Revisioning of Business Tools

1. Reporting & Analytics Revisioning of Business Tools Mike Zang – Director of Information Services Russ Dinsmore – Assistant Director & Data Base Administrator Bess Wildman – Vice Chair and Chief Operating Officer University of Virginia, Department of Medicine

2. Overview of Presentation • First Impressions & Legacy Systems – the beginning • Issues to be addressed – initial goals • Solutions – desired characteristics, systems and data • Transparency – building in trust and quality • Driving the Business – how transparency leads to communication and communication leads to changes in organizational behavior • Overview of Standardized & Analytic Reporting Modules • Demonstration of live system if networks cooperate

3. Legacy – First Impressions • New COO – asking naïve questions “What’s our bottom line” • Institutional View – • UVa – not our problem unless there is a UVA wide scope • HSF – great project but not interested in investing in solution • SOM – great project but no one else needs this • Birds of a Feather – DOM, Radiology, Pediatrics, all have multiple divisions, all have significant research and clinical enterprises

4. Legacy • Decentralized Approach • Two systems of record for finance, one for clinical billing, all running on differing technologies • Access – systems only accessible to analysts and role specific staff, not faculty • Analysis & Presentation – data flows through a waterfall of analysts from the school, to department, to division before it makes it to the faculty. Along the way the data is massaged and recast to suite each group’s needs and perspectives and is presented in an equally diverse set of formats

5. Legacy cont. • Data Characteristics • Differing fiscal years • No unique identifier for a faculty member across systems • No uniform interpretation of all elements of the chart of accounts, each department uses\interprets COA differently • Report Characteristics • Reporting – yearly ( leaves no opportunity for mid stream corrections) • Reporting level – department aggregate, no division level, no individual level reporting • No lexicon of terms across systems

6. Solution Overview • Centralized Data Warehousing Approach • Multiple modalities • Access

7. Solution Overview • Centralized Data Warehousing Approach • Standardized lexicon • Standardized fiscal year • Implemented unique identifier • Unified Chart of Accounts • Multiple modalities • Access

8. Solution Overview • Centralized Data Warehousing Approach • Multiple modalities • Self service (pull) – access standardized reports from anywhere through a web portal, all reports should be dynamic running off of most current data • Burst\distribute standardized reports through e-mail (push) • Alert management (trigger push or pull notification based on threshold) • Ad-hoc query tools (mine for your own answers) • Access

9. Solution Overview • Centralized Data Warehousing Approach • Multiple modalities • Access • Everyone in organization can access system • Faculty view all personal reports and summary divisional and departmental reports, Chiefs see full detail of all faculty and summary of department, Chair & COO can access full detail for all • If report has significant transactional detail you can drill into the data, which creates a multi tab spreadsheet where faculty and administrators have a well worn environment that they’re familiar with to pivot, filter, sum,…

10. Solution – Core Characteristics • Transparency – this system allows all levels of the organization to work off the same data, presented in the same format. This is particularly meaningful for the individual faculty member who can now review their individual, divisional, and departmental financial performance • Trust – there is a direct causal relationship between transparency and trust. As reporting cycles become routine and predictable and as assurance builds that the faculty view the same data as the division and department , trust builds. Discussions evolve from arguing over the validity of the numbers to the interpretation of the data • Quality – transparency also creates a set of positive feedback loops within the organization (faculty – division) (division to department). Faculty can review their individual revenue and expenses and ask for corrections from their division on a routine basis. The more eyes that review the data the sooner mistakes are corrected

11. Solution – Core Characteristics • Transparency – this system allows all levels of our organization to work off the same data, presented in the same format. This is particularly meaningful for the individual faculty member who can now review their individual, divisional, and departmental financial performance monthly • Trust • Quality

12. Solution – Core Characteristics • Transparency • Trust – there is a direct causal relationship between transparency and trust. As reporting cycles become routine and predictable and as assurance builds that the faculty view the same data as the division and department , trust builds. Discussions evolve from arguing over the validity of the numbers to the interpretation of the data • Quality

