily patient-encounter reports using the NexGen EMR database and query functions, Holly said.

That means SETMA was always at least a half a day behind in seeing, for instance, if patients had received the evidence-based care they should have gotten based on their situation--such as whether they are diabetic or have other chronic conditions.

Now applying the Cognos tools onto data in the data mart, complex analysis can be completed in seconds, said Holly.

The work at SETMA shows that once doctor practices have digitized and scrubbed patient data, applying BI and analytics tools to the data trove can be useful in identifying trends that ultimately lead to programs for improving in care--even if you're not part of large integrated health delivery networks or academic medical centers, said Vi Shaffer a research analyst at Gartner.

"There's no question that this is a hot topic this year, building plans to tap these data assets," she said.

The interest in deploying analytics to improve patient care and clinical performance is also being fueled by healthcare reform and the emergence of new accountable care organizations in which affiliated healthcare providers increasingly will be rewarded based on their quality of care and their ability to reduce costs, said Shaffer.