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History

Capabilities

Data Elements

Opportunities

Phase One Implementation

Full Implementation

Decision Support System Overview

A little known information resource that over the past five years has satisfied ad hoc report requests from a limited number of the Medical Center staff, is currently being upgraded in a joint effort by Information Technology Services and the Finance department. The resource is called the Trendstar Decision Support System. This enhancement is being undertaken to meet the increasing demands from administration and clinicians for timely, ad hoc reports. With our successful Medical Center-wide installation of Winstations coupled with our expanded network capabilities, it is an opportune time to provide staff with the means to more directly access information. When the enhancements are fully operational, any authorized staff member with a Winstation will be able to easily produce reports from a wide range of clinical and financial historical data.

History

The Trendstar System was initially purchased in 1991 by the Finance department to improve our cost accounting processes. They felt that it was important to have an information system in place that would synthesize financial and summary clinical data to support our fledgling managed care initiatives. The standard output that managers are most familiar with is the Monthly Trendstar Operating Report. Over the years, Trendstar’s role as a report generator has expanded to provide information to other departments such as Marketing, Behavioral Health and Clinical Resource Management to name a few. But access to this data "warehouse" of inform-ation has been possible only through requests to those who have had extensive training in Trendstar’s reporting language.

Capabilities

Recently Trendstar’s parent company HBO & Company (who also provide us with our patient management, billing, medical records abstract and materials management systems), has developed a Windows based point-and-click software that allows the user to access data and generate reports. When you select the icon for either the Trendpath or Applied Decision software, you will be guided through the System options so you can easily explore and analyze data by following the cues displayed on the screen. The ability to produce reports or full color business graphics will be complemented by powerful analytical functions and statistical tools that enable the user to analyze details behind summary reports. Sorting and ranking capabilities will allow you to re-arrange the data view, while find and search functions will let you explore relationships between data elements.

Data Elements

The Trendstar data warehouse is populated every thirty days with data from our PM/Medipac and Medical Record Master systems, and annually from cost data derived form Medicare’s Ratio of Costs to Charges (RCC) tables. At the patient level, Trendstar imports demographic data, information on physicians providing care, diagnosis and procedures, DRGs, length of stay, treatment dates, discharge disposition and item specific charges incurred during the patient’s visit to the Medical Center to name just a few of the summary clinical items. As part of the upgrade initiative, we will eventually import UB-92 type data from the various physician billing services into the System, and also import external benchmark data files from either Mecon and/or the University Hospital Consortium’s Information Management System.. Work is also planned to supplement the estimated RCC costs in Trendstar’s Management Cost Accounting module with the addition of procedure level cost data for five high volume departments,

Opportunities

What will having Windows based access to this rich store of data allow you to do? Perhaps the best way to define your opportunities is to see how the additions of Trendpath and the Advisor Applets can simplify access to the Trendstar System as outlined by Jeannine Finn from Hospital Finance.

Strategic

Marketing and Planning - Trendpath can evaluate market share and identify strengths and weaknesses within zipcode, can assess payor distribution, utilization of inpatient and out-patient services, procedures, physician specialties and most frequent diagnosis.

Benchmarking initiatives - Trendpath can help analyze data within the context of project product lines and UICMC primary, secondary and tertiary service areas.

Product line management - Trendpath can generate reports that aid in the development of product lines, and support their performance.

Financial

Cost accounting - Trendpath reports can guide staff in reviewing trends of costs and charges for patient care for varying lengths of stay, and help define cost reduction opportunities.

Managed care analysis - Report information can augment evaluation of actual versus expected payment variance, and can help analyze profitability and utilization.

Clinical/Quality Improvement

Development and maintenance of critical pathways - Trendpath reports can help monitor and improve the process of patient care, and can aid in determining clinical policies and standards.

Practice pattern analysis - Trendpath can provide managers and clinicians with a moving picture of how and clinical decisions occur. It can also aid in re-designing effective and efficient treatment patterns.

Utilization monitoring - Trendpath can track utilization of resources against length of stay, treatments and drugs.

Sequence of care analysis - Trendpath reports can track episodes and services provided in the continuum of care. For example, how preventive health screening services are providing immunizations and mammograms.

Outcomes analysis - Trendpath can present reports tracking costs of adverse outcomes and provide data support for CQI teams which need to provide data measurements at various points of the CQI process, including baseline, followup and outgoing evaluation.

Other areas

External information requirements - Trendpath allows staff to quickly respond to report requests from external entities such as the UHC, IHA, JCAHO, external auditors and others.

Phase One Implementation

Following the Board of Directors approval to fund the recommended hardware and software System enhancements, the ITS and Finance departments petitioned UICMC senior management to form a Steering Committee to guide and prioritize the project’s work plan. The eight members selected to the Committee are Richard Mendola, CIO (Chairman), Cynthia Grueber, COO, Chuck Stanislao, CFO, Carole Miserendino, CNO, Annette Paciga, Director of the Medical Practice Plan, Ross Collins, Resource and Policy Analyst, OVCHS, and the project managers Pat O’Leary, Director of Finance, and David Werdegar, ITS Manager of Decision Support.

The Steering Committee’s first step was to define this phase of the decision support enhancement project as a trial initiative, and to include only the Steering Committee members, the Behavioral Health department, the Clinical Resource Management initiative and the Internal Audit department as participants. Next, a schedule was arranged with a project facilitator from HBO & Co to conduct extensive interviews with the participants and their staff in order to define and build the underlying structures that will support the Windows view and selection of data for reports. These structures will be tested and approved by mid - May, as will a Windows-based data dictionary. Training of the phase one user group will occur shortly after that, and the enhanced Trendstar System should be available for a four month period of performance evaluations, use assessments and minor de-bugging by the end of May.

Full Implementation

What we expect to learn from the phase one evaluations will allow us to more efficiently open the System to a wider base of users in the fall. At that point the Steering Committee will prioritize the access requests from clinicians and administrators, and invite the HBO & Co. project facilitator back for a second round of staff interviews and training. Eventually we expect that the report writing skills of the UICMC staff will improve to the point where they will be able to develop report structures themselves. We also expect that a Trendstar User’s Group will form out of the many staff using the System, and that it will become empowered to carry on the guidance role of the Steering Committee.

Other Information Access Options

As a data warehouse, Trendstar is populated once a month with summarized data from its various mainframe sources. It does not contain daily or weekly transaction information, a patient’s status in the hospital, an account’s current A/R balance or vital signs and consult notes. For a Windows view of the administrative and financial information, ITS and AISS, in a joint venture, will be making the Document Direct Windows-based report viewer available to a broader range of UICMC staff through the spring and summer months. Document Direct will allow the user to see a Windows view of selected sections of very large RMS reports, without having to engage in torturous screen scrollings or worse, pour through reams of paper output. And because it is a Windows-based, you can "cut" out portions of a report and "paste" the section into an Excel spreadsheet, into a Word document, or a Powerpoint presentation as you also can with the Trendpath and Applet products.

For more information on this system, contact Dave Werdegar at werdegar@uic.edu.