13. Solution – Core Characteristics • Transparency • Trust • Quality – transparency also creates a set of positive feedback loops within the organization (faculty – division) (division to department). Faculty can review their individual revenue and expenses and ask for corrections from their division on a routine basis. The more eyes that review the data the sooner mistakes are corrected

14. Driving the Business - Transparency Transparency – increasing communication • As finance and clinical activity data is routinely available to the faculty, discussions bubble up within divisions and within the department. Whether the discussion is allocation of expenses or trends on clinical activity, when the faculty have this data in their hands, can benchmark themselves against their prior history, the division’s average, national benchmarks, and their colleagues, then discussion percolates up through the organization

15. Example – Transparency Faculty in Deficit - Self Elects to Correct

16. Intervention, Coding and Documentation Example – Transparency Chart on the left emphasizes volumes Chart on the right emphasized coding trends

17. Driving the Business - Trust Trust – ensuring we’re all on the same page • Case: Medical Center makes commitment to open a new Allergy clinic and provide $50k support for the medical director, deal is verbal and never documented • Faculty member logs into system and checks FRP to ensure support has been provided, but doesn’t see $ for medical direction of clinic • Faculty member talks to division administrator & chief, finds out that this sort of allocation only takes place quarterly, that div admin has made the allocation, and is given a reminder to check back into the system when the alert is sent out that quarterly FRPs have been published • Faculty learns role of div admin, gains trust that he\she is doing their job, that medical center makes good on its commitments, and that the system will verify this for them but only on a quarterly basis, and that system will alert them of the appropriate times to check on these commitments

18. FRP and Drill Detail for A2

19. Driving the Business – Quality Illustrations of Quality Feedback Loops • Faculty member gets 1st quarter FRP (P&L), finds that they are seriously in the red, can see that they are getting no support from a new grant • Physician performs two week rotation on inpatient consult service, systems of record have no ability to track consults, physician keeps his own count and can use DOM-ERS to verify that all consults were captured and billed for • Several physicians not happy that they are not receiving expense reports for grants in a timely fashion (30-60 days), sometimes due to a bottleneck in admin capacity, sometimes because they’re out of the country. By giving them the ability to access this data on a daily basis the number of deficit grants has greatly decreased

20. Quality – performance We are moving towards productivity bonuses for our clinical faculty. These are based on hitting certain RVU thresholds. This report has been particularly meaningful for them to project whether they are going to meet these targets or if they need to make adjustments. The targets can be adjusted for clinical effort, but we have not yet implemented because Uva has not established a clear prospective way of determining CFTE

21. Moving onto Overview of Reports & Analytic Objects • We’ve looked at the impetus to start this project • Key problems to solve • Key characteristics of a desired tool • Role of transparency in generating communications, trust & quality • How these characteristics play out in our business • Now let’s move onto a review of the reports

22. Overview of System & Reports • Data Sources \ Systems Integration • Financial Reports • Grants Management • Clinical Billing & Activity Module • Human Resources • Dashboards (Beta)

23. Data Sources \ Systems Integration Oracle – UVa’s ERP solution providing general ledger, purchasing, payroll, grants management and human resource data Epicore - HSF (Practice Plan) financial system providing detail of expenditures, revenue, payroll Precision – HSF (Practice Plan) reporting system, clinical billing, charges, collections, RVUs Licensure – DEA, Medical licenses, HSF appointments, VISAs, I9s, pulled from a variety of sources, including Oracle and Compliance Office New Innovations – Residency Management Suite, currently exploring integration of teaching evaluations, strategic importance to support teaching mission, complications due to SaaS deployment model SOM Budget – Export to School of Medicine budget database EHS – Environmental Health & Safety database providing training documentation for handling of hazardous materials, radiation safety, etc… Decision Support - Medical Center system for quality metrics, final order by 9:00am, discharge by noon, length of stay, etc…

24. Financial Reports Consolidated Financial Report : 1st goal of ERS systems was to produce a consolidated financial report which brought together all sources of revenue and expenses, aggregating data from UVa – Oracle and HSF – Epicore in one system Development of report allowed for financial reporting to move from Yearly to Quarterly Effort – automating of this report greatly reduced the effort required to produce departmental and divisional financial reports Drill to Detail – This report features the ability to drill on Column, Row, or Cell to export detailed transactions into MS-Excel

