Dr. Craig Feied (left), who designed the Emergency Insight System, with Paul Shapin, MedStar's assistant VP for decision support.

Evolving With the Times

Flexible Software Helps Create Business Intelligence Strategy at MedStar

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

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

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

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

Laying the Foundation

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

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

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

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

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

Discovering WebFOCUS

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

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

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

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

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

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

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

Entering the World of EIPs

Shapin envisions creating an Employee Portal using Lotus K-station and WebFOCUS that will provide a central hub where employees can retrieve virtually any information that they need. "We'll have a window right into WebFOCUS where reports can be generated in response to particular user requests," he says.

The Employee Portal will improve communication, supply Web access to clinical systems, enable self-service HR applications and improve collaboration among dispersed groups of workers.

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

Real-Time Clinical Information for Doctors

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

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

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

Personal Data Delivery

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