Overview of approach to creating a unified web portal where faculty and staff can access all information relevant to clinical activity, clinical quality metrics, grants administration, HR, and financial performance.
We’re going to try and cover a lot of ground this afternoon. I’d like to talk to all of you today about our department’s approach to information systems and development of a business toolset designed to provide insight into our organization and to enhance operational performance. Very few departments attempt such ambitious tool design at Uva. The norm is for departments to look to enterprise groups within the University and Health System to provide tools and for departments to integrate the data from these disparate systems in Excel. Prior to the arrival of Bess Wildman to the DOM this was the case for us as well. We took excel dumps from Uva’s financial software, comma delimited files from our practice plan, as well as variety of local excel workbooks and would massage these to produce our financial, grants management and other reports. To understand the dynamics which motivated the DOM to undertake this project I’d like to ask Bess to talk to you for a few minutes about some of her early experiences in the DOM. We’ll then continue framing the problems faced, the desired characteristics of a solution, outcomes and illustrative business cases. Once you have an idea of what we were trying to accomplish and how that plays out in our business I’d like to give you a quick look at the scope of the standardized reports and analytic tools and wrap up with a demonstration by Russ Dinsmore of our production system and one of our analytic modules and will try and leave approximately 15 minutes for questions at the end.
Talk about at my arrival nearly 6 years ago, the DoM was reported to be 10M in the red and when I asked the naïve question of what is our bottom line. The answer was which one? See the Dept of Medicine lives firmly in the University and in the Practice plan. Each has their own chart of accounts, fiscal years, accounting rules and data rule sets. Yet our faculty and our expenses can move freely from a practice plan account and a Uva account. The practice plans financials only include the clinical side of our business and not the teaching and research and at the University our Oracle system did not provide a single place to see the Departments financial performance. So we first built systems in excel and access to get the data to our faculty. The cost and the amount of time was both unduly burdensome so about 3 years ago after discussions with Pediatrics and Radiology who were struggling with similar issues we approached the University, School and Practice Plan. All were interested but didn’t see this as a priority and felt our challenges were unique to our Departments.
To continue with framing the problem we hadhave three primary sources for critical business data, two financial databases, one clinical billing & productivity database, none of which talk to the other in any significant fashion. Access - access to the data is limited to a few specialist, requiring specific training, different passwordsauthentication mechanisms. Creating a natural bottle neck to the flow of information, and in all cases leaves the faculty member without direct access or timely updates on the health of their activities. Restricted access also increases the number of times that data sets are handed off from the institution, to department analysts, to divisional analysts and hopefully eventually to the faculty. This generates a variety of problems not least of which are 1) The faculty often get different versions of the same information presented in different ways and often even in different data formats which leads to a lack of trust in the data and the administrators who present them this data. 2) Also this makes it tricky for faculty and administrators alike in knowing whether they have the right answer to the question that they are trying to answer. Without the data being brought together and issues of format, date, fiscal period, etc.. Being worked out in advance it’s difficult to know whether you’re actually comparing apples to apples and actually getting a meaningful answer to the question asked.
In the previous slide I mentioned the diversity of data sources, system access, and data manipulation & analytic techniques which inhibited the success of the system in providing insight and effectiveness to our business. I’d like to look just a little closer at some of the data issues that complicate this picture. Our two financial systems not only sit on different system with differing chart of accounts, they also work off of different fiscal years. No unique identifier exists between the systems for a faculty member, no standardization of faculty names across systems Williams, Michael ; Michael Williams M.D. , Michael A. Williams, etc… To further complicate manual marrying & analysis of these data sets different departments with in the school used the elements of the ORACLE system differently. Fortunately there was one field element in the account coding structure (TASK) was left open for departmental level interpretation. We used this to standardize our system and our data to allow us to present information to a faculty member, a division, and the Department level in a cascade manner. So for us standardizing the chart of accounts had to be a day 1 task (every pun intended) Because the manual systems and disparate reporting structure was so burdensome, the characteristics of the reports themselves did not promote good business practices. Many reports (Consolidated Financial Report and our individual faculty P&L (called FRP at UVA) were only produced yearly giving no opportunity for mid stream analysis, review, and modification of our practices. No change to intervene with a clinician who was not providing sufficient documentation and therefore having their services down coded, no opportunity for a faculty member to be made aware that she was running a deficit and needed to increase her clinical load to cover her cost, it was difficult for a PI to get real time information to realize that equipment charges had been applied to the wrong grant. To add another dimension to the problem of presenting and analyzing our business many data sets were only presented in a department aggregate, requiring the development and implementation of an often arbitrary costing splitting tool. Where our desired state is to book both revenue and expense at the faculty level whenever possible. Not to belabor the point of unproductive reporting characteristics, but even the language and descriptors of common finance elements was different between the varying systems, requiring specialized language skills to interpret reports which faculty are never going to have the time or inclination to acquire.
