Extending Your EMR with Business Intelligence Solutions

Our Speakers

Heidi Rozmiarek Manager of Business Intelligence &

Enterprise ApplicationsMeriter Hospital

Martin SizemorePrincipal, Healthcare

Perficient

Joseph ParanteauPrincipal - Platform Solutions

Microsoft US Health & Life Sciences 

Delivering Epic InsightsLeveraging the Epic EMR for Business Intelligence

Who is Meriter?

Community Hospital (Not-For-Profit, 448 Bed)

Home Health

Medical Group (130 providers)

Ambulatory Clinics (9 sites)

Laboratory

FoundationHealth Plan(85,000 members)

Madison, WI

Enterprise Applications

Clinical Applications

Business Intelligence

Data Exchanges

Epic – The hub of the businessData Exchanges96+ EDI Exchanges100+ Interface Engine Jobs

Operational Reporting1,390 Unique Reports6,000+ Report Distributions390 Reporting Workbench Reports 85 Dashboards

Analytics4 SSAS Cubes215+ SSRS Reports50 PowerPivot Dashboards

Systems IntegrationEnterprise ApplicationsClinical Applications

Community Connect3 Provider Group Partners

Epic Implementation Timeline

2003 2006 2007 20092008 2010 2011

CPOE & Physician Documentation

ASAP

2012 2013

EpicCare Inpatient (CDR & Clerk Order Entry),ADT, Prelude, Cadence, Hospital Billing, HIM, Remote Access

EpicCare Ambulatory

OpTimeWillowInpatient

Radiant

Willow Ambulatory

MyChart

CareEpic (CareEverywhere)

Community Connect (Affiliate Extension)

ProfessionalBilling

Tapestry

Stork

Meaningful UseCogito

Info

rmati

on

Exch

an

ges

Core

Ap

plicati

on

sD

ep

art

men

t A

pp

licati

on

s

2014

Clarity &Reporting Workbench

Key Drivers for Business Intelligence

i n c r e a s i n g l y complex q u e s t i o n s

evolving d a t a p r o p e r t i e s

p a p e r t o digital

population h e a l t h m a n a g e m e n t

I m p r o v e qualitycost c o n t a i n m e n t

Moving Towards the Future

Paper Based RecordsInfancy of Standard Reporting

Electronic RecordsMaturity of Standard Reporting

Infancy of Business Intelligence

Maturity of Business Intelligence

“Most of healthcare, stuck in the hashes”

Meriter’s Business Intelligence Strategy

Data

Process

People Culture

Technology

Goal: Tell Stories to Empower Decision Making

Data

Transform

Information

Discover Insights

Tell a Story

Empower Decision Making

2009 2010 2011 20132012 2014 2015

Meriter’s Business Intelligence Journey

Architect

BI Developer BI Analyst

Developer/AnalystRealignment

DBA

BI DevelopersBI Developer

Health PlanRealignment

BI Analyst

Data Scientists

SQL Server2008 R2

SQL Server2012

SQL PDWHadoop/PolyBase

SP 2013SP 2010SSRS

SSISSSAS

PowerPivot

Excel 2010 Excel 2013

Info SystemsReporting

Forum

Clinical DataCouncil

Financial DataCouncil

Medical Group Reporting Committee

Patient/MemberEngagement

Report DeveloperConsolidation

Why Microsoft for the Journey?

Leverage Existing Investments

Familiar Tools & Tight Integration for Users

Cost Effective

Easy Deployment

Microsoft Technologies Leveraged

manage enrich insights

EpicClarity

EDW

Lawson

API

Analysis Services

IntegrationServices

ReportingServices

PowerPivot

Excel(w/ PowerBI)

SharePoint

EpicCogito

Source Systems

Extending Epic for Business Intelligence

Epic

OtherSources

Reporting/Staging

Clarity

Epic Data Warehouse

Cogito

Enterprise Data Warehouse

Parallel Data Warehouse

Why Parallel Data Warehouse?

