No catch-22 here: for 22 Connecticut hospitals, using a uniform Web-based decision support system has cut operating costs and streamlined business - ASP/Internet: case history

Health Management Technology, March, 2002 by Vincent Catrini

We were growing more inefficient each week. My colleagues at Health Connecticut were convinced there was a better way to manage the data we collected from and provided to our 22 member hospitals. We were using Access and SQL queries, a slow process because it tapped an entire database of information without providing us with specific data we needed.

One of the missions of Health Connecticut, a consortium affiliated with the Connecticut Hospital Association but owned by the hospital members, is to provide hospitals with information services to support them in their managed care contracting and population health management activities.

By bringing together claims data from multiple payors in the state, we hoped to create a comprehensive warehouse of information that would provide the quality assurance staff and financial analysts at all 22 owner hospitals with a powerful analytic repository to support their demand planning, disease management program design and contracting activities.

But we had to reinvent the wheel every time we ran a query or issued a report. For example, isolating pharmacy data for pneumonia cases could take up to six weeks. Some queries to our data warehouse could take several days to complete, depending on complexity. We use typical healthcare measures across our analysis, which were being recalculated for each dataset. This excessive use of staff time convinced us it was time to make a bold change: We needed a Web-based system everybody could use.

Finding a Solution

Health Connecticut established a subcommittee with representatives from each of the hospitals to find a commercial solution. The process was long--almost 18 months--and encompassed two RFPs and examining nearly a dozen vendors' products.

In January 1999, we issued our first RFP and subsequently conducted multiple rounds of interviews, but had difficulty identifying even one vendor and decision support product with the Web-based reporting functionality we sought. One year later, we issued a second RFP. This time, we concluded the process in less than four months with our selection of W3Health Corp., a company that delivers analytic software solutions to healthcare payor and provider organizations through an application service provider (ASP) model and features a distributed reporting system.

We selected W3Health for several reasons. Their price was competitive, and they guaranteed us they could meet our implementation timeline. We had spent nearly a year on the first RFP, so we wanted to be operational as soon as possible. We also wanted a vendor that would incorporate our business rules into their product rather than the reverse.

Implementation began in mid2000 and was completed by the fall. During this time, W3Health processed 6 million claims and created a viable test product in just four weeks from claims, eligibility and provider data.

Easy Implementation

With the testing complete and the functionality claims proven, we moved into the customized implementation phase, in which the product was tailored to fit our requirements, needs and rules.

For our initial implementation, we created a task force of 10 members from both internal Health Connecticut users and external users (either managed care or utilization management from our member hospitals). The core user group received two full days of on-site training and then went into full user mode.

Next, Health Connecticut expanded the user group, training 30 people from the 22 member hospitals. We had a users group meeting that was well attended, but we have not measured the actual use they are making of the system independent from the reporting we have done.

In the wake of terrorist attacks last September, users are increasingly focusing on bioterrorism preparedness as a key issue. At our next users group we will attempt to poll the group and develop collective ideas for future studies.

Also, Health Connecticut is currently working on measuring antibiotic utilization for acute otitis media and will use that study as a springboard to examine resistant organisms and antibiotic usage across other disease states. It will be particularly interesting to review the spike in antibiotic usage following anthrax attacks. Since an elderly Connecticut woman died due to anthrax exposure, we are likely to see an increase in antibiotic prescriptions.

It will take about a year before we see that reflected in our claims data, allowing for runoff and completion factors. But the entire scope of that study hasn't been defined yet. Unfortunately, the anthrax attacks are going to have a negative effect on the work that had been done to try to reduce the demand by patients for antibiotics suffering from common colds.

Technology at Work

The W3Health DRS system uses online analytical processing (OLAP) technology to essentially predigest data into cubes or related data. Hierarchical categories, called dimensions, and healthcare measures in standard or custom form, are built into the system based on our business rules. Users designate the healthcare measures they want to report on and select the dimensions the report should contain. Detailed data is rolled up to summary levels and can be drilled down to fine detail, all with a few clicks of a mouse. Users need not know how to write queries or program code.