The document discusses how Sentara Healthcare used enterprise data and analytics to drive surgical performance improvement across their healthcare system. They integrated clinical, operational, and financial data to gain a complete view of their enterprise. This allowed them to address questions from different perspectives and embed analytics throughout their organization. By establishing a common foundation of data and evidence, they were able to align strategy, drive quality improvements, and increase operational performance across Sentara Healthcare.

3. Environment Growth in Knowledge…… Time for Knowledge to Double 1930 30 Years 1970 7 Years Accelerating Growth in Information 2011 11 Hours

4. Environmental Participants Digital Natives vs Digital Immigrants

5. Enterprise Questions: Multiple Perspectives Needed Clinical  “ Where are we achieving our quality goals across service lines ? ” Operational  “ Are our resources deployed optimally to satisfy the patient mix ? ” Financial  “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ” Anticipatory  “ What can we do to intervene and change the outcome ? ” Financial Systems Clinical Systems Operational Systems Application Reports Application Reports Database Database Database Application Reports

6. Neglecting Analytics in IT Adoption* Analytical Infrastructure Transactional Systems Infrastructure Comprehensive Enterprise Analytical Capabilities Analytical Insights Limited to Entity Level Little or No Analytical Capabilities Financial and Administrative Systems Ancillary and Departmental Systems Fully Functional Clinical Systems * Research from The Advisory Board

7. Industry showing three basic models* * Research from The Advisory Board

8. Vision: Attaining a Complete View of the Enterprise Health Plan Data OR Scheduling Materials Management Billing & Reimbursements MedAI Epic Lab Data Costs Legacy

9. Enterprise Questions: Single Hospital View Costs, Charges & Reimbursements Surgery Operations Materials Management Labor Accounting “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ” Application Reports & Graphs Application Reports Application Reports Database Database Database Database Application Reports

10. Surgery Reporting – Current State “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ”

11. Surgery Reporting – Isolated Data Extraction

12. Enterprise Questions: Multi-Hospital View “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ” Sentara CarePlex Hospital Sentara Norfolk General Hospital Sentara VA Beach Hospital

14. Operations: Process Metrics Embedded Process Metrics  Operational Analytics

16. Driving Improvement Through Data & Metrics “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ” Requires Actionable Data Organizationally-Focused Resource-Focused Process-Focused Accountability for Focused Action and Metrics Costs, Charges & Reimbursements Surgery Operations Materials Management Labor Accounting

17. Driving Improvement Through Data & Metrics “ What is profitability in surgery across Sentara for 2008 vs. 2007 ? ” Actionable Data Enables Focused Response Identify Areas of Under Performance Localize and Intervene Identify Areas of Over Performance Characterize and Standardize Review for Best Practices Focused Interventions

18. The Future: Embedded Analytics Patient Seen in Emergency Dept Admit Patient: Presumptive Diagnosis: Pneumonia Discharge Monitor Care Delivery Standard Order Sets Equipment Labor Materials Facilities Nursing Orders: Respiratory Therapy: Medication Orders: Resource Demand Day 1 Day 2 Day 3 Day 4 Day 5    

19. The Future: Predictive Analytics Standard Order Sets Labor Materials Facilities Equipment Demand Operating Plan & Schedule Labor Materials Facilities Equipment Capacity

20. Enterprise View: Across the Full Spectrum of Care Integrated Sentara EDW Sentara CarePlex Hospital Sentara Norfolk General Sentara VA Beach Sentara Medical Group Sentara Health Plans Ambulatory Acute Care SNF Home Care Emergency Long-Term Longitudinal Medical Record

22. OPERATIONAL PERFORMANCE DASHBOARD This could be daily, weekly, as opposed to monthly like mortality ratio. This would then be related to SSE. Look to get actionable things on patient experience KPIs first, then look at larger trends? Monthly report – drives executive pay, can link to this as a PDF or Excel and show active data when clicked. Can analyze from either direction. Using various attributes, can link to patient charts. MRI procedures per 24 hour period * # of MRI machines. Perhaps drill into revenue per hour or procedures per hour for a specific facility. Similar to MRI Utilization Review POSSIBLY ‘DEATH IN LOW RISK DRG’? PRODUCTIVITY LABOR COSTS AS A % OF NET REVENUE PATIENTS OVER 30 DAY LOS READMISSION PERCENTAGE HOURS PATIENTS HELD IN ED ICU BEDS OPEN ED TURNAROUND TIME DAILY CENSUS MRI VOLUME CT VOLUME CATH PROCEDURE VOLUME PURCHASED LABOR OVERTIME PREMIUM HOURS PAYER MIX GROSS REVENUE : INPATIENT GROSS REVENUE : OUTPATIENT SUPPLY COSTS LEGAL & CONSULTING COST FIXED COSTS CT VOLUME PER HOUR CATH PROCEDURE VOL PER HOUR MRI VOLUME PER HOUR RED LIGHT / GREEN LIGHT SERIOUS SAFETY EVENT (SSE) COUNT PATIENTS PENDING PLACEMENT OR LATE STARTS, ROOM TURNAROUND SURGEON CUT TO CLOSE TIME AVERAGE OR TURNAROUND CRITICAL PATIENT CARE SYSTEM DOWNTIME CUSTOMER SATISFACTION MRI REVENUE PER HOUR CT REVENUE PER HOUR CATH LAB REVENUE PER HOUR MORTALITY RATIO COMPLICATION RATIO DAYS SINCE LAST SSE High End Imaging MRI UTILIZATION CT UTILIZATION

23. PRODUCTIVITY LABOR COSTS AS % OF NET REVENUE PATIENTS OVER 30 DAY LOS READMISSION PERCENTAGE HOURS PATIENTS HELD IN ED ICU BEDS OPEN ED TURNAROUND TIME DAILY CENSUS MRI VOLUME CT VOLUME CATH PROCEDURE VOLUME PURCHASED LABOR OVERTIME PREMIUM HOURS GROSS REVENUE - INPATIENT GROSS REVENUE - OUTPATIENT SUPPLY COSTS LEGAL & CONSULTING COSTS FIXED COSTS CT VOLUME PER HOUR CATH PROCEDURE VOL PER HOUR MRI VOLUME PER HOUR RED LIGHT / GREEN LIGHT SERIOUS SAFETY EVENT (SSE) COUNT PATIENTS PENDING PLACEMENT OR LATE STARTS, ROOM TURNAROUND SURGEON CUT TO CLOSE TIME AVERAGE OR TURNAROUND CRITICAL PATIENT CARE SYSTEM DOWNTIME CUSTOMER SATISFACTION MRI REVENUE PER HOUR CT REVENUE PER HOUR CATH LAB REVENUE / HOUR MORTALITY RATIO COMPLICATION RATIO DAYS SINCE LAST SSE PTCA in 30 Min CHF Protocol Joint Replacement PT Ordered Antibiotic in 4 hrs OR Cases OT Out of Area Transfers Voluntary Turnover  Metrics and Dashboard focused around strategic and supporting operational imperatives OPERATIONAL PERFORMANCE DASHBOARD PAYER MIX

24. Relevant, Timely and Escalating Patient Seen in Emergency Dept Admit Patient: Presumptive Diagnosis: Pneumonia Discharge Monitor Care Delivery Standard Order Set Nurse Station 2. Notify Nurse 1. Order Set includes:  Labs  Antibiotics in 4 hrs  4 hr Clock Starts 4. Notify Supervisor 3. List of Patients Approaching 4 hr Compliance Threshold Supervisor Dashboard VP MA, VP RN, C-Suite 5. Performance Review 6. Process Review 7. Review & Revise Order Sets As Needed