In the past few years, health care organizations in the United States have spent tens of billions of dollars on IT. Much of this investment has been in response to the “meaningful use” section of the American Investment & Recovery Act of 2009 and provisions in the Affordable Care Act of 2010, which required health providers to invest in patients’ electronic health records and allow for electronic data reporting to the government.

But many providers are still not leveraging the vast amounts of data that they are collecting to improve the quality of care, increase patient satisfaction, and reduce costs. Indeed, most information available to health care workers and managers is still retrospective. For instance, it is common for organizations to produce reports on infections and patient falls on a monthly basis and those reports only reflect what has already occurred, not what is happening now or is expected to occur in the future. (See this article on predictive analytics.) In this regard, health care is way behind manufacturing, consumer products, and financial services companies.

To make the most of their data, providers should follow in the footsteps of pioneering health care systems like ThedaCare in Wisconsin, and Salem Health in Oregon and make clinical business intelligence (CBI) a priority. CBI is an IT system that collects and analyzes data and delivers the results to frontline clinicians in real time, helping them to make better decisions. It can be used to keep clinicians informed about everything from infections and iatrogenic injuries (those caused unintentionally by physicians) to whether units are over- or understaffed. In the case of the ThedaCare, the staff- and technology-related cost of implementing CBI was about $750,000.

Insight Center Innovating for Value in Health Care Sponsored by Medtronic A collaboration of the editors of Harvard Business Review and the New England Journal of Medicine, exploring best practices for improving patient outcomes while reducing costs.

For example, ThedaCare, which has seven hospitals and 25 clinics, created an application that provides frontline clinical managers with up-to-date information about admissions and staffing in their units, allowing them to make real-time adjustments to staffing. In the first year that managers had the app, ThedaCare saved $850,000 in overtime costs.

Salem Health, which has two hospitals, a rehabilitation center, and nine clinics, uses CBI to examine and compare infections reports across hospital units. This led a team to identify the need to reduce the incidence of Clostridium Difficile (C. diff) infections as a real priority. Using Plan, Do, Study, Act (PDSA) cycles, Salem then devised an approach that includes early identification and isolation of the infection, administering the optimal treatment, and being more systematic about cleaning and disinfecting the environments in question, including getting the members of the clinical staff to wash their hands. After implementing the changes at two units with high infection rates in 2013, Salem then implemented them more broadly throughout its hospitals. The infection rates in the original units were reduced to zero; the broad hospital changes show promise, but it is too soon to report results. (It turned out that one major source of infection was computers used by nurses, which environmental services hadn’t been cleaning.)

Developing a CBI Strategy

The ThedaCare Center for Healthcare Value, an independent non-profit educational institute, has worked with 18 organizations in North America to implement a CBI strategy. It links organizational goals, quality-improvement efforts, and daily work with data technologies that can collect and analyze information and deliver it in real time to frontline clinicians in a useful format. From the center’s work, it has identified three key building blocks required to create and implement a CBI strategy:

Change leaders’ mind-set. This is the most difficult but is imperative. A sustainable, transparent, empowered, evidence-based culture supported by CBI is the end state. Getting there requires leaders to understand the need for information at the front line of care and to support efforts to provide it. The best way for them to obtain this understanding is to go and see what’s happening at the front line. For example, leaders may not know how hungry for data their frontline staff is until they visit a unit where staffers are diligently attempting to limit the spread of an infection, but the only infection data they have available is a monthly summary for the previous month.

This way of thinking was already established at ThedaCare. For more than a decade, it has been a lean organization — one that employs the Toyota Production System to continuously improve its processes in order to increase quality and eliminate waste. ThedaCare’s leaders realized that their employees’ ability to improve care and work processes was limited by the lack of real-time information. Once its analytics department was made aware of this issue, it adapted the applications so that the members of its staff could access metrics and information that they needed when they needed them.

Standardize data. Organizations must create a centrally located area for storing data and develop standard definitions for variables and exclusions. For example, when managers in primary care clinics compare their track records in getting their diabetic patients to comply with their medication regimens, they must be certain that they are comparing apples to apples. This level of data coordination and analysis requires interoperability of programs within an organization so that its data collection program (which is most likely its electronics-health-records system) can speak with its data-management and analysis programs.

Build a culture of transparency. In a culture of continuous improvement, a red dot on a visual management board that lays out key metrics for an operation or activity indicates that a target has not been achieved and highlights an opportunity to provide a better care outcome. Almost every error in medicine is the result of a process in need of redesign. But too many organizations attribute red dots to bad personnel. To transform this culture, health care leaders must look to automotive and aerospace industries and learn how to create an environment where workers are empowered to identify and solve problems each day without manager intervention. Workers need leadership support, transparent work environments, and the essential data on defects, wait times, inventory, and so on.

CBI can be a remarkably effective tool to reduce the cost and improve the quality of health care. But it requires more than the installation of IT hardware and software. It needs engaged leaders, standards, and frontline workers who are empowered to use their creativity to solve problems every day.