Realized we didn’t want to act like a shadow system, not a system of record, chose warehousing paradigm Must be flexible to push and pull Faculty must have direct access
Warehouse – opportunities to address, standardization of terminology, chart of accounts, design in unique identifier for faculty
Opportunities – Self Service - allow the faculty to review their activity whenever, wherever they have the time to do so Push - when business need is a priority or where bursting and distribution saves significant admin time Alert – If the data is in the system to recognize a potential problem area, grant heading rapidly to deficit, labor not scheduled appropriately, let the system tell us not wait for someone to run a report and passively receive this message, let the system actively inform
Access Allow all to directly access their data at anytime, with appropriate scope Scope – faculty see summary of division & department, etc… Detail – where data sets are small drill is available from summary reports to detail reports, where data sets are large reports drill into Excel where faculty and administrators can leverage a familiar set of skills in filtering, pivoting, sorting data to mine for meaningful results
In addition to our systems methods (warehousing, modality, access) we also looked at knowledge methods. Where the systems methodologies adopted provide for data integrity and ease of access they don’t fully address the core characteristics of the value of the information provided to the individual. They don’t fully address how people interact with a data, whether people accept data, or how people interact with explicitly or implicitly communicated conclusions or actions based on an analytic tool. To address these issues we had to be particularly sensitive to issues of Transparency, Trust, and Quality. Our emphasis on these human perception factors has been pervasive throughout all phases of this project and more than any technology or methodology is responsible for the successful adoption of this toolset. So let’s look briefly at each factor and then we’d like to share some examples of how these characteristics have played out in our business.
Transparency provides linkages, the faculty member can see their contribution to the division, the division to the department. For a department as large as Medicine working together, the left hand recognizing the right, is a continuous challenge. When reports across the missions, Education, Clinical, Research, all support the concept of being a part of the organization, the individuals start to think on multiple levels, what is the health of my activities, what is the health of my division, what is the health of my department. Without transparency reports, analytic tools tend to create an inward looking, individualistic identity. With transparency perception grows laterally, creates awareness of scope and impact on the whole.
When our Chair sits down with his Division Chiefs to review financial performance, clinical productivity, faculty promotion & tenure, all involved know that they are working off the same data set, they no longer need to argue over who’s data is “right”, not the discussion can move to the “Whys’” and “How to Improves’”
Compared to the strategic impact of Transparency and Trust, Quality of data may seem like a lesser tactical gain. Another way to look at this may be that in a department the size of DOM you may have 2 set of eyes at the department level, 2 set of eyes at the division level, reviewing individual data points which make up expenses on a grant or clinical production. But when you have all faculty reviewing data at regularly defined intervals within the year (quarterly for some reports, monthly for others, on demand for others) you now have hundreds of set of eyes looking for what’s right (did my clinic revenue post this month) and what’s wrong (why is that confocal microscope on my grant, that should be charged to the Center). In some ways improvements in Quality are byproduct of Transparency, Trust and Access, but it’s a HUGE tactical win each and every year. It’s a gift that keeps giving.
