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Lee Memorial Health Systems: Increasing
Patient Satisfaction & Growing Margins through Business
As a leading not-for-profit community-owned healthcare provider, one
of the primary aims of Lee Memorial Health System (LMHS) is to be
a vital asset to the Southwest Florida community by providing high
quality, cost effective services. This commitment to community goes
beyond the facility's walls and the millions of dollars in uncompensated
care that is provided to those unable to pay. To achieve this, senior
executives at LMHS have an ongoing initiative to increase patient
satisfaction, the key driver of profit margins, enabling them to give
back more to their community.
By partnering with Dimensional Insight, LMHS is able to:
- Increase patient satisfaction by reducing patient waiting time
and providing exceptional nursing care.
- Reduce operating costs by increasing bed utilization, and optimizing
- Increase revenues by maximizing reimbursements.
- Continually improve its business efficiency by spending more
time on intelligent analysis of data and less time waiting for
detailed analysis of summary data.
Why Did Lee Memorial Need Dimensional Insight's Diver Solution?
As a thought-leader in non-profit healthcare in the United States,
LMHS is always striving to improve patient care and the operational
efficiency of their business. Dimensional Insight's Diver Solution
enabled this by tapping into years of accumulated clinical and financial
data, providing new and timely insights into the operation of the
business. No other tool they'd found would allow them to get true
business information to executive decision makers in real-time, and
anything other than real-time is a lost opportunity to grow revenue
or manage costs. Like most healthcare providers, Lee Memorial has
a large number of disparate IT applications to manage both clinical
and business operations, including some of the most popular in the
McKesson/HBOC Trendstar has been used for cost accounting at
Lee Memorial for approximately 15 years. It has provided a very
stable and robust system for transaction processing, accumulating
a wealth of information on patient stays and treatments that can
be used for cost analysis and budgeting.
CliniComp is the clinical charting system that's been used for
acute care on all 3 campuses for 12 years. Highly configurable and
extensible, the system allows clinicians to record an array of detail
about any patient condition, virtually any data that they believe
may be relevant.
Siemens Invision, part of the SMS product portfolio acquired
by Siemens, is housed on an IBM MVS mainframe with a proprietary
database. It supports all patient care functions. Daily downloads
are taken from this system to support billing and to track patient
GEAC financials is implemented using VSAM on IBM MVS. This application
provides conventional financial applications, such as a general
ledger. Summary data from this suite is used for forecasting and
planning, plus payroll applications.
LMHS struggled to deliver timely information to decision makers.
While each individual application may be outstanding at recording
the transactions necessary for a given medical or business function,
many were conceived before the need to have a truly holistic view
of a business was recognized.
In fact, Lee Memorial was so concerned at their inability to garner
business intelligence from their operational systems that they were
planning to spend several million dollars to replace them. Diver
has eliminated this capital expense through a key competitive advantage:
The ability to weave multiple disparate data sources from any application
or platform into coherent knowledge to enable executive decision-making.
One high-profile application at LMHS is "Bedboard," an
executive level view of bed utilization across all 3 acute care
hospitals. The objective of the application is to maximize the use
of existing facilities, with a resulting reduction in capital expenditure
and staffing costs. The data needed to drive this application is
sourced primarily from CliniComp, providing raw data on admissions,
discharges and transfers (ADT). Other data on staffing is sourced
from the OneStaff human resources application.
Reducing Operating Costs & Minimizing Capital Expenditure
At the highest level, Bedboard provides a summary of bed occupancy
at the nursing unit level, showing utilization by shift or by time
of day, as well as other metrics. From here, a user can interactively
dive through the data, right down to the patient level, identifying
who occupied a bed at what time and accessing all related clinical
information. This rich picture is updated 3 times a day. Typically,
Bedboard is used by nursing managers, the Vice President of Nursing,
and the Chief Nursing Officer, in addition to other administrators
and decision support staff.
Prior to Bedboard being implemented, optimizing bed utilization
was almost impossible. Executives had only a paper report generated
from 4-6 week old data extracted from Trendstar. In short, decisions
on asset optimization were based on old, coarse-grained information.
This powerful application has, however, taken just a few days work
to build and deploy. Yet, executives at LMHS have already gained
powerful insights into ways that bed utilization could be tuned
by reworking their patient discharge process. With further enhancements
planned, it will be possible to obtain real-time snapshots of patient
flow throughout the hospital, ensuring that patients are being treated
in a timely manner. Not only will this optimize bed usage, but eliminating
unnecessary waiting for patients will make a valid contribution
to improving patient satisfaction.
The Executive Dashboard
The Chief Financial Officer and Chief Operating Officer, as well
as department directors, all have access to "Daily Monitor,"
an executive dashboard. Very simply, Daily Monitor pushes the key
indicators for the business onto the computers of the most senior
executives in LMHS. The key information in Daily Monitor provides
both daily and monthly snapshots, including:
Financial information: Revenue vs. budget - month-to-date, year-to-date,
compared to the previous year - for example. Inpatient and outpatient
revenue is also reported separately.
High level performance metrics: Admissions, discharges and transfers,
OB days, newborn days, ER admissions etc.
