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Best Practices:Business intelligence helps Centra Health improve care and lower costs

By Judith Lamont, KMWorld senior writer

Centra Health is a regional, non-profit healthcare system located in the Piedmont region of Virginia, just east of the Blue Ridge Mountains. Over the past decade, Centra developed a reporting and analysis system that has achieved the dual goals of improved healthcare and effective cost controls. The analytical capabilities are available both through Centra's Decision Support Department and on the desktops of its staff. The most recent enhancement of the system has resulted in a remarkable increase in the number of analyses that the Decision Support Department can do—from six a year to about 500. Those analyses guide Centra in its medical decisions and its business planning.

Centra includes a range of facilities from hospitals to nursing homes and long-term care, and a full spectrum of medical services. The Stroobants Heart Center at Lynchburg General Hospital ranks among the top 100 in the country, according to ratings from Solucient, a provider of healthcare information and market intelligence. Centra has been aggressive in its use of information technology to improve both the medical and the business sides of its operations. Its reporting initiative began in the early 1990s with a data repository developed by the SAS Institute, which provides software solutions for business intelligence and analytics. Centra is using SAS online analytical processing (OLAP) technology, the SAS/IntrNet product, which integrates SAS and the Internet, SAS QC, and SAS Graph.

In its earliest form, the SAS system provided paper reports based on data collected within Centra and data provided through the state reporting system, which includes information about other organizations. At that time, analyses beyond the standard reports required additional programming, so ad hoc queries were laborious. Also, the reports related primarily to financial data, and clinical staff were generally not aware of what information could be obtained. By the mid-1990s, a desktop version of the system was available to managers, but it did not yet have the flexibility or ease of use sought by Centra.

Under the direction of Kim Price, who heads Centra's Decision Support Department, a team of business and clinical professionals considered their needs, and collaborated with the IT staff to re-invent the SAS system.

"We spent a lot of time exploring what information we had available and building data sets. We also audited the information to make sure it was clean," says Price. The important thing was to tie all the information together, according to Price, so that medical and financial data could be analyzed in a meaningful way. In addition, the newer Web-based tools incorporated into the system broadened access to a wider audience.

The SAS system contains more than 20 million records that reside on multiple platforms and databases. The information includes billing records, clinical data and demographic data such as patient age and zip code. Analyses are used to make decisions about everything from patient treatment to investments in new facilities. Some Centra staff choose to conduct their own analyses, while others direct their inquiries to the Decision Support Department.

Skip Meador, director of Cardiovascular and Neuroscience Services, is a regular and enthusiastic user of SAS. Responsible for both the day-to-day operations of the department and for its strategic planning, he turns to the system for information about medical practice and business operations.

"Working with SAS, our Decision Support Department has developed a point-and-click approach that gives me a tremendous amount of information about service volume, market share, charges, length of stay and other measures," says Meador. "I can compare our presence in a given area to that of other medical systems, or look at our costs for services at a very detailed level."

Cardiovascular services are an important practice area for Centra and an important element in the organization's strategic planning. "If our steering committee is discussing the possibility of expanding services in areas that have not had adequate access to specialists," says Meador, "I can quickly compare the volume of procedures in a given service area to national utilization rates." Information about medical needs in certain geographical areas helps determine whether expanded facilities are viable and useful to the community.

Meador can also analyze medical practice down to a very granular level, such as how much of a given medicine is being used by a particular physician. "We provide a comprehensive dashboard for each physician summarizing their practice," continues Meador, "which helps them monitor whether they are using best practices."

At first, Meador recalls, when doctors were asked what they needed to know in order to improve their practice, they didn't know how to respond. "But now we are there," he says, "and the doctors are seeking information proactively." They can explore the outcomes in terms of complications, mortality and how they relate to length of stay and other factors. "Our emphasis is on quality of care," says Meador, "and the physicians see SAS as a way of helping them reach the highest possible standard."

Sometimes the goals of good healthcare and cost containment seem to be in opposition, but that is not necessarily the case. In fact, good quality care frequently leads to lower costs. For example, in cardiac care, the Solucient study shows that top-rated hospitals, which have lower mortality rates and quicker recoveries, also have costs for cardiovascular care that are 11% lower than other facilities. A study by the National Registry for Myocardial Infarction (NRMI, nrmi.org) placed Centra in the top 2% nationally for speed in getting heart attack patients from the ER to the cath lab and reopening the blocked blood vessels. Improved care reduces complications and length of stay, which in turn affects costs.

The longer the SAS system is in place, the more uses Centra has found for it. "We can look at whether certain drugs in our inventory have not been used for a specified period of time," says Price, "and then decide whether it makes sense to stock them." Carrying an unused inventory is wasteful of both space and money, particularly if medicines reach their expiration date before they are used. Centra also examined their discharge process and found that in some cases patients were not being discharged on weekends. That data was then shown to doctors and discharge planners who worked together to schedule discharges for the weekends. Centra was able to reduce length of stay, which improved patient satisfaction and reduced costs.

In addition to the larger issues such as medical outcomes and financial information, the development and use of SAS has improved quality in seemingly small areas. Administrative staff have realized that the zip code data they input is being used for reporting and planning purposes, and therefore they have a heightened awareness of the importance of accuracy in data entry.

Questioned about why Centra has achieved such high standards in cardiovascular care (and other areas—it also ranked in the top 2% nationally for orthopedics), Meador first cites the dedication and commitment of the individuals who provide the care at its facilities. Next is the teamwork among those individuals. But he is quick to add that without SAS, the staff would be hard pressed to get the information they needed to make the best decisions for its patients and the organization. Business intelligence has been effectively used at Centra to support its primary objective of top quality medical care and leadership in its field.

Judith Lamont is a research analyst with Zent

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