At this point lets move on from Characteristics of the system and start looking at how it drives our business. Just a warning this is a byproduct that’s very similar to the old adage of “be careful what you ask for you might get it”. When you start to go down the road of transparency you also have to be ready to respond to increased quantity and increased quality of the questions that your faculty will ask. First the faculty challenge the data (I know I saw 100 patients last month the data only says I saw 88, the data is wrong). Plan to spend some time walking several faculty from the beginning to the end through the system. After a few times they will begin to trust the system. But then they challenge other peoples parts in the system. Our reimbursement rates are two low, we need to contract better. The billing staff down codes my services, they need to stop. Then finally comes acceptance that this is a tool that can help them manage their destiny and they begin to find solutions to help themselves. With clinical billing we have seen an increase in request for coders to work on the floors with physicians, we have seen docs add clinic sessions when as year end nears they haven’t gotten as close as they need to be to targets, encounter forms that used to get lost for months on end are suddenly making it to our door step with a much higher degree of certainty. We are also seeing changes in how we work together. Doctors are seeing opportunities to change process and are bringing their thoughts forward.
Case – Faculty running a deficit – Faculty Story SOM requires all faculty to at least cover their own expenses as defined through the FRP (P&L) Reporting requirement is yearly not allowing for midstream corrections By moving to quarterly and supplying Chief and faculty access to the same report the faculty will self-elect to take corrective action and as you can see this physician has self managed his efforts to move from the red to the black.
Case – Opportunity for an Intervention: Top Down Comparison of Peers, Allow Division Chief or Section Head to view trends in coding, side by side, of peer group and to compare to division average which makes for a defacto norm, Variances come right to the forefront, Allows opportunities for further analysis Leads to training opportunities Physicians highlighted in red have a very similar practice, both practice in the same location, share the same patient population, have the same payor mix. Division Chief can easily spot an opportunity for further analysis As you can see one of our highest volume faculty members well out of the divisional averages. Division Chief and Coding educators have met with this physician to review to see if issue is coding, documentation or both. Result was faculty member was scared to over code. Upon reviewing the data he understood and is now much more comforable with coding higher. Outcome is that upon review of coding practices with the second physician and a coding analyst the physician is comfortable that their documentation supports a level 5 and that they are within their peer group for coding practices Follow-up, Chief needs to review this graph for the next two quarters to see if intervention actually led to the agreed upon change in coding practices What is the count different, level 4 vs. level 5 $34 math works out to an opportunity cost of approximately $4255 for consults for one physician , from 12% of business at level 5 to division average 47% , documentation supports that he had been underbilling
Now that we’ve reviewed how transparency drives a business need let’s look at a sample case for how Trust drives a business scenario.
Several examples of faculty using the system to increase the quality of the data in the system have been worked through in the past year: Faculty gets 1 st quarter FRP, seriously in the red, drilled into expenses, found that they received a new grant and no labor had been scheduled on it effectively not showing revenue from grant for the faculty member, upon pointing this out labor was scheduled and additional revenue balanced FRP Faculty X, two weeks rotation on inpatient consult service, no ability in system of record to track consults, physician tracks this locally and can ensure that consults were captured and billed for? TRUST – back a few, physicians complaining that they were not receiving expense reports in a timely fashion, lab between 30 & 60 days, gave them the ability to pull this information wheneverfrom wherever they want on a daily basis. Number of grant accounts which go into deficit decreases.
Quality, in the previous cases we talked about examples of Quality defined as the ability to take corrective action, now I’d like to show you an example of Quality driving performance. Here we’re not talking about correcting a data point, or taking corrective action for the next fiscal year, but driving clinical performance to meet performance based benchmarks.
