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Business Intelligence (BI) encompasses a wide variety of concepts, technologies, and processes. It also includes many departments of an organization. BI is the term used for technology and applications that are used for gathering, storing, analyzing, and providing access to data in order to help enterprise users make more informed business decisions. The applications used in BI processes are decision support systems, query and reporting software, online analytical processing software, statistical analysis, forecasting, and data mining software. BI has been developing and progressing steadily over the past 20 years, so it is not a new business angle or phrase.

BI applications can be mission critical and essential to an organization’s operations; they can be organization-wide or local to one project or department; driven by user demand or centrally initiated. BI applications cover more than just technology. They also cover corporate performance management; data warehousing; online analytical processes; user interface (“dashboard”); can monitor and measure an organization’s performance against targets and goals (“scorecard”); data mining; analytics; text analytics; business activity monitoring; and complex event processing.

The healthcare industry encounters many challenges, and providers must stay ahead of their competition, or at least stay even. Business intelligence can help healthcare organizations increase their advantage by developing knowledgeable business solutions.

An HIM director will no doubt be involved in business intelligence, but in a less technological manner. His/her role will be on the side of ensuring that the data inputted into any BI software or function is correct and that it is in proper format, in order to generate accurate and efficient reports. HIM directors oversee the raw data that essentially becomes the backbone of key reports and data.

BI is poised to play a critical role in the transition to value-based healthcare. In March, outgoing U.S. Secretary of Health Michael Leavitt labeled the transformation to a value-based health care environment as both imperative and the most significant financial challenge that the country has ever faced. He defined the value-based movement as “a growing collection of people, organizations and governments who believe that the value of care should replace the volume of care as the most important virtue in the way health care is paid for and consumed” (“Transforming Healthcare with BI,” Lisa Loftis, Information Management Magazine, March 2009).

According to Leavitt, BI provides a consolidated collection and view of data, one that can be used to develop major performance indicators, identify diagnosis patterns, illuminate process differences, and identify cost factor variations. These all help improve accountability and visibility and can drive an organization toward efficiency.

Evidence-based cultures must emerge from the practices of the past, says an article in Information Management Magazine (William McKnight, “Business Intelligence in Healthcare Today,” May 2005). Information must be incorporated into care provisioning, clinical research, organization, compensation and care-related decision making. BI is the strategy to achieve an evidence-based culture. There is a huge need for BI in healthcare today.

The state of healthcare data today makes this a fairly large challenge with non-integrated systems and a legacy of failed integration attempts. In a typical hospital, it is common to have a patient’s record recorded in a specialist’s paper-based system according to an internal interpretation of industry coding standards. Patient procedures are then disseminated to multiple systems, such as billing. Another set of encoding is performed. Outpatient and other follow-up visits are not always linked efficiently to the original procedures or billing.

The complexity, high cost, and long time to develop, create and implement data warehousing solutions has prevents many hospitals and healthcare organizations from investing in them, but newer BI products today are shorter to implement and easier to use. Healthcare organizations are beginning to see that these new products are crucial to enhance patient care and improve strategic decision-making. Given today’s high costs of healthcare, likely to continue climbing, BI solutions may be the key to tracking and evaluating efficiencies in different aspects of healthcare, including operational effectiveness and patient care. Performance indicators cover many operational and clinical areas, such as resource utilization, staff utilization, financial measurements, and clinical outcomes.

Seven applications that qualify as BI applications – methods for healthcare payers to use BI to improve revenue, efficiency and process (“7 Highly Elegant Business Intelligence Applications for Healthcare Payers,” by Laura Madsen, B-eyeNetwork):
1. Compliance
2. Operational and performance dashboards
3. EMR/HER
4. Quality and performance analysis
5. Data mining
6. Fraud and abuse
7. Cost and utilization analysis

According to Shravan Miriyala (“BI in Healthcare: Lessons Every Industry Should Heed,” March 29, 2007, B-eye Network), most healthcare organizations continue to struggle to educate the their peers on the use and promised efficiencies of business intelligence and how it can drive business value.

Here are the main reasons for healthcare’s sluggish BI implementation, according to Miriyala:

•  Different locations and formats – healthcare data is usually stored in file cabinets, computer databases, and as unstructured data in other applications (i.e., other than databases)
• Unmanaged data – healthcare data is largely not stored uniformly or organized uniformly; upcoming legislation, including previous HIPAA, should help improve this situation
• Data usage immaturity – Miriyala notes that “manual report building practices are a key indicator of a low BI maturity level” and recommends that healthcare organizations adopt more disciplined approaches to generating operational reports - reports that support strategic planning and decision making driven by data.
• IT treated as a cost center - Immature healthcare organizations don’t view data as a supply chain in the enterprise; Miriyala says that “IT can become the agent of change to empower the organization with integrated information to support the business through business intelligence; healthcare organizations can and should should elevate IT beyond systems support and entrust IT organizations to begin gathering requirements for information, thus deploying business intelligence as a business solution.”
• Proprietary systems are the norm - Many software vendors focused on the healthcare market offer little or no documentation, no data extract interfaces, and no data models that can help annotate the systems and their functions. These cause major data integration challenges and thwart BI efforts to extract common data from many disparate systems with little in common, according to Miriyala.