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,
- 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.
The key subject areas for analysis include individual and group
- 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
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