Decision Support Systems

1. Decision Support Systems Dale W. Wells Senior VP of Finance & Operations Alliance Community Hospital Presenter has nothing to disclose, except that he is a porcine obstetrician!

2. Guiding thoughts from Albert Einstein. . . • “If you can't explain it simply, you don't understand it well enough” • “Information is not knowledge” • “If we knew what it was we were doing, it would not be called research, would it?”

3. Typical Health Care Decision Support System Examples(from the past)

4. The 50/50 Option

5. Vegas Style

7. What is a Decision Support System? Decision support system From Wikipedia, the free encyclopedia • A decision support system (DSS) is a computer-based information system that supports business or organizational decision-making activities. DSSs serve the management, operations, and planning levels of an organization and help to make decisions, which may be rapidly changing and not easily specified in advance. • DSSs include knowledge-based systems. A properly designed DSS is an interactive software-based system intended to help decision makers compile useful information from a combination of raw data, documents, personal knowledge, or business models to identify and solve problems and make decisions.

8. Information vs. Knowledge?? • Information systems are historical in nature and provide static data points. • Knowledge systems are interactive and allows users to provide differing data inputs to gain a better understanding of the variables and their impacts. • i.e.: a pivot table

9. Why in healthcare? • Payment Reform • Clinical Quality Enhancement • Managed Care Contracting • Consumer Transparency • Decisions on Service/Product Lines • Accreditation requirements

10. Health Care’s version of a DSS • Managerial/Executive Decision Support System • Clinical Decision Support System • Hybrid

11. Managerial D.S.S. • Typical Financial Decision System • May include data specific to physicians, lines of business, and other detailed data • Typically employed by a finance department • May be one system or a compilation of systems including ad-hoc reporting

12. Clinical D.S.S. • Clinical Pathways and Outcomes • HCAHPS • SCIP • Core Measures • OASIS • RUGS • Etc., etc. etc. etc. • Electronic Medical Records

13. Hybrid • Combines both the quality outcome with the operational performance

14. Alliance Community Hospital, Alliance, Ohio

15. About ACH • Independent Community Hospital • In operations since 1901 • Licensed for 252 beds • Net Revenues $100M+ • Approx 1,000 Colleagues • S&P Rated Facility

16. Why Did we put in a Cost Accounting System? • Meditech system didn’t easily provide reports that the end user could make decisions on. Most reporting done thru an ad-hoc system. • ACH needed to be able to find waste quickly and scientifically. • Managers needed to know what their impact was on the whole organization • ACH wanted to find a way to evaluate services • We didn’t know what we didn’t know!

17. Pentech Rev Runner Meditech QS1 Carevoyant Many others Pyxis Picis Medlink

18. Medlink Cost Accounting System • Chosen in 1998, implemented in 1999 • Initial cost was $45,000 • Took about 9 months to install • We dedicate about ½ an FTE to annual servicing • Reports are available to us on a Quarterly basis • Significant amount of input from all directors as to cost drivers

19. Types of Information ACH can Analyze

20. Departmental Specific

21. DRG Specific

22. Physician Specific

23. Other Ad-hoc Reports developed for end users.

24. Next Steps at ACH • Move to a more integrated model • Challenge of lining up outcomes with cost and profitability • JCAHO/HFAP desire to monitor ongoing practitioner performance • Drive performance down to lowest levels possible

25. Cost Satisfaction Driving Customer Value Outcome

26. Medlink Data Clinical Outcomes Data (HCAHPS, Core Measures SCIP, etc.) Crimson

27. Crimson • Is in the test phase now • Expect that it will be able to help us: • Identify waste • Track physician performance • Better identify services we should and shouldn’t be providing • Become more transparent

28. Pearls of Wisdom

29. Decision Support Systems. . . • Will be needed to compete as health care continues to transform. • Require the input of everyone to make the system robust and accurate. • Must be maintained to avoid GIGO • Will have a high up-front cost and have significant long-term benefits • There are many vendors to choose from, just make sure they capture all of your data.

30. Questions? Dale W. Wells Senior VP of Finance & Operations Alliance Community Hospital 200 E State St Alliance, Ohio 44601 dwwells@achosp.org 330-596-7066