How a trauma system uses Business Intelligence to evaluate protocols, track costs, monitor quality, optimize billing and more


A Business Intelligence (BI) system is an information system that integrates data from across an organization to enable better decision-making. Most BI systems include performance dashboards with powerful reporting and analytic capabilities. But while BI dashboards are common in healthcare, they are almost unknown in trauma.

Recently, however, a large Colorado healthcare system has developed a unique BI dashboard for monitoring and managing trauma system performance. Trauma leaders are using the tool to evaluate the effectiveness of clinical protocols, identify PI events, monitor referral patterns and optimize trauma financial performance.

Orchestrating data streams
The trauma BI system was developed by clinical and financial leaders at Centura Health, a Colorado health system that includes 18 designated trauma centers.

“The whole thing started when we began looking at how accurately we were capturing trauma activation fees,” said Ray Coniglio, RN, MSN, vice president of trauma and pre-hospital services. “We wanted to understand how we were building the charge structure and what we were getting reimbursed.”

The ultimate goal was to assess the system’s ROI on trauma activation. To achieve this goal, leaders needed to aggregate clinical data and financial data for trauma patients. Their solution was to create a BI system that orchestrated data from both the trauma registry and the hospital cost accounting system.

Coniglio explained the basics: “Every month, we export a list of patient account numbers from our trauma registry and send it to the finance department. Finance staff then flag these accounts as trauma patients within the cost accounting software.”

This account data is then imported into an Excel file, where it is blended with clinical data from the trauma registry. Decision support staff have built a dashboard that presents the entire data set visually. The dashboard includes specially configured pivot tables that allow users to analyze and report on the data in multiple ways.

“The dashboard gives us a lot of ability to drill down on the data,” Coniglio said. “We can look at financial measures like cost per case or contribution margin. If we want to look at specific injuries, we can search by ICD code. And everything can be sliced by month, quarter or fiscal year and by individual facility or by regional group.”

Powerful management tool
Trauma leaders at Centura are using the BI dashboard to manage a full range of clinical, financial and strategic objectives. Uses include:

Maximizing trauma billing. As noted above, the original goal was to analyze financial margins under trauma activation fees. The trauma BI dashboard provides accurate data on trauma patient costs and reimbursement, and it allows users to analyze the data by facility. These capabilities allowed system leaders to identify specific hospitals with low or negative margins on trauma activations.

Free Report: PI and Data: 5 Things Most Trauma Teams Do Wrong“What we eventually found were some process-related issues, including misunderstandings regarding things like trauma consultation fees,” Coniglio said. Identifying the problems allowed trauma leaders to devise targeted solutions. “We made sure that trauma program staff review all activation charges the following day, as opposed to just relying on the ER record.” This helps the system capture activations, while ensuring all activation charges are appropriate and defensible. “Sometimes the next-day review shows that a patient who was not classified as a trauma activation should have been. Other times, we might find no evidence of pre-hospital notification, in which case we remove the activation charge.”

Evaluating clinical protocols. Three years ago, trauma leaders at Centura established new protocols for reducing unnecessary blood transfusions. “We know from the literature that mortality as well as complications like pneumonia and acute lung injury all increase with blood transfusion on a per-unit basis,” said Charles Mains, MD, FACS, trauma medical director. “So we created a transfusion protocol using evidence-based national guidelines. We then got buy-in, and put the protocol out to each trauma service in our system.”

The BI system proved to be essential. “Initially, we were relying on the trauma registry to capture transfusion data, but we found that transfusions were tracked inconsistently within the registry across our trauma centers,” Dr. Mains said. The BI system, on the other hand, was able to identify patients who were charged for a unit of blood within the cost accounting system. “What we found was that the cost accounting data was more accurate with regard to blood use, because it was tied to a charge.”

Data was examined both retrospectively and prospectively as the transfusion guidelines were implemented. “We used the dashboard to check protocol compliance at each facility,” Dr. Mains said. “Whenever blood was given outside the protocol, those cases were reviewed within the trauma performance improvement process to ensure it was an appropriate deviation.”

Accurate tracking of blood utilization has allowed trauma leaders to quantify the clinical and financial impact of the new protocol. “Over the past three years, we have seen a reduction in blood utilization for orthopedic cases of about 20 percent,” Dr. Mains said. “We have also seen reductions in both complications and mortality.”

Centura also used the BI dashboard to evaluate the impact of a trauma protocol for reducing geriatric hypoperfusion. “Input from the cost system allows us to sort patients by inpatient versus outpatient admission,” Coniglio said. “That’s important when we are looking at length of stay, because we need to make sure we are not skewing inpatient LOS lower because we are mixing in outpatient data.”

Accurate data on admission status allowed trauma leaders to quantify the cost impact of the new protocol. “We have reduced length of stay for geriatric trauma patients by about half a day. Across 3,000 patients, that’s a substantial savings,” Coniglio said. “The protocol has also helped us reduce mortality for this population by a full percentage point.”

Guiding strategic decisions. The BI dashboard also lets users monitor overall trends affecting the trauma system. “We can use the system to analyze patient distribution by zip code,” Coniglio said. “So we can see if patient volumes from a certain geographic area are increasing or decreasing.”

Trauma leaders are using this function to monitor transfers from outreach referral areas. “It lets us watch for trends,” Coniglio said. “You can’t always act on data on a monthly basis, but the dashboard allows us to keep an eye on trends as they unfold, as opposed to realizing you have a problem and then trying to go back and find out what happened retrospectively. The whole system is helping us with higher-level strategic planning.”

Right data, at the right time
Trauma leaders at Centura are currently using the BI system to implement or evaluate more than a dozen trauma initiatives. These include evidence-based protocols for spleen salvage, liver injury and severe TBI. “We are using the system to measure outcomes and identify system issues,” Dr. Mains said.

Trauma leaders say the dashboard supports, but does not replace, management thinking. “The system provides a consistent high-level dashboard, but you still have to go in and ask questions,” Coniglio said. “Especially when you identify outliers, you need to go in and take a detailed look at the data and think about how to drill down on the numbers.”

One of the biggest challenges of the BI system is devising an efficient data strategy. “Our goal is not just to chase data, but make sure we are getting the right data,” Coniglio said. “Delivering this data takes time and resources, which are fixed costs.”

One benefit of Business Intelligence is that it is helping Centura prepare for the future. “We all know that healthcare is moving from a volume-based to a value-based delivery system,” Dr. Mains said. “Our feeling is that value-based payment is not close for trauma, but there is a potential for bundled payment for something like hip fracture. This dashboard system is helping us prepare for that possibility, because it provides the data we need to demonstrate the value of trauma care.”

In the meantime, Centura’s BI system is helping trauma leaders pursue a strong quality improvement strategy. “Quite frankly, it’s helping us make sure we are doing the right thing,” Coniglio said. “It’s helping us make sure we are asking the right questions and not making assumptions we can’t back up.”

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