I’d like to take a moment to review what the material we’ve covered so far and now hand off the presentation to Russ Dinsmore to review the breadth and depth of our data, reports and analytics
One stop shop, unexpected number of data sources available to add to our warehouse Abstracts network rules, VPNs, multiple passwords down to one set of access parameters for our faculty
Academic Helathcare - Business Intelligence Tool
Reporting & Analytics Mike Zang – Director of Information Services Russ Dinsmore – Assistant Director & Data Base Administrator Bess Wildman – Vice Chair and Chief Operating Officer University of Virginia, Department of Medicine
Overview of Presentation <ul><li>First Impressions & Legacy Systems – the beginning </li></ul><ul><li>Issues to be addressed – initial goals </li></ul><ul><li>Solutions – desired characteristics, systems and data </li></ul><ul><li>Transparency – building in trust and quality </li></ul><ul><li>Driving the Business – how transparency leads to communication and communication leads to changes in organizational behavior </li></ul><ul><li>Overview of Standardized & Analytic Reporting Modules </li></ul><ul><li>Demonstration of live system if networks cooperate </li></ul>
Legacy – First Impressions <ul><li>New COO – asking naïve questions “What’s our bottom line” </li></ul><ul><li>Institutional View – </li></ul><ul><ul><li>UVa – not our problem unless there is a UVA wide scope </li></ul></ul><ul><ul><li>HSF – great project but not interested in investing in solution </li></ul></ul><ul><ul><li>SOM – great project but no one else needs this </li></ul></ul><ul><li>Birds of a Feather – DOM, Radiology, Pediatrics, all have multiple divisions, all have significant research and clinical enterprises </li></ul>
Legacy <ul><li>Decentralized Approach </li></ul><ul><ul><li>Two systems of record for finance, one for clinical billing, all running on differing technologies </li></ul></ul><ul><ul><li>Access – systems only accessible to analysts and role specific staff, not faculty </li></ul></ul><ul><ul><li>Analysis & Presentation – data flows through a waterfall of analysts from the school, to department, to division before it makes it to the faculty. Along the way the data is massaged and recast to suite each group’s needs and perspectives and is presented in an equally diverse set of formats </li></ul></ul>
Legacy cont. <ul><li>Data Characteristics </li></ul><ul><ul><li>Differing fiscal years </li></ul></ul><ul><ul><li>No unique identifier for a faculty member across systems </li></ul></ul><ul><ul><li>No uniform interpretation of all elements of the chart of accounts, each department usesinterprets COA differently </li></ul></ul><ul><li>Report Characteristics </li></ul><ul><ul><li>Reporting – yearly ( leaves no opportunity for mid stream corrections) </li></ul></ul><ul><ul><li>Reporting level – department aggregate, no division level, no individual level reporting </li></ul></ul><ul><ul><li>No lexicon of terms across systems </li></ul></ul>
Issues to be Addressed <ul><li>To begin this project we knew we had to work through: </li></ul><ul><li>Data Issues – Bring together three major data sources into a consistent data set, with one set of data definitions </li></ul><ul><li>Reporting & Access Issues – Had to solve access issue enabling our faculty timely, accurate access to information </li></ul><ul><li>Analysis – create analytic tools that answer the questions our faculty were asking </li></ul>
Solution Overview <ul><li>Centralized Data Warehousing Approach </li></ul><ul><ul><li>Standardized lexicon </li></ul></ul><ul><ul><li>Standardized fiscal year </li></ul></ul><ul><ul><li>Implemented unique identifier </li></ul></ul><ul><ul><li>Unified Chart of Accounts </li></ul></ul><ul><li>Multiple modalities </li></ul><ul><li>Access </li></ul>
Solution Overview <ul><li>Centralized Data Warehousing Approach </li></ul><ul><li>Multiple modalities </li></ul><ul><ul><li>Self service (pull) – access standardized reports from anywhere through a web portal, all reports should be dynamic running off of most current data </li></ul></ul><ul><ul><li>Burstdistribute standardized reports through e-mail (push) </li></ul></ul><ul><ul><li>Alert management (trigger push or pull notification based on threshold) </li></ul></ul><ul><ul><li>Ad-hoc query tools (mine for your own answers) </li></ul></ul><ul><li>Access </li></ul>
Solution Overview <ul><li>Centralized Data Warehousing Approach </li></ul><ul><li>Multiple modalities </li></ul><ul><li>Access </li></ul><ul><ul><li>Everyone in organization can access system </li></ul></ul><ul><ul><li>Faculty view all personal reports and summary divisional and departmental reports, Chiefs see full detail of all faculty and summary of department, Chair & COO can access full detail for all </li></ul></ul><ul><ul><li>If report has significant transactional detail you can drill into the data, which creates a multi tab spreadsheet where faculty and administrators have a well worn environment that they’re familiar with to pivot, filter, sum,… </li></ul></ul>