Familiar SQL Server Environment

Query Hadoop with SQL via PolyBase

Scalable – “Grow with you model”

Leverages MPP Technology

Projects on the Horizon

Migrate legacy warehouse to PDW

Implement Hadoop for unstructured data

Exploring migration to Office 365 with PowerBI

Initiate data science program

Integrating EMR information Reporting to disease registries, service line profitability, and tracking surgical scheduling and material use

Perficient is a leading information technology consulting firm serving clients throughout North

America.

We help clients implement business-driven technology solutions that integrate business processes,

improve worker productivity, increase customer loyalty and create a more agile enterprise to better

respond to new business opportunities.

About Perficient

• Founded in 1997• Public, NASDAQ: PRFT• 2012 revenue of $327 million• ~2,000 colleagues• ~85% repeat business rate • Alliance partnerships with major technology vendors

• High value use cases for maximum ROI on healthcare analytics• Focus on high labor and material costs (surgery) for potential cost savings• Create evidence about best practices with cost optimizations

Epic Optimize: Surgical Analytics

manage enrich insights

EpicClarity

EDW

Lawson

APIAnalysis Services

IntegrationServices

ReportingServices

PowerPivotExcel

(w/ PowerBI)

SharePoint

EpicCogito

Bringing together critical data on surgical scheduling, materials, labor and outcomes

Does the $3,000 spine spacer have better outcomes than the $8,000 one?

Clinical +Costs

Projected Savings of $3-5 Million+ in First Year of Use

KPIs have their Foundation in a Process

OR

ScheduleCase

RegisterPatient

Process Bill &Payments

Labor

Materials

Equipment

Procedure

Patient Times In/Out

MaterialConsumption

Actual vs.Schedule

BillingDiagnosis

Demographics& Status

PreferenceCard

Pick List

MaterialCosts

RoomCosts

LaborCosts

Charges

Payments

DischargePlanning

• Block / Non-Block• Requested Time vs. Average

• Procedure Code

• Confirm Privileges• Labor Rates

• Confirm Availability

• Demographics

EquipmentCosts

Billing Info,Payers

• Resource Utilization

• Resource Utilization• Time of Day• Day of Week

Total Costs

Profitability

• SupplierEquipment

Usage

PerformSurgery

• Re-Admits

• Discrete Cost Capture allows Activity Based Costing

• Costs are captured at the Event level (procedure)

• Allows benchmarking, process improvement and best practices for cost reductions without sacrificing outcomes (evidence-based approach)

Microsoft PDW: Complex Dimensional Analytics

Surgery Case Count: by Facility, by Care Setting

Add Total Case Charges, Direct Costs, Payments

Sort by Descending Total Reimbursement

Select Top 40% based on Reimbursement

Drill-Down by Procedure Class

Drill-Down by Procedure

Select Orthopedics Cases

Drill-Down by Surgeon

Drill-Down byPrimary Implant

Show Payer Mix

Show Case Costs by Quarter Year-over-Year

Show Profitability by Payer Type

Show Profit by Supplier

Show On-Time vs. Late Starts

Ordinal Position

Day of Week

Drill-Down by Case Duration

Drill-Down by Cost Class

Show Surgical Team

Drill-Down byBlock Utilization

PrimaryService Line

Definition

• Motivation, Strategic Context for Service Lines• Specification for assigning individual encounters.

