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Emergency department brings order to patient care with operational BI

Thanks to operational business intelligence, the old whiteboard is out and a new electronic tracking board is in at one hospital emergency room.

When many people hear the term business intelligence (BI), they think first of business analytics. But not Ed Norwich, who's partially responsible for the health of thousands of people.

As head of IT for Cambridge Memorial Hospital, a 155-bed community hospital in Cambridge, Ontario, Norwich instead thinks first and foremost of BI as a technology to help frontline workers better manage daily operations.

“The traditional analytical model is but one aspect of an effective and useful BI tool,” Norwich said. Operational BI is another.

The traditional analytical model is but one aspect of an effective and useful BI tool.

Ed Norwich, manager of information management technology, Cambridge Memorial Hospital

While traditional BI helps executives and other power users report against and analyze corporate data, operational BI aims to get timely data to frontline workers to help them make better decisions in the moment.

To be effective, operational BI tools and software must be able to integrate data from transactional systems in near real time. Operational BI’s most popular use case is in the call center, but it is increasingly being applied to other scenarios, including healthcare.

Until recently, doctors and nurses working in Cambridge Memorial’s emergency department (ED) kept track of patients the old-fashioned way: with a whiteboard and magic marker. When a patient was admitted, his or her name went up on the whiteboard and nurses managed and updated the information manually.

But the ED, which treats an average of more than 100 patients per day, needed a better way to manage patient care, not least because not doing so was costing the hospital much-needed federal funding, Norwich said.

In order to receive funding from Health Canada, the country’s national health ministry, all EDs must meet specific requirements laid out in the Canadian Triage and Acuity Scale, or CTAS. CTAS is essentially a scale that ranks the severity of patients’ conditions and mandates timelines in which EDs must treat them. The more severe the condition, the sooner the patient must be attended to.

Tracking nearly 40,000 annual ED patients to meet CTAS requirements on a whiteboard was simply too inefficient, error-prone and difficult to report against, Norwich said.

The whiteboard also offered little help to managers tasked with determining staffing requirements based on patient workloads, and coordinating patient care with other departments like radiology and x-ray was difficult, sometimes leading to lengthy wait times for patients.

So about a year and a half ago, the hospital enlisted the help of Information Builders, the New York City-based BI and data integration vendor, to find a better way.

That better way proved to be an electronic tracking board that displays patient data in near real time, giving doctors and nurses the up-to-the-minute information they need to make better clinical decisions.

Built on Information Builder’s WebFOCUS platform, the large, TV-like monitor displays data fed from the hospital’s Meditech admission and clinical information modules, Norwich explained. The information includes patient names, times of admission, CTAS levels, test results, and tests pending.

It also tracks and reports patient wait time against CTAS requirements, so doctors and nurses can better prioritize care.

“Quite literally, the board says you have one hour until this patient is over the [CTAS] limit or that patient is over the limit by so many hours,” Norwich said. “It’s no different than moving trains along a track or widgets through a factory.”

The tracking information is also available to authorized personnel via any PC. Managers use it to better allocate ED staff, while other departments can anticipate when to expect patients (and how many of them) from emergency.

“This tracking board is now critical in the management of the patients and resources within emergency,” Norwich said. “It gives you a very visual basis with which to make a decision.”

In all, it took just under six months to design and implement the tracking board, he said. Much of that time was spent customizing data connectors between the Meditech modules and the tracking board, for which the hospital hired Westwood, Mass.-based Blue Elm to help them.

“Meditech is a rather proprietary product,” Norwich said. “Extracting data is always a challenge because they [Meditech] aren’t open and they play these games of proprietary standards.”

Still, even factoring in the extra costs associated with the custom data integration work, the hospital’s investment in operational BI has been money well spent, he said. In the year since deployment, the electronic tracking tool has already paid for itself in the form of increased funding resulting from better CTAS compliance.

More importantly, Norwich said, it has improved the quality of patient care, and it’s difficult to put a price on that.

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