25. Financial Reports FRP – Faculty Remuneration Plan 2nd goal of ERS project was to automate the generation of FRPs. The SOM requires each department to produce this document on a yearly bases for faculty Automation allowed for report to be produced quarterly, very close to producing monthly Table of Contents feature allows division chief to quickly review his\her division and drill into detail as desired Drill – allows faculty member to drill on any row to view detailed transactions in MS-Excel

26. Financial Reports Financial Subcategory Graph: Rudimentary analysis tool which allows selection and graphing of each expense or revenue category over time (2006-2009)

27. Financial Reports Financial Subcategory Graph: Graphs MOU (revenue sharing \ funds flow) from the medical center to the department by division Each division is drillable into a graph which details the trend by quarter Each quarterly graph is then drillable into a detailed Active HTML Report of all transactions

28. Financial Reports Financial Subcategory Graph: Quarterly trend Drills to transactional detail AHTML (Active HTML) – portable HTML file with data and analysis tool Allows for basic OLAP features, sorting, calculations, graphing, etc…

29. Grants Management PI Summary Report: Allows for quick overview of all grant activity, including status of grant (open, closed, approved), expenses for the period and to-date, budget, planned expenses and budget available after planned expenses Allows drill into Funds Available Report for each grant This series of grant reports allows each PI to review their activity at any point in time without the need for a fiscal tech to access the system of record, run their reports, print their reports, and review them with the PI improving access and reducing labor

30. Grants Management PI Funds Available Report: Reconciliation requirement for UVa, must be reviewed and signed by PI on a monthly basis. This is normally the only detail a PI would see on their grants. This report allows the PI to review this online or print off as a PDF prior to review with finance\grants management staff at monthly meeting Drill – also allows drill into full detail report in MS-Excel for further analysis

31. Clinical Billing & Activity Monthly Gross Charges / Net Collections 4-in-1 This report is our leading indicators report showing month over month and year to date comparisons to clinical budgets at the Department, Division and Individual levels In previous systems this report was produced quarterly due to the intense labor involved in producing a graph for each faculty member. Now in ERS this report is automatically produced monthly This is the first of a two page report showing year to year variance to charge budget

32. Clinical Billing & Activity Monthly Gross Charges / Net Collections 4-in-1 This is the second page which demonstrates year to year variances in collections to budget both on monthly and year to date basis These reports represent the highest level overview of a department’s, division’s or individual provider’s clinical activity

33. Clinical Billing & Activity Services Billed – Specialty Area by CPT, Volume, RVUs, Charges: This report provides full detail on service billed for the physician who has the time and inclination to really dig into the health of their practice Sort order is by Type of Service (Inpatient Attending, Inpatient Consults, Outpatient, Specialty Procedures) , Specialty Area (General Nephrology, General Medicine, Kidney Transplant, Palliative Care, Renal Dialysis, Vaccines) , CPT /w Description. The analysis provides Volumes, RCUs, Charges on a YTD and Variance from prior year. This provides a very detailed look at services provided

34. Performance Benchmarking

35. Human Resources Labor Distribution Exception Report by Person: Labor Distribution is an Oracle methodology for managing payroll across multiple funding sources, no one should be scheduled at 100% Areas of concern which would trigger highlighting in red would include under allocations, over allocation or a funding source (grant) nearing its end date. Of particular importance to grants management where a PI or staff person may be funded on more than one grant and need the labor schedule to match their effort report to the sponsor The grants implication transforms this from a purely finance process into a compliance process making it doubly important to manage this process on a monthly basis This report is also distributed (in email) by ERS’ report bursting and distribution engine once \ month to appropriate business managers to alert them of needed actions

36. Human Resources Licensure & Compliance: DEA licenses, Medical licenses, Visas, i9s,etc… have always been very manual compliance issues to track down and to keep current Sources for this information include the medical center compliance office, practice plan legal department, and often the physician themselves

