The public medical sector is one of the most paradoxical areas of activity in Romania: there is a large customer base, an even bigger market potential due to precarious medical assistance throughout the different age categories but still remains one of the most unproductive and unprofitable activities to be in as a manager. Hospitals, clinics, laboratories and pharmacies alike from across the country are facing increased pressure to improve operations from multiple directions.

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BI tools for the healthcare sector
The public medical sector is one of the most paradoxical areas of activity in Romania: there is a large customer
base, an even bigger market potential due to precarious medical assistance throughout the different age
categories but still remains one of the most unproductive and unprofitable activities to be in as a manager.
Hospitals, clinics, laboratories and pharmacies alike from across the country are facing increased pressure to
improve operations from multiple directions.
There is government pressure aimed at cutting expenses and driving state held institutions to at least a break
even financial result by the end of each year. Unfortunately, the lack of a long term vision concerning healthcare
as being one of the pillars for high quality public services granted to Romanian citizens resulted in a less than
average performing sector where such topics as poor financing and investments due to relying solely on public
budget which drastically limits the possibility to increase funding in this sector and an immature private health
insurance system that can’t support financing a medical system, massive brain drain of medical staff to western
European states that offer better working conditions and benefits structure, legal requirements that interfere
strongly with management to such a point that running a medical institution becomes an exercise in futility, lack
of modernized infrastructure and up to date medical equipment that makes procedures a high risk undertake,
hold the hospital managers’ agenda.
And then there is the managers’ micro agenda that turns the medical institution’s particular activities into an
operational challenge: high levels of variations per case, low levels of daily routines automation (and therefore,
high level of human intervention), small margins per case, capacity utilization, bed occupancy are all questions
that beg for an answer that will ultimately drive organizational efficiency up if applied consistently.
One of the most efficient ways to improve day-to-day operations as well as financial forecasts, what-if scenarios
and section profitability is to deploy business software that empowers managers and medical staff alike to make
decisions at the point of contact – the person who is most entitled to make a decision should have first class data
at their disposal. That is the end goal of Business Intelligence (BI) solutions.
But first, managers need to learn to integrate software tools in their day to day activities in order to grow
accustomed to them and then to make the next logical step, that is to implement widely, at organization level,
complex management and activity systems such as ERPs, cost analysis BIs, Electronic Medical Records,
instruments that facilitate telemedicine and more.
Nowadays, BI systems are at the very best marginal in spread and almost non-existent in daily usage. Even with
some localized investments in information technology, much of the data has not been coordinated, analyzed and
deployed to improve operational performance. What is needed is a new generation of BI tools and applications
designed with the healthcare sector in mind, capable of integrating cross- and inter-departmental processes and
information. Due to financing restrictions, most managers are nowadays faced with only one alternative: make
better use of the resources at hand.
Few take into account the fact that the activities they operate produce large quantities of data that is seldom
used to make better informed decisions or to have a much thorough inside look on the organization’s financial
health. Furthermore, this wide array of data is concentrated around areas that lack the resources to transmit
information where it’s mostly needed. Data can nowadays be processed and delivered as information beyond
administrative offices and directly to clinical staff who can make to most use of it. In turn, this access to

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increasingly “real-time” data provides a finer level of insight into the organization, resulting in a more precise
decision making process and optimization.
Source: proprietary BI dashboard application- 2011
Now, by integrating BI within business processes and distributing it more widely, decisions can be made at the
point of impact. But to ensure that the data can be trusted, a solid data foundation must first be established.
Effective BI tools are both simple and relevant: simple to allow a large number of users to access the information
through an interactive, user friendly interface – regardless of the type or source of information – and relevant so
that users can employ it to address immediate needs and to support business decisions.
To deliver information to the person most adept to make a decision IT systems need to deliver business
intelligence in a simple way that is consistent with the decisions it supports. This level of simplicity is required as
organizations open to a wider audience: BI tools need to migrate from the higher echelons of management who
have access to high level reporting, thus often creating information bottlenecks, to administrative departments,
doctors, replenishment responsible ordering supplies and nurses making patient priority decisions. Customized
dashboards deliver against this objective by offering reports with data most relevant to certain user groups (e.g.
senior management, middle management, doctors, nurses, IT staff etc.) all based on a common back-end. For
example a manager might want to know how many beds are occupied and for how long while a doctor wants to
know how many patients are waiting for a consultation and in the same time having access to their medical
history in order to prepare the visit; the used data is the same but with different clearance and focus on
delivering information.
One of the main constraints that may result in a staff rebuff is the degree of IT literacy with medical personnel:
these may be users who must make use of information that can assist their activity without prior knowledge of
data structures or content. The proper approach to BI tools for medical purposes is to ignore current limitations
and begin with an outcome based approach that focuses on ideal information needs to be delivered for each
specific role in the organization. The focus here is to fight with BI non-consumption: that is making it simple to
use, relevant and convenient enough for users who didn’t have before the tools or the necessary aptitudes. By