Resolving conflicts and overlaps: precedence, allocation

OngoingMeasurement

• Position in Life Cycle• Portfolio Management

ChangeManagement

• Cultural, Authority Structures• Measures, Incentives

OrganizationalModel

• Range of Possible Models

Metrics• Clinical, Operational, Financial• Internal Focus; External Focus; Individual Comparative,

Benchmarks

High Value Use Case: Service Line Profitability

The SolutionService Line DefinitionsService Line AnalyticsExtensible Rules-Based Data / SL Definition

Architecture

The BenefitsIntegrated View of Service Lines Across Entities

and Care SettingsProjected Efficiencies and Consistency in

Operations and Outcomes

Service Line Conceptual Model

CareEvents

Enterprise

Service Line

Group

Physician

PatientCare Model

Planned Actual

Facility

Care Setting Resources

ActualCases

Standard Workflow

• Case Volumes• Patient Outcomes• Quality Metrics• Productivity

• Service Codes• Charges• Costs• Reimbursements

Descriptive Dimensions for all aspects of an Integrated System Views• In- / Out-Patient Distinction• Dept View• Administrative View• Bill of Resources

Centers ofExcellence

Competitive Profiles

Benefits• Operations Management• Strategic Planning

CurrentState

• Tests, Observations, etc.• Attributes, Values

• Monitor, Follow-up• Observation Period

ProblemList

ActionPlan

Monitoring Diagnosis Treatment

• Make, Clarify or Confirm• Assess Risk• Prognosis

• Treat• Maintain• Modalities

DesiredState

• Diagnosis• Treatments• Outcomes

Assimilate, Evaluate, Decide

Plans, Actions

• Standard or Target• Attributes, Values / Ranges• Modality-based Desired Results

Assess Delta

• Desired Result• Measures

Prevention

• Screening• Modalities• Surgery• Behavioral

Enabling Care Plans for Clinical Decision Making …

Collect &Measure

• Creating the Care Plans

• Tracking the success of the Care Plans

• Determining the effectiveness of the Care Plans

Leveraging Microsoft’s BI Solutions Extend the value of your EMR

The New World of Health Data

• Many Healthcare Systems today are focused on developing, implementing, or revising their biggest investment – their Electronic Medical Record system or EMR.

• EMRs require the ability to capture, view, and process individual transactions to support mission critical services around patient care, but data STILL exists in silos. EMR’s alone are insufficient for a long term data strategy.

• Health organizations must leverage advanced analytics across the care

continuum to include the patient and populations.

Consumerization

10x increase every five years

85% from new data types

Dataexplosion

6.4 Zetabytes

4.3 connected devices per adult

6.5MilWearable health devices

Going Beyond MU Stage 127

Source: The Advisory Board Company analysis.

Valu

e t

o O

rgan

izati

on

• Data Capture and Sharing

Stage 1

Future Stages

?

Accountable Care Models

Stage 2

Stage 3

Key Strategic Assets Required across Stages

Robust IT Infrastructure

ChangeManagement

Patient Engagement

AlignedGovernance Structure

CultureShift

• AdvancedClinicalProcesses

• Improved Outcomes

• Real-TimeEvidence-Based Medicine?

• Population Management

Organizational Capabilities and Degree of Difficulty

Level of Organizational Capabilities, Degree of Difficulty, and Value Creation

2011

2014

2016

94.2

64.7

25.0

Q3‘12

Q3‘14 P

Q4‘08

Stages 0-3

EMR Optimization – So That’s Where Those Benefits Were Hiding!

28

Source: The Advisory Board Company analysis.

Percentage of US Hospitals

by EMRAM Stage

5.8

35.3

75.0

Q3‘12

Q3‘14 P

Q4‘08

Stages 4-7

Momentum of Advanced EMR Functionality Growing, Implementation Timing Compressed

Rapid Implementation Does not Guarantee Desired Benefits; Benefits-Driven Optimization is Required

EMR Implementations Using “Big Bang”

• Meet meaningful use requirements

• Time and cost savings

• Experience with EMR implementations

• Increased clinician familiarity with IT

Drivers of Big Bang, Standard Approach

Early 2000s 2012

10 – 20% 50 – 70%

Study Finds EMRs Increase Cost

“Hospitals that adopted EMR between 1996 and 2009 did not experience a…significant decrease in costs on average. In fact, [in many cases] costs rose after EMR adoption, particularly for…advanced EMRs.”