Solution – Core Characteristics <ul><li>Transparency – this system allows all levels of the organization to work off the same data, presented in the same format. This is particularly meaningful for the individual faculty member who can now review their individual, divisional, and departmental financial performance </li></ul><ul><li>Trust – there is a direct causal relationship between transparency and trust. As reporting cycles become routine and predictable and as assurance builds that the faculty view the same data as the division and department , trust builds. Discussions evolve from arguing over the validity of the numbers to the interpretation of the data </li></ul><ul><li>Quality – transparency also creates a set of positive feedback loops within the organization (faculty – division) (division to department). Faculty can review their individual revenue and expenses and ask for corrections from their division on a routine basis. The more eyes that review the data the sooner mistakes are corrected </li></ul>
Solution – Core Characteristics <ul><li>Transparency – this system allows all levels of our organization to work off the same data, presented in the same format. This is particularly meaningful for the individual faculty member who can now review their individual, divisional, and departmental financial performance monthly </li></ul><ul><li>Trust </li></ul><ul><li>Quality </li></ul>
Solution – Core Characteristics <ul><li>Transparency </li></ul><ul><li>Trust – there is a direct causal relationship between transparency and trust. As reporting cycles become routine and predictable and as assurance builds that the faculty view the same data as the division and department , trust builds. Discussions evolve from arguing over the validity of the numbers to the interpretation of the data </li></ul><ul><li>Quality </li></ul>
Solution – Core Characteristics <ul><li>Transparency </li></ul><ul><li>Trust </li></ul><ul><li>Quality – transparency also creates a set of positive feedback loops within the organization (faculty – division) (division to department). Faculty can review their individual revenue and expenses and ask for corrections from their division on a routine basis. The more eyes that review the data the sooner mistakes are corrected </li></ul>
Driving the Business - Transparency <ul><li>Transparency – increasing communication </li></ul><ul><ul><li>As finance and clinical activity data is routinely available to the faculty, discussions bubble up within divisions and within the department. Whether the discussion is allocation of expenses or trends on clinical activity, when the faculty have this data in their hands, can benchmark themselves against their prior history, the division’s average, national benchmarks, and their colleagues, then discussion percolates up through the organization </li></ul></ul>
Example – Transparency <ul><li>Faculty in Deficit - Self Elects to Correct </li></ul>
Example – Transparency <ul><li>Chart on the left emphasizes volumes </li></ul><ul><li>Chart on the right emphasized coding trends </li></ul>Intervention, Coding and Documentation
Driving the Business - Trust <ul><li>Trust – ensuring we’re all on the same page </li></ul><ul><li>Case: Medical Center makes commitment to open a new Allergy clinic and provide $50k support for the medical director, deal is verbal and never documented </li></ul><ul><li>Faculty member logs into system and checks FRP to ensure support has been provided, but doesn’t see $ for medical direction of clinic </li></ul><ul><li>Faculty member talks to division administrator & chief, finds out that this sort of allocation only takes place quarterly, that div admin has made the allocation, and is given a reminder to check back into the system when the alert is sent out that quarterly FRPs have been published </li></ul><ul><li>Faculty learns role of div admin, gains trust that heshe is doing their job, that medical center makes good on its commitments, and that the system will verify this for them but only on a quarterly basis, and that system will alert them of the appropriate times to check on these commitments </li></ul>
Driving the Business – Quality <ul><li>Illustrations of Quality Feedback Loops </li></ul><ul><li>Faculty member gets 1 st quarter FRP (P&L), finds that they are seriously in the red, can see that they are getting no support from a new grant </li></ul><ul><li>Physician performs two week rotation on inpatient consult service, systems of record have no ability to track consults, physician keeps his own count and can use DOM-ERS to verify that all consults were captured and billed for </li></ul><ul><li>Several physicians not happy that they are not receiving expense reports for grants in a timely fashion (30-60 days), sometimes due to a bottleneck in admin capacity, sometimes because they’re out of the country. By giving them the ability to access this data on a daily basis the number of deficit grants has greatly decreased </li></ul>
