MUSE International Session #314 May 29, 2009 Glen R. D’Abate

1. What’s Going on in the Operating Room? MUSE International Session #314 May 29, 2009 Glen R. D’Abate

2. Educational Session Overview • We will discuss why we care about “what’s going on in the OR” • We will look at the specific events of interest in the OR that are used to help determine “what’s going on” • We will look at a collection of technologies available to assist in analyzing “what’s going on in the OR” • We will demonstrate a series of reports using these technologies that finally shed light on “what is really going on in the OR”

3. About the Operating Room (OR) • OR resources are among the most expensive in a healthcare organization • Efficient use of OR time is the major factor of total OR activity costs • A single OR room’s fixed and variable costs can exceed $1,000 / hour (exclusive of staff) • Optimizing OR resources has a direct impact on the bottom line

4. How Do We Know “What’s Going On” • The MEDITECH ORM Scheduling Module collects a significant amount of “event activity” data related to processes in the OR • Different implementation of ORM at different sites can impact the granularity of event data available…more is better • Retrospective analysis of event data can reveal patterns and trends needed to implement optimized OR resource utilization

5. ORM Events Available for Analysis • Utilization based on a comparison of scheduled time in the OR versus actual time in the OR • Operating Room Delay Reasons • Specific OR Event Time Requirements • Start of Procedure (Entrance into OR) • Initial Incision • Incision Closed • Procedure Ended (Exit of OR) • Interval Between Last Procedure End and Next Procedure Start

6. Analysis of Technologies Employed • Data is stored in the MEDITECH Data Repository (DR) Module • SQL Server Store Procedures generate and update the ORM datamart • SQL Agent Scheduled Jobs automate the process of refreshing the ORM datamart • Microsoft SQL Server Reporting Services (SSRS) enables custom report development • SSRS Report Builder allows users to build their own reports • SQL Server Analysis Services OLAP Cubes allow easy slice & dice of data • Microsoft Internet Information Server (IIS) hosts the ORM Analysis portal solutions

7. ORM Datamart DR Server demodb_ORM datamat This strategy uses the MEDITECH DR but could be accomplished directly against the ORM application database using the OpenGate or IPortal product Datamat tables (updated using DR data on a regular basis

8. ORM Datamart Generation Schematic MEDITECH DR Server MEDITECH DR livedb Report Datamart LIVE Data extract and normalization from DR livedb to datamart database (batch process) Batch Update Pre-Designed SSRS Report Production Environment Ad-hoc Report Designer Reports IIS Web-Server Report Datamart SSRS Report Generation OLAP Reports

9. 1. ORM Demonstration SSRS Reports • Actual Surgery Time versus Estimated Surgery Time Reports • Delay Reasons Reports • Delay Reason for First Case Report • Delay Reason by Surgeon Report • First Case Delay Missing Reason Report • Event Time Span Report • Entrance to Incision Report • Close to Exit Report • Close to Next Incision Report • Exit to Entrance Report

10. SSRS Report Deployment Options • Reports can be ad-hoc (with or without parameters) • Reports can be pushed to a file-share on a schedule • Reports can be e-mailed on a schedule • Snapshots of report data at a specific time can be taken • Reports can be rendered in web-format (html or xml), text, image format, Adobe, Excel, and more

11. 2. ORM Report Builder Features • Report Builder provides the ability for a non-programmer (power-user) to generate flexible, sophisticated ORM reports • Report Builder has a drag & drop, user-friendly GUI that allows report developers to easily layout, format, and preview custom developed reports • Report Builder provides three default templates • Table (columnar report) • Matrix (cross-tab or pivot table report) • Chart Reports • Report Builder can develop parameter-driven reports to filter, format, or display data based on user input.

12. 3. ORM OLAP Cube Features • OLAP Cubes allow any user (with virtually no training) to generate 100s of view of ORM data • OLAP Cubes view ORM measures (i.e., summarized numeric data). • OLAP Cubes allow any user to slice-and-dice data looking for trends across dimensions (i.e., MEDITECH dictionaries) • OLAP Cubes allow users to “drill-down” into ORM data from general summary to the transaction detail level

13. Advantages ORM Datamart Approach • Reports can be custom designed to meet specific data, summarization, and formatting requirements • Takes full advantage of Microsoft Reporting and Analysis Services software that is available as part of the SQL Server system • Provides web-based access to reports for easy distribution and use

14. Custom SSRS ORM Report Portal

15. Demonstration

17. Deviation from Scheduled Time

18. Estimate Versus Actual – Specific Month

19. Est. vs. Actual (Prov. Group) for Feb. 09

20. Specific Provider Group and Month

21. Delay Reasons for First Case

22. Delay Reason by Month (Grid)

23. Delay Reason for Specific Month

24. Delay Reason by Group for Specified Month

25. Delay Reason Detail for Specific Provider Group and Month

26. On-Time Start Percentage By Month

27. First Case On Time by Provider (2/09)

28. First Case On Time by Provider (2/09) Best Practice is >76% On Time Starts

29. OR Entrance to Incision Summary

30. OR Entrance to Incision Summary - Grid

31. Turn Around Times for OR Events

32. Turnaround Times for OR Events – in Grid

33. Turnaround Times Detail by Provider Group and Month

34. Entrance to Incision By Provider

35. SSRS Report Builder in ORM Report Portal

36. Report Builder User Interface

37. ORM Report Builder Generated Custom Report

38. Analysis Service - OLAP Cube Development Environment

39. OLAP Cube User Interface

40. Thank you!