National Board of Economic Research, 2012

”

Technically-Driven

Optimization

Process-DrivenOptimization

Benefits-DrivenOptimization

Good

Bett

er

Best

Goals: Improve screen design, interfaces, reporting capabilities, functionality to meet requirements, etc.

Goals: Identify better ways to use system capabilities, change and/or standardize workflows, address cultural issues, etc.

Goals: Achieve business value as defined by the strategic goals of the hospital; a high-level focus on few key objectives.

Exploring Today’s Data is TransformationalNew Ways to Get Big Insights

Local Data Mart

Syndromic

SurveillancePlatform

Hadoop File Management

Natural Language Processor

Ascribe Clinical App

Anonymiser

Ascribe Clinical App

Windows 8 App

National Data Mart

Saving lives with big and small data in real time

“This will reinvent the way we work with medical records in the future.”

Paul HendersonBI Division Head

Physicians finally have an easy way of accessing data on the various devices and hospital recommendations on which device is best suited for a given patient and clinical scenario. This helps physicians maintain their focus where they want it to be—on giving their patients the best care possible.Dr. Richard LemonOrthopedic SurgeonMeriter Hospital

The information I need is right in front of me on the SharePoint dashboard. Instead of trying to figure out what the problems are, my job has become trying to figure out the solutions.

Jennifer SandersAssistant Director of Nursing,Texas Children’s Hospital

Harness power of complete data platformTake action and operationalize

Office SQL Server Windows Azure Windows Server

Self-service Collaboration Corporate apps Data Search

Non-relationalRelational Analytical Streaming

Virtualized networking

Scalable physical and virtual compute

Virtualized storage

SAN like intelligence built into OS

Internal & External

Quality and accuracy

Scale user-driven BI

Action over data in real time

Security, governance, and compliance

Cloud and on-premises

Presentation Layer (Browser, Tablet, Phone, TV)

Security Layer (Authentication, Access Control, Roles, Encryption, Logging)

Application Integration Adapter Layer (Clinical, Administrative, Financial, Custom)

Data Access/Enterprise Service Bus Layer (Business Rules, Custom Logic, ETL, HL7)

CLINICALTRANSACTIONS

FINANCIALTRANSACTIONS

VENDORTRANSACTIONS

DIGITALIMAGES

UNSTRUCTUREDDATA

CLINICALDATA

FINANCIALDATA

ADMINISTRATIVETRANSACTIONS

Microsoft PDW Appliance Partners

HadoopPlatform

Performance

• Queries 10-100x faster than

traditional DW systems

• Optimized for “mixed workload” &

“near real-time” data analysis

• Enhanced loading, 2+TB/hour

Simplicity

• Ease of installation , one throat to

choke

• Ready to go for immediate load

and query = fast “time to value”

• No indexing, tuning, data sorting

or materialized view maintenance

Value

• Non- Proprietary Standards

based architecture reduces risk &

cost

• Minimal implementation and on-

going administration cost

• Lowest “full life cycle” TCO

Delivering Your Data Needs

Intelligent, elastic infrastructure/Cloud OS

Traditional Relational Databases

NoSQL Databases

Parallel Relational Database

Hadoop (Map Reduce Engines)

traditional data processing new generation data processing techniques

Monolithic hardware

Parallel Data WarehouseMicrosoft HDInsight

HDInsight Service

BI Solution Builder DemoUnderstand what I own and what capabilities I can unlock

Ask real questions, get answers

Ask questions in everyday language

Instant answers in charts and graphs

Featuring Power BI for Office 365 Q&A

Q&A feature uses natural language query

Type questions into the speech bubble

Get immediate answers in the form of interactive charts and graphs

Excite and Engage UsersDeliver Immersive, Connected Customer Experiences

Optimize for discovery and reach

Connect with social apps and networks

Real time content and updates

Beautiful experiences + security and performance