By Monica Mehta
During the 2009 flu pandemic, the H1N1 virus caused major disruptions at hospitals around the globe. In the United States, the Centers for Disease Control and Prevention estimate that the virus, known commonly as the “swine flu,” killed as many as 17,000 Americans. Approximately 57 million Americans were infected with H1N1, and roughly 257,000 cases resulted in hospitalizations. U.S. President Barack Obama declared a national emergency in October 2009, stating that “the potential exists for the pandemic to overburden healthcare resources in some localities.” Indeed, the scores of people reporting flu-like symptoms strained medical centers, which had to respond quickly to contain and treat the virus.
Western New York’s Kaleida Health was no exception. The largest healthcare provider in the region, Kaleida saw a tremendous influx of patients with flu-like symptoms. Patients had to be triaged, quarantined, diagnosed, and treated immediately. Failing to do this properly would endanger the lives of patients and hospital staff. Managers needed to anticipate the number of incoming cases to assign resources properly. But they needed a way to quickly access and analyze the relevant data. With the help of Oracle Business Intelligence Suite, Enterprise Edition, Kaleida’s staff was able to allocate resources on time, treat patients quickly, and save lives in the process.
Lots of Information, Little Insight
Kaleida Health, the largest employer in Western New York, is made up of five hospitals, four nursing home facilities, a home care organization, and a variety of clinics. It houses the only pediatric hospital in the region, and sees about 1 million patients every year.
Buffalo, New York
More than 10,000
Net patient service revenue:
More than US$1.2 billion
Oracle Database, Oracle Business Intelligence Discoverer, Oracle Business Intelligence Suite, Enterprise Edition
Over the past 10 years, Kaleida has been expanding its Oracle data warehouse to include data from its financial, clinical, human resources, and quality-of-care departments. Executives needed a best-of-breed intelligence tool that would allow them to fully utilize this robust data warehouse. Although users were able to run reports using Oracle Business Intelligence Discoverer, Kaleida’s business intelligence (BI) team wanted to enable executives and department heads to view and manipulate the data more intuitively. They sought a graphical, dashboard-centric environment that would actively push information out to the people who needed it.
“The users needed a better way for us to convey the data, so they could consume information onscreen rather than having to mess around with creating reports. That’s not their core competency or what they need to spend their time on,” says Dan Gerena, director of BI and analytics at Kaleida.
Based on their existing footprint and experience with Oracle, in late 2008 Gerena and his team selected Oracle Business Intelligence Suite, Enterprise Edition. The product would also allow Kaleida IT staff to leverage their previous investment in Oracle technologies by using the Oracle Business Intelligence Discoverer End User Line Migration tool to migrate reports from Oracle Business Intelligence Discoverer to Oracle Business Intelligence Suite, Enterprise Edition. “Oracle is investing a lot in research and development to build out its business intelligence,” says Gerena. “We knew there would be additional capabilities that we could really grow into. We were very comfortable staying with the Oracle product set.”
After the installation was complete, the BI and analytics team developed executive dashboards to serve as a balanced scorecard for monitoring financial, operational, quality, staffing, and growth metrics. The team nicknamed the project “Magellan” after the Portuguese explorer whose expedition was the first to circle the earth. In August, within approximately nine months, Magellan was rolled out to approximately 40 top executives as a series of 25 dashboards detailing statistics such as gross revenue, payroll, number of in-house patients, mortality rates, and patient readmissions.
Oracle Business Intelligence Suite, Enterprise Edition enables the BI and analytics team to create dashboards using visual best practices, so that the graph, chart, or table conveys key information for executives. The dashboards are clickable; for instance, the financial dashboard includes tabs for accounts receivable, payroll, and budget versus actual spending. If hospital executives see a decline in revenue, patient days, or Emergency Department (ED) visits, they can determine the causes of the decrease. Quality-of-care dashboards provide statistics such as mortality rates, patient satisfaction, and readmissions. Executives can see poorly performing departments in the system and act to improve their performance. The tool also can be configured to send e-mail alerts to executives based on a date, a data exception, or other factors.
“We’re able to lay out the data intuitively now, from the perspective of how the business operates,” says Gerena. “We can segment the reports and stratify them in terms of departments, service lines, or subject matter. That’s helped everyone understand what the available data is and where it’s located. People are now more comfortable manipulating the data themselves.”
Gerena says the most important benefit of Oracle Business Intelligence Suite, Enterprise Edition is the ability to leverage the large amount of information amassed daily. “The product has allowed executives to focus more on the insights garnered from the data as opposed to data gathering,” says Gerena. “Instead of spending time running a report, exporting it to [Microsoft] Excel, and trying to make heads or tails of it—for instance, which doctors we’re losing or gaining volume from, or which cases are most profitable—all of that is readily available. Now, they can focus on crafting strategies to address certain scenarios.”
Leveraging all of its information to gain real-time insight was a boon to the system. But Kaleida Health didn’t realize the full impact of the tool until the flu pandemic hit.
Gaining Intelligence on a Viral Threat
In the spring and summer of 2009, hospital staff began seeing an increased number of patients with H1N1 flu symptoms. Multiple departments, including Corporate Emergency Management and the EDs, were bombarding the BI and analytics team with requests for reports. How many inpatients and employees had the flu? How did the number of ED patients compare to last year? Which staff had not gotten a flu shot? Did they have the capacity to treat the number of ED patients?
