MedStar Health, a health care organization comprised = of 25 integrated businesses in the Baltimore/Washington, D.C. = area.

Snapshot

Organization
MedStar Health, a = health=20 care organization comprised of 25 integrated = businesses=20 in the Baltimore/Washington, D.C. = area.

The Challenge
To improve the = quality of=20 health care and better manage customer = relationships by=20 reducing administration time across the = enterprise.=20

The Strategy
Building upon an = established=20 business intelligence system, to pull together=20 historical and new data to provide real-time = access to=20 complete, accurate information for both = technical and=20 nontechnical users.

The Results
All levels of users = =96 from=20 doctors and nurses to executives and financial = analysts=20 =96 have fast, simple, and intuitive access to=20 administrative and clinical information for = improving=20 patient care.

Information Builders = Solution
WebFOCUS.=20

Good patient care stems from careful = management of information, both administrative and = clinical.=20 Accurate information helps health care practitioners = make=20 better decisions and enables insurance companies to=20 efficiently process payments.

"Insurance adds significant = complexity to=20 health care," says Paul Shapin, assistant vice = president for=20 decision support at MedStar Health. "It all comes down = to=20 keeping track of patient data. In order to get paid by = the=20 insurance companies, you need complete, accurate = information=20 about all procedures recommended and performed, along = with=20 information about the primary diagnosis, secondary = diagnosis,=20 complications, and so forth."

Shapin specializes in decision = support and=20 business intelligence technologies. All of MedStar's = Executive=20 Information Systems, data warehouses, and decision = support=20 applications are under his domain. To help organize = reams of=20 transaction data into meaningful information, MedStar = is using=20 Information Builders' WebFOCUS technology. The result = is a=20 raft of reporting options for all types and levels of = users=20 and an employee portal that is being designed to = improve=20 collaboration among health care practitioners.

"We're using Information Builders = software to=20 support many types of users, from complex financial = reporting=20 to Web-based access for nurses and physicians," Shapin = says.=20 "It all comes back to providing better patient care. = This=20 fundamental objective is at the root of everything we=20 do."

Laying the Foundation

Based in Columbia, Maryland, MedStar = Health is=20 a not-for-profit, community-based health care = organization=20 comprised of 25 integrated businesses, including seven = major=20 hospitals in the Baltimore/Washington, D.C. area. As = the third=20 largest employer in the region =96 with more than = 22,000=20 employees and 4,600 affiliated physicians =96 MedStar = serves=20 more than half-a-million patients each year. Its = comprehensive=20 services include primary, urgent, and sub-acute care; = medical=20 education; and research. Other health-related services = include=20 assisted living, home health, hospice, and long-term=20 care.

MedStar's relationship with = Information=20 Builders began in 1989 when developers created a data=20 warehouse for patient discharge records. Shapin and = his team=20 used Information Builders' technology to create a data = warehouse to store patient histories, demographic = information,=20 and insurance information as well as diagnosis and = treatment=20 information on a mainframe computer at MedStar = headquarters.=20 The target audience was a fairly technical group of = analysts=20 who used the data to do financial planning, = profitability=20 projections, and related tasks.

Developers took an incremental = approach to=20 building the data warehouse, extracting data out of = the Shared=20 Medical Systems (SMS) applications, then building the=20 warehouse one subject or "mart" at a time. "We have = data marts=20 for payroll, general ledger, patient history, patient = charges,=20 patient billing...it's very topical," Shapin explains. = "We=20 devised a flexible data warehouse architecture that = allows us=20 to add information based on need."

The warehouse was immediately = successful, but=20 it was just the start. In the early 1990s, the = president of=20 one of MedStar's main hospitals decided he wanted his = own=20 access to the data warehouse. In response to this = request,=20 developers built an Executive Information System (EIS) = using=20 Information Builders technology, then gradually = expanded the=20 user base to include executives throughout the MedStar = organization.

"The EIS was designed for a = different class of=20 user from the analysts," says Ken Samet, president and = chief=20 operating officer at MedStar Health. "Senior officers = want=20 activity 'snapshots' that they can acquire quickly, = such as=20 30-day trends on admissions and current occupancy = reports. The=20 EIS isn't meant to answer all of their questions, but = it's=20 highly accessible and puts a solid base of information = at=20 their fingertips."

Discovering WebFOCUS

With the completion of the EIS, = senior=20 managers gained access to information that was = formerly only=20 accessible through technical specialists. But what was = still=20 missing was what Shapin refers to as the middle = ground, or=20 casual user. "That's when WebFOCUS came along," he = says. "For=20 the first time, it gave us the tools we needed to = enable=20 nurses and nurse managers to write their own = reports."

