George Washington University Medical Faculty Associates

The project was designated the MFA Executive Dashboard. Its essential purpose is to provide physicians, executives and department chairpersons on a virtually real-time basis with the clinical, financial and operational metrics needed for optimal practice management.

The George Washington University Medical Faculty Associates (MFA) is a non-profit academic multi-specialty medical group practice that includes more than 270 physicians and 41 medical and surgical specialties. The physicians in this practice have embraced IT and the benefits it can deliver. As a result, their information requirements are increasingly sophisticated.

Until 2005, physicians had used information from multiple systems that was synthesized and summarized in monthly reports to manage their individual practices. In order to increase their effectiveness in practice management, they began requesting performance and financial data much more rapidly so that problem areas could be identified and appropriate responses made much more quickly.

The application developed and implemented to meet this need is called the MFA Executive Dashboard. Primary project goals included:

• To provide physicians with the requested financial and clinical data on an effectively real-time basis in an easy-to-understand graphical form;
• To provide MFA executives and department chairpersons with a real-time view of the same information, delivering the business intelligence needed to implement operational improvements that offer the potential for increased practice profitability;
• To deliver the requested information in an easy-to-understand, easily accessible graphical form.

The only real business risk tied to the Executive Dashboard would have been NOT to provide physicians and executives with clinical, financial and operational metrics in a much tighter timeframe than in the past. The two most critical drivers in healthcare today are the need to constantly improve the quality of care delivery while simultaneously ensuring that care is delivered in the most cost-effective way possible. In an increasingly competitive healthcare environment, the ability to provide practice management data that is up-to-date in a real-time way so that problems can be quickly identified and resolved is key to practice success and survival.

The MFA Executive Dashboard went live in July 2005. It provides physicians with easy Web access to data that is individualized and up-to-date. For example, the MFA organizational standard for each physician’s billing hours is set based on a complex algorithm that takes into account variables such as the time they may be involved in teaching, research, medical education and professional conferences. The dashboard makes it easier to identify potential problem areas in practice management and to make the adjustments needed to meet the goals that have been set. In addition, the physicians have access to a best practices database that illustrates how improvements can be achieved.

In addition, the Executive Dashboard provides MFA executives and department chairpersons with a close to real-time view of over 30 key financial, clinical and operational performance indicators—business intelligence key to increasing revenue levels. They also receive year-to-date summary billing and scheduling data that is never more than one day old, enabling them to quickly identify areas of concern and implement whatever measures are needed to address operational issues.

Short-term benefits including delivery of the information needed to identify problem areas and rapidly rectify practice management problems have been specified in section I.i. under description of how the system helps users. It is too soon to provide an accurate measure in terms of saving time and money. However, the appreciation and satisfaction of the physician/users is already obvious.

In the longer term, there may be a tie-in between physician compensation and some of the dashboard metrics. The information that is being gathered may eventually be used to create a performance baseline for new compensation formulas which will enable increased efficiency for the overall organization.

In addition, the MFA Executive Dashboard is also expected to contribute to faster care delivery as physicians improve operational processes to meet specified objectives. That means a more satisfied patient population…one of the less tangible but most important benefits delivered by any healthcare organization.

Given the competition that has become a fact of life in the healthcare sector, the business intelligence delivered by the MFA Executive Dashboard is viewed as mission-critical at every organizational level. It is a system that is key to enabling MFA physicians deliver optimal care to their patient population.

As stated previously, the business purpose of the MFA Executive Dashboard is to provide the financial, clinical and operational information needed to improve overall practice management for all MFA physicians. With intense competition a fact of life in healthcare today, physicians recognize the need to set goals and identify best practices in areas such as practice management as well as in care delivery. In this environment, monthly reports on how physicians are performing are not enough. The MFA Executive provides the virtually real-time information needed to compete effectively.

The MFA Executive Dashboard is built on InterSystems Corporation’s Ensemble universal integration platform. Developers leveraged Ensemble’s Business Activity Monitoring (BAM) framework, which includes prebuilt components such as speedometers, light bars, and line, bar and pie charts, to create an interface that provides physicians with a real-time illustration of their individual performance metrics through a Web browser. As a result, up-to-date information is available easily and at the physician’s convenience on a 24x7 basis.