Quality – performance <ul><li>We are moving towards productivity bonuses for our clinical faculty. These are based on hitting certain RVU thresholds. This report has been particularly meaningful for them to project whether they are going to meet these targets or if they need to make adjustments. The targets can be adjusted for clinical effort, but we have not yet implemented because Uva has not established a clear prospective way of determining CFTE </li></ul>
Moving onto Overview of Reports & Analytic Objects <ul><li>We’ve looked at the impetus to start this project </li></ul><ul><li>Key problems to solve </li></ul><ul><li>Key characteristics of a desired tool </li></ul><ul><li>Role of transparency in generating communications, trust & quality </li></ul><ul><li>How these characteristics play out in our business </li></ul><ul><li>Now let’s move onto a review of the reports </li></ul>
Overview of System & Reports <ul><li>Data Sources Systems Integration </li></ul><ul><li>Financial Reports </li></ul><ul><li>Grants Management </li></ul><ul><li>Clinical Billing & Activity Module </li></ul><ul><li>Human Resources </li></ul><ul><li>Dashboards (Beta) </li></ul>
Data Sources Systems Integration <ul><li>Oracle – UVa’s ERP solution providing general ledger, purchasing, payroll, grants management and human resource data </li></ul><ul><li>Epicore - HSF (Practice Plan) financial system providing detail of expenditures, revenue, payroll </li></ul><ul><li>Precision – HSF (Practice Plan) reporting system, clinical billing, charges, collections, RVUs </li></ul><ul><li>Licensure – DEA, Medical licenses, HSF appointments, VISAs, I9s, pulled from a variety of sources, including Oracle and Compliance Office </li></ul><ul><li>New Innovations – Residency Management Suite, currently exploring integration of teaching evaluations, strategic importance to support teaching mission, complications due to SaaS deployment model </li></ul><ul><li>SOM Budget – Export to School of Medicine budget database </li></ul><ul><li>EHS – Environmental Health & Safety database providing training documentation for handling of hazardous materials, radiation safety, etc… </li></ul><ul><li>Decision Support - Medical Center system for quality metrics, final order by 9:00am, discharge by noon, length of stay, etc… </li></ul>
Financial Reports <ul><li>Consolidated Financial Report : </li></ul><ul><li>1st goal of ERS systems was to produce a consolidated financial report which brought together all sources of revenue and expenses, aggregating data from UVa – Oracle and HSF – Epicore in one system </li></ul><ul><li>Development of report allowed for financial reporting to move from Yearly to Quarterly </li></ul><ul><li>Effort – automating of this report greatly reduced the effort required to produce departmental and divisional financial reports </li></ul><ul><li>Drill to Detail – This report features the ability to drill on Column, Row, or Cell to export detailed transactions into MS-Excel </li></ul>
Financial Reports <ul><li>FRP – Faculty Remuneration Plan </li></ul><ul><li>2 nd goal of ERS project was to automate the generation of FRPs. The SOM requires each department to produce this document on a yearly bases for faculty </li></ul><ul><li>Automation allowed for report to be produced quarterly, very close to producing monthly </li></ul><ul><li>Table of Contents feature allows division chief to quickly review hisher division and drill into detail as desired </li></ul><ul><li>Drill – allows faculty member to drill on any row to view detailed transactions in MS-Excel </li></ul>
Financial Reports <ul><li>Financial Subcategory Graph: </li></ul><ul><li>Rudimentary analysis tool which allows selection and graphing of each expense or revenue category over time (2006-2009) </li></ul>
Financial Reports <ul><li>Financial Subcategory Graph: </li></ul><ul><li>Graphs MOU (revenue sharing funds flow) from the medical center to the department by division </li></ul><ul><li>Each division is drillable into a graph which details the trend by quarter </li></ul><ul><li>Each quarterly graph is then drillable into a detailed Active HTML Report of all transactions </li></ul>
Financial Reports <ul><li>Financial Subcategory Graph: </li></ul><ul><li>Quarterly trend </li></ul><ul><li>Drills to transactional detail </li></ul><ul><li>AHTML (Active HTML) – portable HTML file with data and analysis tool </li></ul><ul><li>Allows for basic OLAP features, sorting, calculations, graphing, etc… </li></ul>
