The Community Health Access Network, a network of Federally Qualified Health Centers, has learned a great deal about creating effective business-intelligence reports in recent years.
Members of the Community Health Access Network (CHAN), most of whom are located in New Hampshire, get a large share of the funding from the federal government, and the money comes with requirements that they lead initiatives designed to improve care quality. To participate in these programs effectively, providers must be able to track the health status of their entire patient populations across many visits. But by 2010, the volume of data was increasing, and CHAN's original SAP-Crystal Reports business intelligence (BI) implementation wasn't keeping pace.
This led CHAN to implement SAP BusinessObjects Edge on top of SQL Server. The new system allows CHAN's network of 10 Federally Qualified Health Centers (FQHCs) to create and access the reports they need to manage patient health.
Several federal and private initiatives are forcing healthcare providers to be more thoughtful about how they manage and analyze data. A provision of the Affordable Care Act will reduce Medicare payments to hospitals that have high readmission rates. Meanwhile, both public payers, such as Medicare and Medicaid, and private insurance companies are asking providers to move from fee-for-service reimbursement models that pay physicians based on how many procedures they administer, to models that reward doctors for successfully keeping patients healthy.
There was so much push for quality improvement, but before you do quality improvement, you have to have the data.
executive director, CHAN
FQHCs, in particular, are under a lot of pressure. To maintain their federal funding, the government requires them to participate in a quality assurance program. Many of the providers in the CHAN network have chosen to follow the patient-centered medical home (PCMH) model of the National Committee for Quality Assurance, which emphasizes coordination among primary care doctors, pharmacists and hospitals. Jane Arquette, CHAN's clinical quality data manager, said it would be difficult for practices to achieve PCMH certification without the ability to generate BI reports on patients.
As part of the PCMH model, providers must give extra attention to patients with "important conditions," which include diabetes, hypertension and childhood obesity. Before these patients come in for visits, doctors on the care team will get together to discuss how they are doing and what types of services they'll need during the visit.
CHAN was able to use its BusinessObjects implementation to build BI reports that providers can access at the beginning of the day to see which patients with important conditions will be coming into the office. The reports also include information on the health status of these patients.
"We're able to get the timely information when we need it," Arquette said.
But getting to this point took a lot of work. Kevin Fournier, a consultant at DataSense Solutions who worked on the BusinessObjects implementation with CHAN, said the organization initially did all its reporting with Crystal Reports. But as the needs of CHAN's members grew, it became apparent that a more robust analytic technology was needed.
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The biggest challenge of the project, Fournier said, was creating the analytical logic that identifies patients based on their condition. Providers may ask for a report including information on all diabetic patients with appointments on a given day, but there is no standardized field in electronic health records -- the standard document for recording patient information -- that identifies patients based on disease state. This information may be inferred based on blood test scores or notes in free-text fields. Fournier's team had to write a significant amount of code to pull together all this information from patient records to group individuals based on disease state.
"That logic is fairly complex and coding it into the data warehouse was probably the greatest challenge," Fournier said.
Today, CHAN still uses the original Crystal Reports implementation to create some BI reports and move them into the new BusinessObjects environment. Others are created with SAP's Web intelligence tool, which enables users to create self-service BI reports.
Kirstin Platte, CHAN's executive director, said the pressure placed on the network's FQHCs to improve quality was what pushed the organization to implement the SAP data warehouse and BI reports. It's a trend that could play out across the healthcare system as public and private payers push providers to accept reimbursements based on quality, which demands a data-driven approach. Platte said this kind of approach was a key element of CHAN's plans.
"There was so much push for quality improvement, but before you do quality improvement, you have to have the data," she said.
This was first published in September 2013