How Chief Medical Officers Use Business Intelligence

Business intelligence provides improved information to support the evolving role and responsibilities of today's chief medical officer.

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This article originally appeared on the BeyeNETWORK

Healthcare organizations are facing a number of enormous challenges today. Purchasers, payers, patients and governmental agencies are calling for better performance, higher quality, improved patient safety and more transparency, all at a lower cost and with greater efficiency. In addition, it is becoming increasingly difficult to recruit and train enough physicians and other staff members, and to maintain the quality and expertise of those already on board.

All of these pressing issues to some degree land on the desk of the chief medical officer (CMO). Handling this tremendous responsibility requires the use of a variety of organizational resources and tools, including people, process, capital, policy and often political leverage. In addition, the CMO must have and use a vast store of information and knowledge, as well as the ability to sort the important from the unimportant facts quickly and with confidence. Additionally, in this rapidly evolving role, the CMO’s workload is going to steadily increase.

Business intelligence can help the CMO in a number of ways. Using data the organization already owns and applying the tools and techniques of business intelligence to combine, organize and manipulate clinical, operational, administrative and financial data, the CMO as well as those working for the CMO can address the key issues facing their organization with evidence and with confidence. Tactically, this means having the information to confront the increasing demand for accurate, pertinent and timely information, such as for compliance reporting. Strategically, this means having greater control of the information required in order to work with others in the organization to make far-reaching decisions, such as improving operations and making sound investments.

The answer lies in managing data effectively in order to slice, dice, sort, sum, combine and distill it to provide the information needed to make these decisions.

The Evolving Role of the CMO
At a typical healthcare provider organization, the CMO is responsible for:

  • Clinical performance
  • Quality improvement
  • Patient safety
  • Patient and provider satisfaction
  • Physician recruiting, retention and satisfaction
  • Risk management
  • Credentialing, continuing education and staff development
  • Medical informatics

This list represents a CMO’s daily responsibilities. However, the CMO’s responsibilities are evolving to include greater input into managing strategic issues such as organizational direction, investment decisions, business structure decisions, as well as addressing regulatory and market demands.

Of course, one person cannot be responsible for all of these activities. The CMO must rely on his or her staff, peers in other areas of the organization and people outside of the organization to get this job done.

All of these people must make decisions that are aligned with the goals of the organization and the constituencies that the organization serves. As you can see from the list of responsibilities, there are a number of very different types of information that must be combined in order to make these decisions and to achieve a high degree of alignment in those decisions.

Therefore, it is essential for the CMO and each of these groups to have consistent, reliable information. Ideally, these groups would all be working from the same information base.

Business intelligence using an enterprise-wide data repository is the key to getting everybody on the same page, if you will; however, enterprise-wide repositories such as data warehouses can take years to define, design and develop. This is especially true for the healthcare organization with a wide range of groups and organizational entities, each with a wide range of perspectives and opinions regarding the data they own and use.

One of the best ways to work toward this ideal of a single version of the truth, and to achieve enterprise-wide alignment, is to build the repository in building-block fashion, starting with the blocks that provide the highest return on investment to the organization. Of course, each of these blocks must be designed and built under an enterprise-wide umbrella. If that is not done, the repository will just be a collection of useful, but non-integrated applications.

This is where the high-level perspective of the CMO is required. With information needs as far ranging as operations, clinical quality, staffing and investment decisions, the CMO is the one who can see the forest as well as the trees.

Business Intelligence Applications for the CMO
What applications are most helpful to the CMO and can be implemented most quickly? Let’s begin with the list of responsibilities listed earlier, and look at ways that business intelligence can assist with some of them.

Clinical Performance
In quality circles, there is a famous quote by an anonymous factory foreman: “What was outstanding performance five years ago, today doesn’t even make the grade.” Recognition and pay-for-performance contracts are fast becoming the norm for influencing quality improvements in clinical healthcare. Eventually, however, even higher levels of performance will be expected. Data is needed on services performed, timeliness, interventions provided, clinical outcomes and their effect on improved patient functionality. This information is then analyzed by payers and purchasers for its effect on worker productivity and absenteeism, among other measures. The CMO in a clinical organization can use these measures internally to judge the effectiveness of the organization’s results and the processes that produced those results. The monetary incentives from pay-for-performance programs can be reinvested in quality improvement programs, and the recognition received can be used to improve the organization’s marketing.

Quality Improvement
The measures developed by quality accreditation organizations such as the National Committee for Quality Assurance (NCQA) are becoming standards adopted by other industry accreditation bodies as well. Therefore, either directly or indirectly, performance is likely to be judged using these measures. The qualification requirements are fairly complex and require extraction, reconciliation and auditing of data from a number of internal systems such as claims, encounters, labs, etc.

Patient Safety
Identifying patient populations for infection control surveillance, for instance, can be done using business intelligence, especially with a patient data registry. Instead of relying on a variety of reports that are potentially confusing and conflicting as a starting point for investigation, the exact data could be retrieved from the patient registry. Additionally, it would be possible to slice, dice, sort and sum populations by date time, provider, location, etc. This allows identification of patients who came into the facility with safety issues versus those patients who may have developed these issues after becoming patients at that facility.

Patient and Provider Satisfaction
Powerful business intelligence tools and capabilities are available to capture, organize and analyze satisfaction survey information, as well as to detect potential satisfaction problems from point-of-care information. Using business intelligence tools, the CMO and others in the organization can spot patterns and trends as they are developing and implement solutions proactively. For instance, are patients having a difficult time getting to a certain facility? This can lead to one form of patient dissatisfaction with services. One organization learned that their patients were having this problem and developed a number of ways to help patients get to their facilities more easily, as well as ways for their staff to visit these patients.

By using the data already owned, the CMO can address some of the biggest issues facing the organization and make changes to proactively address problems and even discover new opportunities.

Collaboration within your Organization
Tactically, the CMO can use business intelligence to solve a number of urgent issues for the organization, as described earlier in this article. However, the CMO is increasingly becoming involved in strategic decisions that require greater collaboration with others in the organization, as well as those outside the immediate organization. This is where business intelligence truly shines.

Some examples of how the information used by the CMO can also help with strategic decisions include:

Investment Decision Support
Having visibility into trends and emerging patterns in clinical practices and patient populations helps determine the best location for a new facility, what patient groups it should target, what type and size facility it should be, and so on.

Organizational Direction Decision Support
Practice patterns and trends also reveal strengths and weaknesses so that recruiting and development efforts can be directed appropriately.

Marketing Message Support
Clinical patterns and trends help an organization define who it is as well as where it is going, providing tangible, meaningful messages that resonate with payers, purchasers and, of course, patients.

Operating Efficiency Analysis
By understanding the total operational picture, trends can be used to put a value on each proposed project so they can be prioritized with greater ease.

Having a base of structured, reliable data has strategic uses and benefits that go beyond the direct tactical benefits of analyzing and addressing clinical healthcare issues. It takes collaboration with peers and some additional investment to combine the disparate data sources, but it definitely pays to be ahead of the curve.

Next Steps
The role of the CMO is a demanding one that requires a number of skills and resources that cross a wide variety of disciplines both inside and outside the organization, and the level of responsibility is increasing dramatically. Access to information and knowledge that spans the organization and its operating environment is essential. This is where business intelligence applications can enable the use of information for tactical advantage and, more importantly, for strategic advantage.

Begin by looking at what is causing the greatest amount of pain. Develop a prioritized action plan to produce information that will help to quickly address the key issues. Determine the potential value in increased effectiveness, efficiency and strategic decision support.

Thanks for reading. I look forward to your comments.

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