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Benefits of Business Intelligence in Regional Health

A Regional Health Information Organization [RHIO] is a group of healthcare organizations aligned by geographic proximity. It consists of a combination of hospitals, physician organizations, clinic groups, health plans, research organizations, labs and major employers in the area. RHIOs vary in size and type of members based on the needs of the particular area.

The main aim of forming such organization is to share and gain more value from combined healthcare information. They are assisting healthcare providers to develop solid organizational strategies and access information that can keep the services provided ahead of the needs of the population.

This combined information is used to improve the quality of healthcare, measure provider performance (clinical and financial) and provide public reporting to help purchasers, payers, patients and consumers make informed healthcare choices.


National Healthcare Information Network

Individual RHIOs are the basis for a National Healthcare Information Network [NHIN] is an joint initiative between federal government, major healthcare and non-healthcare business leaders. NHIN was launched to respond to the lack of consistency in patient care, safety, cost, effectiveness and quality across the United States.

A single, national organization and information repository is too big to be successfully formed and operated. RHIOs at state and local levels are considered 'the first step' toward the development of the NHIN. Given the volume of transactions and information flowing through members of even small RHIO members we can appreciate the enormity of the task for a national database.


Key Issues in RHIOs

There are four major issues relating to RHIO formation:

A viable business model - how to fund the organization. Gaining a real balance between who will benefit most from the RHIO [patients, purchasers and payers] and who will have the largest relative investment [providers - data input and technology investment]. Patients struggle with perceiving the value of something they assume should already be in existence. Patients mistakenly assume that healthcare organizations work together and share information that is important to their health needs.

A viable governance model - how the RHIO will be organized and how priorities will be sets. Governing an individual healthcare organization where stakeholders share the same basic mission and goals is somewhat easier than an umbrella organsiation where the diversity of stakeholders makes strategic alignment of all parties diffcult, if not impossible.

This challenge is further complicated by the fact that many members are direct competitors.

Sustainable value proposition - The key value RHIOs provide is the sharing of patient-level data for operational and analytical purposes. Eighty percent of work of RHIOs is standardizing data requirements and improving the efficiency and consistency in sharing this data. The other twenty percent is in using the aggregated data for analytical purposes [quality reporting, performance and pricing comparisons, and safety and satisfaction trends].

As the information flows become more efficient and the analytical needs grow in importance this ratio will change. Business intelligence applications will be pivotal to RHIOs achieving this goal.

Achievable technical architecture - the volume of transactions expected to flow through a RHIO and the complexity of the data records is very high. Several data architecture models have been proposed, including:

  • Distributed model - get data when called for, as in collaborating law enforcement agencies
  • Centralized model - keep all of the data in a single repository, and process key transactions through large clearinghouse repositories.
  • Hybrid models - combining the benefits of both


Business Intelligence For RHIO’s

One of the key issues in RHIO formation is creating a model for sustainable business value. The current focus is in improving the efficiency of getting operational data in the right place at the right time [patient data across the organizational borders]. As data sharing networks improve, the focus will shift to analytical uses of this data.

Business intelligence systems aggregate data for clinical, financial, administrative and research purposes.

Users of this aggregated data include:

Purchasers - to understand patterns and trends in the quality and cost of the healthcare they are buying.

Payers - to understand the same patterns and trends to provide the greatest value to their clients in terms of efficiency, protection and cost-effectiveness.

Providers - to understand the patterns and trends in the care members are providing and how their care measures compare to their peers and to industry averages. Patient wellness and preventative measures across employers and demographic dimensions.

Payer and purchaser scorecards are being used to provide measures of provider performance [treatments, outcomes, costs, patient satisfaction] and payer performance [speed of paying claims, efficiency in adjudicating claims, timeliness of settling disputes etc]. Such evaluations will likely extend back to purchasers themselves in measures such as workplace safety, wellness programs etc.

Researchers - as RHIO's grow larger and more diverse information from multiple RHIO's can provide larger sample populations on which to test research hypotheses. This is just one possible use of aggregating, reporting and manipulating data for member use, as well as public reporting purposes.


Key Analytics

The key subject areas for analysis include individual and group comparison of:

  • Treatment and outcome effectiveness
  • Cost and efficiency performance
  • Service and access effectiveness
  • Standard quality measures for various types of provider organizations - hospitals, physician groups, specialty clinics, etc.
  • Claims payment and claims processing efficiency
  • Wellness, prevention and chronic condition management and their effect on reducing reactive forms of healthcare such as hospitalization, emergency room visits, etc.


Demographic Trends and Patterns

There are numerous measures and analytical uses for the aggregated data being provided by RHIOs. The measures developed or chosen depend on the current healthcare issues and makeup of the specific RHIO.

The rapid growth of the RHIO movement is being driven by intense pressure for all participants in the healthcare industry to return value on health dollars spent.

Aggregated data for analysis of trends and patterns at individual member level and across the entire group [normative] is core to business intelligence. Analysis of:

  • Effectiveness of various services, treatments and other initiatives
  • Expectations of patients, payers, purchasers, providers, consumers, government and other public authorities.

The insight gained from this preliminary analysis will drive the develop of products and servcices and standard measures for higher level analysis.

Next: BI Implementation in Healthcare

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