Grants Management <ul><li>PI Summary Report: </li></ul><ul><li>Allows for quick overview of all grant activity, including status of grant (open, closed, approved), expenses for the period and to-date, budget, planned expenses and budget available after planned expenses </li></ul><ul><li>Allows drill into Funds Available Report for each grant </li></ul><ul><li>This series of grant reports allows each PI to review their activity at any point in time without the need for a fiscal tech to access the system of record, run their reports, print their reports, and review them with the PI improving access and reducing labor </li></ul>
Grants Management <ul><li>PI Funds Available Report: </li></ul><ul><li>Reconciliation requirement for UVa, must be reviewed and signed by PI on a monthly basis. This is normally the only detail a PI would see on their grants. </li></ul><ul><li>This report allows the PI to review this online or print off as a PDF prior to review with financegrants management staff at monthly meeting </li></ul><ul><li>Drill – also allows drill into full detail report in MS-Excel for further analysis </li></ul>
Clinical Billing & Activity <ul><li>Monthly Gross Charges / Net Collections 4-in-1 </li></ul><ul><li>This report is our leading indicators report showing month over month and year to date comparisons to clinical budgets at the Department, Division and Individual levels </li></ul><ul><li>In previous systems this report was produced quarterly due to the intense labor involved in producing a graph for each faculty member. Now in ERS this report is automatically produced monthly </li></ul><ul><li>This is the first of a two page report showing year to year variance to charge budget </li></ul>
Clinical Billing & Activity <ul><li>Monthly Gross Charges / Net Collections 4-in-1 </li></ul><ul><li>This is the second page which demonstrates year to year variances in collections to budget both on monthly and year to date basis </li></ul><ul><li>These reports represent the highest level overview of a department’s, division’s or individual provider’s clinical activity </li></ul>
Clinical Billing & Activity <ul><li>Services Billed – Specialty Area by CPT, Volume, RVUs, Charges: </li></ul><ul><li>This report provides full detail on service billed for the physician who has the time and inclination to really dig into the health of their practice </li></ul><ul><li>Sort order is by Type of Service (Inpatient Attending, Inpatient Consults, Outpatient, Specialty Procedures) , Specialty Area (General Nephrology, General Medicine, Kidney Transplant, Palliative Care, Renal Dialysis, Vaccines) , CPT /w Description. </li></ul><ul><li>The analysis provides Volumes, RCUs, Charges on a YTD and Variance from prior year. This provides a very detailed look at services provided </li></ul>
Human Resources <ul><li>Labor Distribution Exception Report by Person: </li></ul><ul><li>Labor Distribution is an Oracle methodology for managing payroll across multiple funding sources, no one should be scheduled at 100% </li></ul><ul><li>Areas of concern which would trigger highlighting in red would include under allocations, over allocation or a funding source (grant) nearing its end date. </li></ul><ul><li>Of particular importance to grants management where a PI or staff person may be funded on more than one grant and need the labor schedule to match their effort report to the sponsor </li></ul><ul><li>The grants implication transforms this from a purely finance process into a compliance process making it doubly important to manage this process on a monthly basis </li></ul><ul><li>This report is also distributed (in email) by ERS’ report bursting and distribution engine once month to appropriate business managers to alert them of needed actions </li></ul>
Human Resources <ul><li>Licensure & Compliance: </li></ul><ul><li>DEA licenses, Medical licenses, Visas, i9s,etc… have always been very manual compliance issues to track down and to keep current </li></ul><ul><li>Sources for this information include the medical center compliance office, practice plan legal department, and often the physician themselves </li></ul>
Human Resources <ul><li>1500 Hour limit (that temps can work in one year) , User or Lose vacation time, Comp Leave balances: </li></ul><ul><li>The University’s system of record requires that HR specialists across the departments monthly run, print and distribute these and similar HR reports for all staff </li></ul><ul><li>ERS allows for these reports to be “run” automatically and distributed in email to each employee on a prescheduled basis, eliminating a great deal of effort and paper </li></ul>