MedStar developers used the WebFOCUS = Managed=20 Reporting Environment (MRE) to set up a user-friendly = business=20 intelligence environment that includes facilities to = create,=20 manage, and deploy dynamic reports and charts. "The = WebFOCUS=20 Managed Reporting Environment is fantastic," says = Shapin. "We=20 have enabled users to build their own reports by = creating=20 templates =96 or reporting objects."

Some reports include the ability for = users to=20 input their own parameters as well as the ability to = perform=20 online analytical processing (OLAP) for in-depth = analysis. The=20 development of these reports is easy, since WebFOCUS=20 automatically generates HTML input screens to prompt = users for=20 parameters.

"I use WebFOCUS regularly," says = Sandra=20 Trakowski, RN, associate director of nursing, = Informatics at=20 MedStar Health. "When the VP of Nursing requested a = list of=20 the top admitting physicians by nursing unit, I was = able to=20 provide a report with this information to her the same = day.=20 Without the local network accessibility of WebFOCUS, a = request=20 of this type could take weeks to fulfill."

Another department, IV Therapy, = requested a=20 report to show all patients currently in beds by = nursing unit=20 and bed location, with diagnosis and billing number = listed.=20 "This, too, was easily and quickly done with = WebFOCUS,"=20 Trakowski continues. "It is now set up as a shared = report that=20 our personnel can run themselves on a daily basis. = This report=20 allows department personnel to define work = requirements and=20 provide more efficient patient care services."

Shapin says he has encountered lots = of tools=20 for developing Web reports and databases, but the = WebFOCUS=20 Managed Reporting Environment is unique. "It's not = only a=20 powerful report writer with excellent analysis = capabilities,=20 but a comprehensive environment for helping users = create,=20 save, and inventory the information they need," he = says.=20 "Users can catalogue reports, put them in libraries, = give them=20 long names, create menus of reports, and even do = sophisticated=20 analytical processing."

Today, MedStar is looking into = rewriting the=20 most popular parts of the EIS with WebFOCUS as well. = "Basic=20 data capture is already taken care of," Shapin = explains. "We=20 simply need to redesign the client/server screens for = the=20 Web."

Entering the World of EIPs

Shapin envisions creating an = employee portal=20 using Lotus K-station and WebFOCUS that will provide = one=20 central place for employees to retrieve virtually any=20 information that they need. "We'll have a window right = into=20 WebFOCUS where reports can be generated in response to = particular user requests," he says. The employee = portal will=20 improve communication, supply Web access to clinical = systems,=20 enable self-service HR applications and improve = collaboration=20 among dispersed groups of workers.

"As MedStar expands and adds remote=20 facilities, we're confronted with several diverse = cultures,"=20 says Corbin Riemer, vice president of marketing at = MedStar.=20 "The employee portal will give us a virtual workspace = that=20 streamlines collaboration via discussion groups, = workflow,=20 e-mail, reporting, and real-time information = analysis."

Real-Time Clinical Information for = Doctors

The data warehouse also funnels = information to=20 the Emergency Insight System, a Web-based repository = for=20 tracking clinical patient data and related = administrative=20 information. In the past, when clinicians wanted this=20 information, they had to request it from the medical = records=20 department. Now, physicians can access lab results = directly=20 while treating patients.

Emergency Insight accesses medical = records=20 from the data warehouse and combines them with live=20 information gathered from other departments. Because = the=20 medical-records data was so well structured, it only = took a=20 week to create the mechanics of the new reports.

According to Dr. Craig Feied, a = physician who=20 designed the system, the Emergency Insight System = improves=20 care in a wide variety of ways. "Because the system = marries=20 past and present data, clinicians make decisions in = the=20 context of complete information," he says. "It's all = presented=20 through an easy-to-use graphical interface." The = system allows=20 clinicians to conduct dynamic queries for more = detailed=20 patient information and to analyze data locally simply = through=20 mouse clicks. "To our knowledge, no other medical = institution=20 is giving clinicians real-time access to past medical = records=20 and current clinical service information in an = integrated=20 format," says Shapin. "We have transformed a data = warehouse=20 that was used for long-range planning into a = transaction=20 system used for day-to-day service and support."

Personal Data Delivery

In the future, MedStar developers = hope to=20 create a wireless connection that will allow medical=20 practitioners to query the Emergency Insight database = from=20 handheld computers and other mobile devices. This will = make it=20 even easier for nurses and physicians to receive = current=20 patient information from any location. "We're a huge=20 organization with many types of data access and = reporting=20 requirements, but our decision support needs all come = back to=20 a database that was built on a mainframe in 1989," = concludes=20 Shapin. "Although our data access strategy is = continually=20 evolving, we have never had to change the format of = the data=20 or upgrade the structure of the database. Information=20 Builders' technology is solid and dependable."

Find out how MedStar's solution saves=20 lives.

Flexible Software Helps Create = Business=20 Intelligence Strategy at MedStar