By using Dimensional Insight's Diver Solution, LMHS can tap the
source data in real-time and upper management can dive into the
data at will. As an example, it's very quick and simple for executives
to discover which doctor has admitted the most patients on any given
day, using the total number of admissions as the starting point.
Furthermore, the software has automated the process of updating
the reports and posting them to the intranet at LMHS overnight.
In this way, new intelligence is immediately available to executives
at the start of each business day. The data needed to drive this
application is sourced primarily from Siemens Invision, GEAC financials
and Microsoft Access databases.
The potential is clear. Without Daily Monitor, executives could
not measure or manage financial performance against budget to any
degree in real-time, as the reports they used completely lacked
the depth and flexibility they have attained with Dimensional Insight's
Diver Solution. Now financial performance can be reviewed daily,
enabling immediate corrective action to minimize costs and maximize
Maximizing Reimbursement Revenues
still under development is aimed at growing income by maximizing
reimbursement from Medicare and Medicaid while still providing
the best possible patient care. Currently, LMHS managers work
with reports generated from Trendstar to show which treatments
were given to specific patients. That treatment data originates
from the Siemens Invision application and is uploaded into Trendstar
about 3-4 weeks after month end. With this situation, there is
the potential for lost revenue. For example, suppose that a doctor
had been prescribing a particular drug for a patient, yet that
drug was not eligible for reimbursement by Medicaid (though other
similar drugs were). With the current reports, that behavior could
continue for as long as eight weeks (6 weeks on average) before
it was recognized with the current reporting system.
Diver's integration technology, it will be possible for LMHS to
build their first analytical application that directly combines
data from both CliniComp and Trendstar. They will be able to standardize
treatment, identifying situations where treatments that are fully
reimbursable may be substituted without jeopardizing patient welfare.
Patient Satisfaction: Dimensional Insight is assisting LMHS
to join the Magnet Recognition Program by demonstrating sustained
excellence in nursing. By becoming a "nursing magnet,"
LMHS will be able to reap several, mutually-reinforcing benefits:
The Magnet Recognition Program incorporates the highest quality
nursing care, rigorously enforced by standards and measurable
quality indicators. To date, only 63 hospitals in the United States
have attained Magnet status, and those that aspire to it almost
inevitable need to improve their standard of care in some way.
Raising care quality increases patient satisfaction.
and retain the very best nursing staff: Increasing patient
satisfaction will assist LMHS to face a growing challenge - a
shortage of key skilled labor. Nursing magnets are better able
to attract and retain the very best nurses. Naturally, a higher
quality nursing staff is intrinsically linked to patient satisfaction.
profit margins: It's been empirically proven that customer
satisfaction is directly linked to profitability and return on
investment. In addition, knowledgeable consumers will seek out
hospitals that have achieved Magnet status, sure in the knowledge
that they will receive the finest nursing care. Higher profit
margins provide more cash to be reinvested in care facilities
and to finance charity care.
Diver's initial role in the Magnet Recognition Program is to enable
LMHS to report on one of the defined quality indicators, the prevalence
of pressure ulcers. To fulfill this quality indicator, Lee Memorial
must submit a report once every quarter on the incidence of pressure
ulcers within all inpatient facilities. Historically, this has been
an incredibly arduous task. On a designated day in the quarter,
every patient must be visited and examined for pressure ulcers (for
700-800 beds). For any ulcer found, 10-12 attributes needed to be
Lee Memorial routinely logs pressure ulcers in their clinical systems
every day, but their frustration was, that despite 12 months of
trying, they had never been able to extract the data and build the
report they needed. The cause of their frustration was the complexity
of the data structures created within their clinical recording system.
While allowing clinicians the crucial flexibility to record every
relevant detail on patients, it also allowed different nursing units
to extend the application in different ways. Reporting on that data
was problematic, since related data could not easily be pulled together
in a systematic way.
However, Diver's integration process combines a powerful set of
manipulators to transform data extracted from multiple sources.
In this case, the key was to unrotate the source data. Simplistically,
this allows a number of records (say 50) to be manipulated into
a single record with 50 fields. Ultimately, a report that LMHS had
been unable to build in a year was constructed using the Diver Solution's
toolset in less than 2 days.
The benefits were immediate. The first time the application was
used, it was executed in parallel with the existing reporting method
so that results could be validated. As fate would have it, the existing
paper report raised concerns about care quality in a particular
nursing unit. Ordinarily, this would have required further extensive
investigation. However, managers were quickly able to verify the
concern using the application and then immediately dive down through
the data to establish the root cause of the problem.
Although the ulcer prevalence report need only be submitted once
every quarter for the nursing magnet program, Lee Memorial is so
thrilled with how easy it is to use that they now execute it monthly.
Therefore, they will be able to identify any potential problems
sooner, quickly determine the root cause and take action any necessary
About Lee Memorial Health System
LMHS runs 3 acute care hospitals with over 1,000 beds, physician
offices, nursing homes and rehabilitation centers throughout Fort
Myers and Cape Coral. More than 5,700 staff, including 830 physicians
and 2,500 volunteers and auxiliaries provide patient care. LMHS
has won numerous awards and is ranked among the best hospitals in
the nation for cardiac, orthopedic, strokes, and obstetrics.
Copyright 2008. Inroads Ltd, Hong Kong.