Enterprise Business Intelligence

Ben KimmelAssistant Director, Fiscal Services

Cleveland ClinicCleveland Clinic

• 3.6 million patient visits

• 160,000 admissions

• 42,000 employees

• 2,700 physicians and scientists

Current EBI InfrastructureCurrent EBI Infrastructure

• Phase I implemented 2006

• SQL Server platform

• Business Objects presentation layer

• 18 TB data

• 40 FTEs

• 93% data load frequency < weekly

• 6,000 total users, ~1k/week

AgendaAgenda

• Cleveland Clinic performance management evolution

• Example dashboards

• EBI infrastructure

• Governance

The CC EBI Evolution

1993 2004 2005 20061995 20021998

Monthly Wheels

CCF Main Campus - Med., Surg., Eye, Peds PERFORMANCE INDICATORS For Month Ending Jul-98Monthly

Operational Indicators

Continuous Improvement

Summits

Web Based Wheels

0

2

4

6

8

10

12

14

6/03

7/03

8/03

9/03

10/0

3

11/0

3

12/0

3

1/04

2/04

3/04

4/04

5/04

6/04

7/04

8/04

9/04

10/0

4

11/0

4

% D

enia

ls

0

1000

2000

3000

4000

5000

6000

Vis

its

% Denials Target Visits

Denial Database Volume

Daily Dashboard

Dashboard Tools and

Data WarehouseExecutive Dashboard

InstituteScorecards

2008

EBI PMDSS Dept DBs

ShortCycle

2010-12

Performance Management

EBI & performance managementEBI & performance management

• Using data to manage business

• Feedback loops & accountability

• Predictive modeling• Enterprise level

Business Intelligence

Data Warehouse

Functional Systems

• Stand alone, functionally specific applications• DSS applications• Financial consolidation tools

• Automated processes that feed a central data warehouse with data from disparate source / transaction systems

• Single source of information• Initiative driven

• Using DW data in fact based analytics

• Augment data with KPIs, business imperatives & scorecarding

• Key metrics & trending analysis

• Division / function specific

Dashboard ArchitectureDashboard Architecture

Executive Dashboard

• High Level• Indicator Driven• Visual & Intuitive • Focused• Flexible

• Finance• Statistics• Patient Access• Quality • Patient Experience

• Physicians• Institute Chair• Department• Nursing• Clinical Operations• Patient Support Services

Finance& Statistics

QualityPatient Access

Operational Dashboards

• Summary• P&L by Entity• Financial Metrics• Key Statistics• Reports• Service Line

• Summary• Core Measures• Patient Experience• Hand Hygiene

• Outpatient Access• Days Wait• Appt when wanted

Operational Dashboards

Executive Quarterly ReviewExecutive Quarterly Review

• Align strategic objectives

• Common scorecard platform

• Transparency

• Best practice sharing

• Continuous Improvement

Clinic AccessClinic Access

• Template Management

• Appointment Days Wait

• Appointment When Wanted

• Same Day Access

Short CycleShort Cycle

• Near “real-time”

• Quicker delivery to clinical managers

• Summarized nursing unit performance

Smoking Cessation (AMI/HF/PN) Smoking Cessation (AMI/HF/PN)

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

Pneumonia Vaccination Pneumonia Vaccination

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

HF EducationHF Education

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

SCIP: Hair RemovalSCIP: Hair Removal

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

SCIP: NormothermiaSCIP: Normothermia

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

SCIP: Periop Beta-blockerSCIP: Periop Beta-blocker

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

SCIP: VTE Prophylaxis OrdersSCIP: VTE Prophylaxis Orders

60%

80%

100%

Jan Jan Jan

PrePost

20102009 2011

“Fast is fine, but accuracy is everything.”

- Wyatt Earp

“Fast is fine, but accuracy is everything.”