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increasing self-service BI and maintaining IT control, this technology empowers business users to effectively
create their custom content thereby reducing IT report creation backlog. The system reuses existing security
protocols, metadata and other services used throughout the organization, meaning it’s easy to administer and
quick to deploy, often in a matter of days, thereby cutting down the time to market and expanding decision
making prerogatives for a wide array of audience members.
Most IT vendors are specialists which have a firm understanding of the verticals they serve and thus they can
accelerate the implementation process by linking business requirements to specific functionality architectures
found in the organizations and existing content and templates. The main focus is relevance: the rule of thumb is
to find the lowest common denominator in respect to the operational capacities of each business model and
build on those with specifications that make the organization unique. These templates, true business blueprints
in themselves, come in the form of pre-defined data models, queries and metrics, and save significant time and
effort when launching a new BI implementation that benefits also from best industry practices (e.g. comparative
analysis of costs/profitability based on DRG case financing); thus implementations have shorter development
cycles and by extension, lower costs.
In their quest to become primary support tools for decisions, BI solutions need to bypass one of the
organizations’ main management concerns, the lack of on-request access to macro-to-micro data splits: financial
health and performance indicators (KPIs) at section level (macro) and information about who comes to the
hospital and occupies the beds, what’s their medical history, what services they need and which they receive,
how long they stay and what are the costs associated at each stage (personnel, medicine intake, paraclinical,
administrative and outsourced services) (micro). Hospitals have to make sure they provide the best care possible
while managing the bottom-line. For this, the system needs to be agile to the point of being able to offer
information at granular level about resources in order to better judge opportunities: hierarchy of budgeted
articles, types of costs (sunk/productive), case level and section analysis etc.
The latest BI tools are moving beyond the reporting functions to an integrated system embedded within business
processes. In the past, users had to wait for the completion of multiple steps in order to review the data:
requests were entered, data was stored, consolidated, processed, extracted in various data warehouses, analysis
were performed, and finally delivered. The new approach is to think of BI in parallel with business processes,
thereby providing clients with more timely access to better information about critical business processes as
decisions are made, not after the fact. The ultimate benefit is derived from complete integration of the
information across medical, clinical and financial systems and departments. The way in which data is collected,
processed and stored has a great impact on the quality and value of business intelligence tools. Master data
management (MDM) is the area which defines how data is managed from its initial collection phase to final use,
a critical necessity of successful BI implementations. Without unitary formatted data across the organization it’s
difficult to answer key business questions.
If we take into consideration the latest shifts regarding the reorganization of over 70 public owned hospitals that
took place in February, BI tools that follow the MDM methodology can cope more efficiently with mergers, in a
conflict free manner, where there are organizations involved that each use a significant number of software
systems simultaneously.
One of the major differentiators of modern BI systems is the fact that they come in a software as a service model
(SaaS), which means software that’s developed and hosted by the SaaS vendor and which the end user customer
accesses over the Internet. Unlike traditional packaged applications that users install on their computers or
servers, the SaaS vendor owns the software and runs it on computers in its data center. The customer rents it,
usually for a monthly fee. SaaS is sometimes also known as hosted software or by “on-demand”. Here are some
of the SaaS model’s advantages over on-premise software:

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The client’s resources applied to IT are minimized: infrastructure – purchase, maintenance, upgrade;
software – backup, updates, security; human resources - support specialized IT staff is not needed. This
translates into a greater concentration on patient care;
Security of data lies solely on vendor’s obligation and is generally enforced by contract;
Replaces multiple resources to run applications with shared computing resources, such as the same
software version that runs on the same platform for all users who are granted access;
SaaS vendors offer flexible contracts that have targeted costs for specific services, especially for projects
that have a clear path in terms of scope and time. This approach results in better cost and investment
management;
Clients can benefit from the “network advances” effect: as vendors gain more knowledge about what
business want these insights are incorporated into version upgrades from which the whole network of
clients benefit, such as features and functionalities;
Software upgrades are performed regularly and automatically by the vendor;
The solution can be accessed 24/7 from anywhere as long as there is an internet connection;
It’s easier to implement because there is no software to install, no license to purchase and no hardware
to purchase (low setup costs);
Costs can be amortized right after installation: there is no need to pay upfront the entire sum as in the
on-premise situation. The billing is done for a recurring service either in monthly, quarterly, or yearly
billing cycles. The payment cycle is dependent on what features or services the vendor is offering and
the organization’s negotiating position. Therefore CFOs can have a more predictable expense stream;
More sophisticated security system for less costs by standardization over a wide array of clients;
Fast application rollout;
Opportunity to achieve ROI faster than on-premise if the users quickly adopt the solution;
It is easier to grant access to members from outside the initial network of users if companies decide to
expand;
The software is less prone to errors because there’s only one version running on all the client network;
Option for standard tools or levels of customization depending on customers’ needs;
Lower overall Total cost of ownership (TCO).

5. Source: www.charisma.ro
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Source: SaaS growth study, Goldman Sachs - 2010
In the present context, faced with a dynamic that is out of reach of the general public owned hospital, BI
solutions become more than a cost-cutting service: they are really a strategic tool for managers who want such
power of insight in their organization. Moving from the pen and paper approach that only serves best for “house
fire management”, to these next generation solutions represents a giant step forward and organizations will
continue to face a choice: execute these best practices or fall behind.