37. Human Resources 1500 Hour limit (that temps can work in one year) , User or Lose vacation time, Comp Leave balances: The University’s system of record requires that HR specialists across the departments monthly run, print and distribute these and similar HR reports for all staff ERS allows for these reports to be “run” automatically and distributed in email to each employee on a prescheduled basis, eliminating a great deal of effort and paper

38. Dashboards Dashboard Strategy: Provide Role Based Dashboards, both for administrative roles (Chair, Division Chief, Department Administrator, Division Administrator) , and for faculty roles \ tracks (CF/CE , CI/AI) 80% rule - provide a quick graphical representation or link to 80% of the content someone will look for on a daily basis Drill – have each top level graph drill into a more detailed standardized report or analytic tool Navigation – don’t leave anything out, provide a method for quick navigation to entire body of reports and tools

39. Dashboards Administrative Dashboard Features: Finance – quick views of Consolidated Financial Report and Faculty Remuneration Plan which drill to both detail reports SOM – Decade plan metrics for clinical care, Discharge by Noon, Final order by Nine, Prelim by Six License Expirations – DEA & Med license Grants Management – Balance Available after Planned Expenses, provide ultra quick look at grants in trouble and quick drill to their detail reports

40. Dashboard Clinical Dashboard Features: E & M Distribution for both inpatient & outpatient, initial visit, follow ups and consults. Allows for a physician to compare themselves against their division and the department, drills down to detailed comparison presented earlier Benchmarks – also provide comparison of productivity against MGMA & UHC benchmarks. Others – in addition these dashboards also have many of the common features of the administrative dashboards with mini-graphs\tables which link to the faculty member’s FRP, grants, licensure, etc…

41. Dashboards Academic Investigator Dashboard Features: Labor Distribution – Allows the PI to quickly see who is scheduled on each grant and quickly drill to the PI Funds Available report for that grant Environmental Health & Safety Training – quickly review personal training records and soon, all those who work in your lab Balance Available After Planned Expenses – provides greater detail on each grant

42. Dashboards Navigation – Let’s not forget the rest: Completeness – each of the mini-graph, mini-table elements of the dashboard provide a quick jumping off point to valuable detail reports but there are some reports that you can’t get to from the dashboard, for completeness sake the Nav Panel provides links to all reports Guiding the Eye – to guide the mind’s eye to the report that you’re looking for each report link also features a complete description and soon a thumbnail view of the report Keeping it Clean – to avoid information overload the menus work in an accordion style, expanding categories as you click on them and collapsing categories not in use

43. Outcomes • Financials • Consolidated financial statement and FRPs (faculty individual balance sheet) evolved from once\year projects for all departmental analysts and division administrators to quarterly reports produced by DOM-ERS, focus is no longer on production of reports, but on QA of data • Reports now available on-line and e-mailed quarterly to each faculty member • Clinical Activity • Labor Restructuring

44. Outcomes • Financials • Clinical Activity • Legacy reports easily migrated into system • Reporting at the physician level transformed from a 3 week process for 2 FTEs to 15 minutes of DBA time to verify the data load, 30 minutes of QA time to validate the data, and 15 minutes to double check report distribution job and distribute reports via e-mail • Additional report generation now being driven by physician focus groups and division administrators, not analysts • MGMA & UHC benchmarking added this year, still working on adding benchmarking to our suite of current productivity reports • Labor Restructuring

45. Outcomes • Financials • Clinical Activity • Labor Restructuring • 2 FTE dedicated to clinical report production reduced to .5 FTE for ad-hoc queries • 4 analysts no longer needed to produce divisional reports • Division Administrators no longer burdened with producing reports and massaging data sets, now focus on mining data and interpreting results for division chiefs and faculty • DOM-ERS team, added 1 DBA, 2 programmers, ½ FTE quality assurance

46. For Further Information • DOM-ERS Web Site: http://deptmedicine.eservices.virginia.edu/dom-ops/SoftDev.htm • E-Mail: dom-ers-team@virginia.edu • Mike Zang: zang@virginia.edu