- Wyatt Earp

35

ICU OperationsICU Operations

• ICU Ops Team created in 2006

• Expanded in 2009

- Oversight committee formed

- 30+ ICUs

- 350 beds

- 30,000 admissions/year

ICU Hand Hygiene Compliance

ICU Hand Hygiene Compliance

60%

70%

80%

90%

100%

2007 2008 2009 2010

Compliance Target

ICU CLABSI RateICU CLABSI Rate

0

1

2

3

4

5

2008 2009 2010 2011

50% reduction50% reduction

Rate

Blood UtilizationBlood Utilization

• Scarce resource

• High cost

• Clinical risk

Physician

Level Detail

Example Physician

Cleveland Clinic Blood Use per 1K patient days

Cleveland Clinic Blood Use per 1K patient days

2008 2009 2010

150

200

250

300

350O

ct

De

c

Fe

b

Ap

r

Jun

Au

g

Oct

De

c

Fe

b

Ap

r

Jun

Au

g

Oct

De

c

Uni

ts

2

2.1

2.2

2.3

2.4

2.5

CM

I

Blood use per 1K pt days Case Mix Index Linear (Case Mix Index)

EBI InfrastructureEBI Infrastructure

Information Delivery Environment Before EBI

Information Delivery Environment Before EBI

CIS

SC

Billing

ORIS

GL

DataSources

Data “Stores” / Applications

Information Access / Display

DSS

Crystal

ODS

Excel

Previous environment characterized by:

Heavy reliance on packaged technology solutions with limited integration

Data stores developed and owned by independent departments – duplicative and expensive

Inefficient and untimely delivery of information

Disjointed approach to information access & display (reports, online tools, excel, crystal, etc.)

Multiple representations of data with inconsistent definitions – no single source of truth

Others Others

Current Information Delivery Environment

Current Information Delivery Environment

CIS

SC

Billing

ORIS

GL

DataSources

Distributed Enterprise Data

Warehouse

Consistent Information Access

/ Display

DSS

Current environment characterized by:

Coordinated approach regarding:Data ETL and storageData visualization and reporting

Data stores developed and owned by independent departments

Efficient and timely delivery of information

Coordinated representations of data with consistent definitions – moving towards a single source of truth

Medops

Others

Infrastructure Configuration & AccessInfrastructure Configuration & Access

Key Areas of Responsibility

Infrastructure: IT

Source ETL: IT

Warehouse: Finance

Dashboard: Med Ops

Distributed Functionality for Flexibility

•Marts•Dashboards•Tools

GovernanceGovernance

Our EBI Strategy Guiding Principles

Utilize proven, best practice methodologies and metrics to facilitate predictable and repeatable outcomes

Continually strive to increase innovation and drive toward creativity and thought leadership

Focus on planning and resource allocation to permit flawless execution even amid unforeseen events

Align enterprise resources to strategic goals and priorities and drive accountability to achieve highest-

value business impact

Consistent Process

Continuous Innovation

Proactive & Adaptable

Effective Governance

The Role of Executive SponsorThe Role of Executive Sponsor

• Drive Strategic Priorities

• Embrace Key Performance Indicators

• Issue Resolution

• Secure Funding & Resources

• Espouse Operational Changes Based on Fact-based Findings

• Executive ‘Champion’ of EBI

Iterative ExecutionIterative ExecutionIterative ExecutionIterative ExecutionPlanning Change ProcessPlanning Change ProcessPlanPlan

Requirements Change ProcessRequirements Change ProcessAnalyzeAnalyze

Design Change ProcessDesign Change ProcessDesignDesign

DeployDeploySupport Training & PreparationSupport Training & Preparation

System TestSystem TestLaunch PreparationLaunch Preparation

DevelopDevelopTest Case DevelopmentTest Case Development Code ControlCode Control

Milestone 2Milestone 2 –– Vision & Scope, Data Model & Report Layout, Preliminary Schedule

11

33

44

55

22

Milestone 1Milestone 1 –– Project Initiation

Milestone 5Milestone 5 –– System Test, Documentation, & Training Complete, Production DeployedMilestone 4Milestone 4 –– Code Complete (Database & Reports), System Test InitiationMilestone 3Milestone 3 –– Business Rules, Final Design, Test Plans, Final Schedule

Driving Toward High PerformanceKey Take-aways

Driving Toward High PerformanceKey Take-aways

• Transition from data-rich to information-rich

• Common source of truth

- Business Intelligence

• Alignment with organizational goals

- Safety, quality, operational excellence

• Transition from transparency to operational excellence

• Culture of continuous improvement