Our clinicians thought that the EHR would be a silver bullet to get the data they needed for quality improvement and operational reporting and they blamed IT when the information wasn’t forthcoming. … Implementing an EDW should really be an appendix to the implementation of an EHR because the surge of data is just unbelievable and the appetite for it is huge.
– Myra Davis, M.E., Senior Vice President of Information Services
To address the challenge of the impending transition to value-based reimbursement, Texas Children’s Hospital launched a quality and safety initiative in 2006 to develop a comprehensive and integrated enterprise-wide data management infrastructure. The first step was to implement an electronic health record (EHR) to collect raw clinical and financial data from across the enterprise.
Although the EHR has proved tremendously valuable as the means of digitizing care across the hospital, Texas Children’s IT leaders soon discovered that the newly digitized clinical data was hard to extract and combine with other data sources in a timely manner. Clinicians and quality teams still lacked access to meaningful information they could use to guide clinical quality interventions and improvements.
“Our clinicians thought that the EHR would be a silver bullet to get the data they needed for quality improvement and operational reporting and they blamed IT when the information wasn’t forthcoming,” recalls Texas Children’s Senior Vice President of Information Services Myra Davis, M.E. “The comment I would hear is, ‘I can’t get the right data from them,’ or ‘they don’t understand what I need from them.’ It created nothing but frustration.”
For her part, Davis was frustrated that the IT department was quickly becoming a “report factory” for the rest of the hospital. She and her team soon identified the ability to leverage their healthcare enterprise data warehouse (EDW) to aggregate and make usable all of the data from the hospital’s disparate IT systems. “Implementing an EDW should really be an appendix to the implementation of an EHR because the surge of data is just unbelievable and the appetite for it is huge,” says Davis.
Beginning in September 2011, the hospital worked with Health Catalyst to implement an enterprise data warehouse (EDW) designed to unlock meaningful data trapped in the EHR and other applications to meet clinicians’ expectations. This was not to be a typical EDW, but rather a healthcare EDW with a Late-Binding™ architecture.
Once Texas Children’s connected with Health Catalyst, the path to implementing the EDW was a short one. In less than three months, the hospital’s EHR data was flowing into the EDW. Just another three months after that, clinicians were using EDW-generated information for the organization’s first clinical improvement initiative.
It wasn’t long before Texas Children’s IT team realized the benefit of the new solution was even greater than expected.
Today, Texas Children’s IT team uses the EDW to create near real-time reports from data that was previously siloed within the EHR, enterprise resource planning (ERP) applications and other business systems. The speed of the EDW report-writing process has exceeded expectations. John Henderson, Director of Enterprise Systems for Texas Children’s, says the average time it takes an analyst to build a report has declined from 97 hours for an EHR-generated report to 29.3 hours for a report generated via the EDW. Average delivery time, defined as the time it takes from when someone submits a request for an EHR report to the time a report is delivered, is trending downward as well, from a previous window that exceeded 120 days to a current time frame of less than 90 days – a 25 percent improvement.
Those improvements translate into significant cost savings. On average, each EDW report costs Texas Children’s 67 percent less to build than an EHR report. Given that the hospital was previously generating an estimated 1,300 EHR reports per year at an average cost of $4,832 per report, the savings are substantial.
Moreover, Henderson estimates that each EDW visualization delivers, on average, 10 times the value of EHR-generated reports. The quality difference is due largely to the relative complexity of the data produced by the two report types. EHR-generated reports, such as daily patient lists, provide a static one-dimensional view of the data. To get a broader view and answer more questions, clinicians need to request on average nine additional reports. By contrast, the EDW’s use of data from multiple applications combined with its powerful analytics delivers drill-down and trending capabilities. Users can analyze the data from multiple perspectives without requesting additional reports.
Explains Davis, “Before the data warehouse, if someone in the organization wanted data from IT to answer a question, they would submit a report request and there was this back and forth that was so frustrating for the clinicians, who really didn’t want to have to communicate with us. Now with the data warehouse as a hub with near real-time data, the clinicians can all see the data at the same time and they can very easily spot the data they’re looking for.”
The combination of fewer report requests and faster reporting time has made a world of difference for the IT department. Reports that once took weeks or even months to prepare can now be generated in days, and sometimes hours. Rather than spending all their time responding to an endless queue of report requests, department analysts now are able to function in their intended role – uncovering patterns in data to reveal the most productive operational and clinical improvements. Thanks to these improvements, business partner satisfaction with the IT department has increased dramatically.
“The days of the report factory are over,” says Henderson. “Our analysts now can use the EDW to drill down and find the information they need, instead of having to piece together static EHR reports into an Excel document. We now have a single ‘source of truth’ that has expedited the budgeting process and driven more robust information delivery across the organization.”
Encouraged by the ease of report generation with the EDW, Texas Children’s has begun to distinguish between the types of reports best generated by the EHR versus the EDW, and to dramatically limit the former. The hospital has found there are still some uses for the EHR’s basic reporting tools.
IT resources also are shifting. Many members of the EHR reporting team are either being reallocated to new initiatives or learning the EDW platform. Within the next year, the number of EDW users at Texas Children’s is expected to triple — at the very least.
“Previously, we were focused on clinical programs, and quality and outcomes improvement. We now have a dual approach that focuses on both outcomes and operations. Our future goal is enhancing the operations reporting program so that our clinicians will have a full-blown suite of healthcare analytics that incorporate not only operational metrics by each unit, but also financial, clinical and patient satisfaction.”John Henderson, Director of Enterprise Systems
“It’s really the utopia of visualization, having a true score card that combines our clinical, financial, operational and patient satisfaction outcomes so we can see how we’re performing not only against our own goals, but also to benchmark against the industry,” he adds.
“We were on this journey for seven years, and it didn’t get us anywhere close to what we’re doing today with Health Catalyst, let alone what I expect we’ll be doing in five years,” he says. “Finding the right partner to help us figure out how to implement a healthcare EDW and engage the organization in quality improvement has been the key to our success.”
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