Dashboards <ul><li>Dashboard Strategy: </li></ul><ul><li>Provide Role Based Dashboards, both for administrative roles (Chair, Division Chief, Department Administrator, Division Administrator) , and for faculty roles tracks (CF/CE , CI/AI) </li></ul><ul><li>80% rule - provide a quick graphical representation or link to 80% of the content someone will look for on a daily basis </li></ul><ul><li>Drill – have each top level graph drill into a more detailed standardized report or analytic tool </li></ul><ul><li>Navigation – don’t leave anything out, provide a method for quick navigation to entire body of reports and tools </li></ul>
Dashboards <ul><li>Administrative Dashboard Features: </li></ul><ul><li>Finance – quick views of Consolidated Financial Report and Faculty Remuneration Plan which drill to both detail reports </li></ul><ul><li>SOM – Decade plan metrics for clinical care, Discharge by Noon, Final order by Nine, Prelim by Six </li></ul><ul><li>License Expirations – DEA & Med license </li></ul><ul><li>Grants Management – Balance Available after Planned Expenses, provide ultra quick look at grants in trouble and quick drill to their detail reports </li></ul>
Dashboard <ul><li>Clinical Dashboard Features: </li></ul><ul><li>E & M Distribution for both inpatient & outpatient, initial visit, follow ups and consults. Allows for a physician to compare themselves against their division and the department, drills down to detailed comparison presented earlier </li></ul><ul><li>Benchmarks – also provide comparison of productivity against MGMA & UHC benchmarks. </li></ul><ul><li>Others – in addition these dashboards also have many of the common features of the administrative dashboards with mini-graphs ables which link to the faculty member’s FRP, grants, licensure, etc… </li></ul>
Dashboards <ul><li>Academic Investigator Dashboard Features: </li></ul><ul><li>Labor Distribution – Allows the PI to quickly see who is scheduled on each grant and quickly drill to the PI Funds Available report for that grant </li></ul><ul><li>Environmental Health & Safety Training – quickly review personal training records and soon, all those who work in your lab </li></ul><ul><li>Balance Available After Planned Expenses – provides greater detail on each grant </li></ul>
Dashboards <ul><li>Navigation – Let’s not forget the rest: </li></ul><ul><li>Completeness – each of the mini-graph, mini-table elements of the dashboard provide a quick jumping off point to valuable detail reports but there are some reports that you can’t get to from the dashboard, for completeness sake the Nav Panel provides links to all reports </li></ul><ul><li>Guiding the Eye – to guide the mind’s eye to the report that you’re looking for each report link also features a complete description and soon a thumbnail view of the report </li></ul><ul><li>Keeping it Clean – to avoid information overload the menus work in an accordion style, expanding categories as you click on them and collapsing categories not in use </li></ul>
Outcomes <ul><li>Financials </li></ul><ul><ul><li>Consolidated financial statement and FRPs (faculty individual balance sheet) evolved from onceyear projects for all departmental analysts and division administrators to quarterly reports produced by DOM-ERS, focus is no longer on production of reports, but on QA of data </li></ul></ul><ul><ul><li>Reports now available on-line and e-mailed quarterly to each faculty member </li></ul></ul><ul><li>Clinical Activity </li></ul><ul><li>Labor Restructuring </li></ul>
Outcomes <ul><li>Financials </li></ul><ul><li>Clinical Activity </li></ul><ul><ul><li>Legacy reports easily migrated into system </li></ul></ul><ul><ul><li>Reporting at the physician level transformed from a 3 week process for 2 FTEs to 15 minutes of DBA time to verify the data load, 30 minutes of QA time to validate the data, and 15 minutes to double check report distribution job and distribute reports via e-mail </li></ul></ul><ul><ul><li>Additional report generation now being driven by physician focus groups and division administrators, not analysts </li></ul></ul><ul><ul><li>MGMA & UHC benchmarking added this year, still working on adding benchmarking to our suite of current productivity reports </li></ul></ul><ul><li>Labor Restructuring </li></ul>
Outcomes <ul><li>Financials </li></ul><ul><li>Clinical Activity </li></ul><ul><li>Labor Restructuring </li></ul><ul><ul><li>2 FTE dedicated to clinical report production reduced to .5 FTE for ad-hoc queries </li></ul></ul><ul><ul><li>4 analysts no longer needed to produce divisional reports </li></ul></ul><ul><ul><li>Division Administrators no longer burdened with producing reports and massaging data sets, now focus on mining data and interpreting results for division chiefs and faculty </li></ul></ul><ul><ul><li>DOM-ERS team, added 1 DBA, 2 programmers, ½ FTE quality assurance </li></ul></ul>
For Further Information <ul><li>DOM-ERS Web Site: http://deptmedicine.eservices.virginia.edu/dom-ops/SoftDev.htm </li></ul><ul><li>E-Mail: [email_address] </li></ul><ul><li>Mike Zang: [email_address] </li></ul>