Introduction to Decision Support Utilizing Allscripts EPSi

1. Introduction to Decision Support Utilizing Allscripts EPSi Indiana University Health

2. This session’s objectives: • Define Decision Support • Who needs it? • Describe Allscript’s EPSi Decision Support Features • What is it? • How does it work? • How can it be used? Indiana University Health

3. Decision Support • A collection of tools providing information that helps management make educated decisions Indiana University Health

4. EPSi • A computer software system on Indiana University Health’s mainframe • Integrating IU Health’s various information systems into a comprehensive database • Providing the tools to better manage cost, operations, and quality Indiana University Health

5. EPSi • Cost accounting; product-line management; departmental budgeting; contract management; resource utilization management; process improvement; decision support repository; clinical analysis tool set; executive information system; standard data marts; and ad hoc reporting. Indiana University Health

6. Interface Diagram - Feeders Indiana University Health

7. Product Line Manager End Product = Patient Case Mgmt Focus = Controlling product utilization per case Cost Center Manager Intermediate Product = Resources used in treating patients (e.g., x-rays, lab tests, office visits, consults) Mgmt Focus = Controlling unit costs Management Focus Indiana University Health

8. Management Focus • Product Line Mgr vs. Cost Center Mgr Product Line Mgr Focus Surgery MD $650 Anesthesia MD 439 Anesthesia Technical 507 Operating Room Time 398 Operating Room Supplies 100 Nursing Room & Board 1400 Nursing Supplies 200 Pharmacy 642 Pathology / Lab Med 344 Radiology 120 Total Product Line $4800 Cost Center Mgr Focus Indiana University Health

9. Physician Product Line Mgr • Dr. Pitts needs to monitor the utilization & related cost of treating Heart Transplant patients Physician Unit Mgr • Dr. Jordan needs to monitor the daily utilization & related cost of services provided to patients during the Medical ICU portion of their stay Indiana University Health

10. Contract Negotiators • Marvin Pember negotiates a competitive price with Anthem and wants to understand the average variable cost of treating this patient population Corporate Finance • Jay Hoffman must respond to a Board member’s question regarding changes to the bottom line compared to last year. He needs to know how changes in casemix index and payor mix have affected net income Indiana University Health

11. Pharmacy Manager • Jim Eskew R.Ph. needs to understand which DRGs have consumed the most pharmaceuticals in order to focus his attention on cost savings opportunities by improving resource utilization Nursing/Case Management • Karlene Kerfoot’s staff has established a patient care protocol for DRG 112 and need to compare it to the actual services and length of stay provided to patients during the last month at Methodist & University Hospitals Indiana University Health

12. Budget Manager • Dave Miller is aware that IU Health has just contracted with Anthem to admit patients to the hospital and needs to simulate the budgetary impact of an increase in inpatients Govt Programs • Terry Cole needs to show how many patients and how many days were Medicaid eligible to support our claim for higher disproportionate share reimbursement

13. Department Administrator • Barb Peters knows that patient volume has increased and needs to know what impact this has had on Cardiology’s expenses compared to budget Marketing Director • David Zirkle is interested in understanding the volume of international patients seen this year compared to last year. What DRGs did they fall in and how profitable are they?

14. Transition Systems Data Base Modules • Core Financial Management • Product Costing & Management • Patient Data & Utilization

15. EPSi Implementation - The Dominos: Budget Development Chart of Accts EPSi Dept Financial Reports Core Financial G/L Feed Management FTE Reports P/R Feed Module $ Cost Types/ Categories Flex Budgets EPSi Pt. Rev & Usage Stats Product Cost Indirect Cost Allocation Management Product ID Module Product Line Profitability Cost Per Unit EPSi Standards Patient Data & Utilization Utilization Reporting Medical Rec Interface Management Module Patient Encounter Detail Patient Billing Interface

16. Financial Database • Department Reporting Analysis • Historical monthly department data >>Revenues, expenses, FTEs, and product volumes • Department operating statements & flex budgets • Perform variance analysis • Monitor FTE levels • Develop cost per intermediate product (X-Rays, lab tests, surgical procedures) • Standard & actual • Variable & fixed • Direct & indirect

17. Cost Cube Standard Actual Fixed Variable $ 1 Direct 3 Indirect 2

18. Forecasting & Modeling Tool • Develop detailed operating budgets • Project gross & net revenues • Develop salary, wage, & benefits budget • Develop other expense budgets (medical supplies, blood, travel, administrative, and overhead) • Revenue Modeling • Model expected net revenues for different contract types • “What If” Analyses

19. Patient Level Database • Detailed information related to each patient encounter • Resource utilization, cost, and profitability • “Slice & Dice” capabilities • Patient-level inpatient and/or outpatient • Individual patients or groups of patients • Case level, day type, or day of stay • Group by: • primary diagnosis, principal procedure, DRG, MD(s), payor, zip code, etc.

20. 12345678901 23456789012 Many Encounter Records within an Encounter file 34567890123 EPSi Encounter Record Layout 45678901234 Encounter # Admit Date Age Disch Date Sex Principal Dx Zip Primary Proced Payor Attending MD DRG Intermediate Disch Products Status Total Charges LOS Direct/Indir Cost etc. Casemix Index etc. • Information contained on each Encounter Record Includes: • Demographic Data • Clinical Data • Financial Data

21. DRG 114 “Drilling Down” in a Patient Activity Analysis Neus Discharges Payor Prin Dx MD 2 MD1 Patient 1 Patient 2 Intermediate Products Intermediate Products

22. EPSi Decision Support • A collection of tools providing information that helps management make educated decisions Adhoc Reports Operating Stmts Flex Budgets Product Line Reports