The initial dashboard implementation includes financial metrics such as gross charges, payments received, contractual adjustments, accounts receivable days, collection rate and missing charges. Clinical metrics displayed in the first version of the application include booked hours versus scheduled hours, rate of "no show" patients, number of new patients, number of prescriptions and tasks completed. Additionally, executives and department chairpersons receive year-to-date summary billing and scheduling data on request.

The MFA integrates information from multiple data repositories and systems including:

• IDX Flowcast
• Allscripts TouchWorks
• Great Plains financial software
• ADP Payroll system
• Excel budget database

Utilizing the Ensemble universal integration platform, information from these applications and repositories is gathered and displayed on a front-end graphical dashboard featuring light bars, pie charts and speedometers—whichever is most appropriate.

MFA physicians can access this information via Web browsers at any time for an up-to-date representation of a variety of clinical and financial metrics which have been previously described.

The same information is also used to provide MFA executives with summary reports and, via Web browsers, with the effectively real-time business intelligence key to improving overall practice management.

MFA physicians and executives were united in sponsoring the MFA Executive Dashboard project. There was organizational unanimity in recognizing that up-to-date clinical, financial and operation data was needed in order to improve overall practice management.

MFA physicians, executives and administrators were actively involved in planning and development of the Executive Dashboard. Input on the dashboard design was actively sought by the IT staff in an iterative process that depended on end-user feedback. Once the initial system version was developed, a pilot system involving 20 MFA physicians as well as executives and administrators was rolled out in 1Q05. Again, the IT staff relied on feedback from this pilot group to make revisions and enhancements to the production version that went live in July 2005 with access provided to all MFA physicians.

The major challenges we faced were:

1. Deciding what information should displayed, which necessitated identifying the key performance indicators (KPIs) critical to measuring performance. The core team developed a preliminary list that was then approved by the Director of the Business Office, director of Finance and Practice group administrators
2. Identifying appropriate information access levels for various users and how that information should be specified and summarized. The legwork was handled by the core team and then approved by the team mentioned above.

The goals of the project did not change.

None were used.

None were used.

The team utilized an informal software development methodology. The core team identified the KPIs to be displayed and, with the help of InterSystems technologists, the KPIs were extracted and displayed.

None were used.

None were used.

The most critical technical challenge was to integrate information residing in five disparate applications and to provide access to the integrated data on a virtually real-time basis. Meeting this challenge required identifying an integration platform that could interface with all of the applications and data repositories.

Another challenge was presented by the requirement to provide access to the needed information in a very short timeframe. The end-user population at MFA is fairly sophisticated about what can be accomplished with IT systems and has high expectations for rapid fulfillment of information requests. Given the fact that enterprise-scale integration initiatives all too often require multiple years of effort before a pilot is even ready for testing , this was a demanding requirement. To meet this challenge, the MFA IT staff made rapid integration and development an absolute requirement for its integration platform.

In both cases, the selection of Ensemble proved to be appropriate.

An extensive evaluation of multiple integration platforms was conducted by the MFA IT staff. Ensemble was selected primarily because it has the capabilities that MFA felt would enable rapid integration, development and deployment. Another factor contributing to the selection of Ensemble was that Flowcast, which is built on InterSystems’ CACHÉ post-relational database, had a very successful track record at MFA and that we had a good working partnership with InterSystems. Based on a successful proof-of-concept project using Ensemble, the decision was made to move forward with that product as the integration platform for the Executive Dashboard project.

The MFA Executive Dashboard is running on a Windows 2005 platform and utilizes a HP 30 server. The architecture also includes Ensemble and information is extracted from the five applications/repositories previously described. End users access the dashboard via Web browsers.

The following Ensemble capabilities were key to project success:

• Ensemble Studio—a development environment that enables technical specialists and business analysts to easily work together and achieve rapid integration and development
• Ensemble Management Portal—enables customizable, end-to-end management during development and when the system goes live
• Ensemble BAM framework—includes capabilities for rapid definition, notification and visualization of key performance indicators that are essential to monitor via the Executive Dashboard.

The development team included three people.

Two of the three core team members have extensive project management and programming experience. As a result, minimum training was required.

Initial project discussion and planning began in January 2005. This was followed by MFA gathering and extracting information and KPIs. Ensemble implementation began in Mid-May 2005.

At this point, the Executive Dashboard is viewed as highly successful by both management and physician/users. Not only are there plans to add additional metrics, but also to add capabilities for physicians to access information via mobile devices—a sure indication of how valuable the user population finds the information provided through the Executive Dashboard.

We wouldn’t do anything differently.