As a response to these requests, Gerena and his team spent two weeks in September building a “flu dashboard.” It automatically updated daily to provide a 360-degree view of the flu’s impact, including the number of patients with the flu, patient symptoms, and employee absences. Most importantly, it enabled the EDs in each hospital to anticipate the number of incoming patients. They were able to view the data and assign resources, such as employee masks and clinical space, accordingly. They could also see a projection of the number of employees who might call in sick, so they could allocate staff appropriately.
As the virus spread, the New York State Department of Health tasked Kaleida with providing statistics on the flu cases as a regional representative. Kaleida was able to report these numbers easily.
“The flu dashboard queried 5 to 10 different systems and put all of the data into a one-pager with interactive links that allowed us to drill down to patient records. It gave us a good, graphical snapshot of where we were in terms of the severity of the virus,” says Jay Roorbach, corporate emergency manager at Kaleida.
Kaleida’s Women and Children’s Hospital of Buffalo would typically see about 125 ED visits per day. In October and November, the number of visits tripled, with about 50 percent of the patients complaining of flu-like symptoms. The trend was abnormal for the flu season, which usually peaks in January and February. Because children are at higher risk of complications from the H1N1 virus, it was critical to ensure that the system had adequate resources to care for them.
With the flu dashboard, executives anticipated the patient increase and were able to develop a “surge plan.” Assessments were performed to allot extra clinic space for patients and ensure appropriate levels of staffing, so patients did not have to wait for extended periods of time to be seen. The pediatric hospital also had an influx of critical care inpatients with flu-like symptoms. The flu dashboard helped staff anticipate resources including beds, medical supplies, and blood volume.
Tim Kornacki, emergency management surveillance coordinator at Kaleida, who was hired to administer the New York state clinical survey, says seeing the patient trends onscreen increased the awareness level throughout the system. “It kept us all on our toes, so we knew what to expect and we had the resources ready,” Kornacki says. “It enabled us to keep our organization afloat during a very busy time.”
Mary Pruski, chief quality officer at Kaleida, says health officials were impressed when they saw the breadth and depth of data Kaleida was able to provide them about the flu pandemic. “As we gave him the information, our Commissioner of Health was very pleased,” she says. “He said he wished he could get this information from other hospitals.”
The success of the solution has lead Kaleida to submit the flu dashboard as an entry in the Data Warehousing Institute’s annual Best Practices Awards.
Preparedness Leads to Better Care
Although the number of flu cases in the fall of 2009 rose by about 15 percent compared to the fall of 2008, the average length of a patient visit fell by 6 percent, from 198 minutes to 186 minutes. Gerena attributes the decrease in this key metric to the intelligence gleaned from Oracle Business Intelligence Suite, Enterprise Edition.
“Even though patient volume went up and staff members were calling in sick at a much higher rate, we actually were able to shorten the length of patient visits,” he says. “This is because we could monitor the increase in patients and were able to move resources around accordingly, while ensuring that the throughput wasn’t affected.”
Given the complexity of the organization, Gerena’s team was able to create the flu dashboard within a remarkably short period of time. “Any toolset that allows for development of a solution so rapidly speaks loudly to users of traditional BI solutions, which have much longer cycle times to get to the desired outcome,” says Gerena.
Prior to the Oracle Business Intelligence Suite, Enterprise Edition implementation, Gerena says, strategic initiatives were typically driven by instinct and intuition. Data tended to be an afterthought, with executives trying to use the closest-fitting metric to measure success months into initiatives. “Executives are now becoming more data savvy and analytically proficient with the new toolset, and crafting strategic initiatives borne from insights derived from the data,” says Gerena. “This dashboard approach and capability fulfills the promise of business intelligence.”
The healthcare system sees enormous future potential for the tool with the introduction of electronic health records.
“From a clinical perspective, the [Oracle Business Intelligence Suite, Enterprise Edition] tool will allow us to leverage the oncoming explosion of data for research projects that lead to better patient outcomes,” says Gerena. “From a financial perspective, we’ll have access to more data that will allow us to decrease lengths of patient stays and readmission rates. As the healthcare system goes toward an outcomes-based reimbursement model, we’ll see even more savings.”
In Phase 2 of the implementation, Kaleida is writing reports to support the back-office areas, including reimbursement, accounting, materials management, purchasing, and patient financial services. In Phase 3, later this year, Kaleida will roll out Magellan to managers and directors. Eventually, Magellan will be available to about 500 to 600 users.
Norman Gennaro, vice president of sales consulting at Oracle, says Kaleida Health provides a great example of how healthcare systems can benefit with a dashboard-centric intelligence model. “Oracle’s BI solution has enabled Kaleida to improve their operational visibility and time to action. We are very pleased that Oracle has been able to assist Kaleida Health in responding quickly to ongoing changes in the healthcare industry,” he says.
Rudy Corsi, senior vice president of North America sales and consulting operations and Oracle Direct, says Kaleida’s ability to provide outstanding service is due in part to its capability to gain deep insight into its business. “Oracle’s business intelligence solution allows Kaleida to respond quickly to changes in the healthcare industry, utilize dashboard-centric reporting, and provide the information to the Kaleida team that helps them best serve their customers,” he says.
Best of all, Kaleida Health is prepared for the future—whatever it may bring.
“In our industry, we have to create solutions for today’s problems today,” says Kaleida’s Gerena. “But we need to shift focus to new challenges with urgency as they present themselves tomorrow. If the need tomorrow is to track severe acute respiratory syndrome [SARS], E. coli, or any other viral or bacterial outbreak, we can rapidly tweak the existing dashboard to instead focus on those respective diagnosis codes with minimal effort.”
Photography by Shutterstock