Making quality and cost transparent in the world of healthcare
Microsoft's Project REAL makes crucial business intelligence available to industry providers, payers, and consumers
Rising healthcare costs have joined death and taxes on the short list of things that are both unpleasant and inevitable. This is especially true in the United States, where healthcare costs are twice what they are anywhere else in the world. The trend has serious implications for both providers and consumers of healthcare. Increasingly, providers will be judged for the cost-effectiveness as well as the quality of their services, while consumers, forced to shoulder an ever larger share their own healthcare costs, will have to become shrewd judges of value in the healthcare marketplace. But how do you judge value in this area?
Microsoft has come up with one solution. It's called Project REAL and it allows clinicians, hospital administrators, and insurers to make sense of the myriad interactions and transactions that occur in a healthcare system and determine what's medically effective and what's not, what's cost-effective and what's not. It also enables consumers to judge quickly where they can get the biggest bang for their healthcare dollar.
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Project REAL: a new source of business intelligence
Based on the Microsoft SQL Server 2005 family of products, Project REAL (shorthand for Reference implementation, End-to-end, At scale, and Lots of users) initially was developed in partnership with Barnes and Noble for retail business intelligence needs. The solution has been adapted to provide interactive, easy-to-use and low-cost business intelligence in the healthcare field. Key benefits include:
| • | Insight into organizational or personal clinical outcomes and financial performance. |
| • | Simple, secure, and roles-based dashboarding. |
| • | Faster solution delivery (you don't need to wait for years foreffective business intelligence). |
| • | Solutions that are low-cost and Web-based. |
A problem faced by workers throughout the healthcare industry is how to generate reports from data contained in multiple systems, both clinical and administrative. Often it's difficult to access data within these “silos” and even tougher to cross reference it. REAL is a relatively low-cost way to pull data from disparate storage sites in near real time, aggregate that data and then apply root-cause analyses, with results reported via a convenient user interface. I'll talk more about how Project REAL works in a minute. First though I want to describe some of its real-world applications.
Enabling tighter control over healthcare quality and cost
Project REAL's reporting system – the manner in which analytical results are displayed – is highly graphical and easy to follow and act upon. It's possible, for instance, to display a data set complete with an overlay of key performance indicators, with numbers falling outside the desired limits highlighted in red. To learn how an undesirable result happened, all a user needs to do is click the offending number and all the steps that led to it will be displayed. This and other of the system's capabilities can be applied across the healthcare world. Consider:
| • | Hospital administrators unhappy with the level of drug expenditures in their clinical network can employ REAL to drill down and determine whether the problem stems from wasteful practices at a single hospital or clinic or is system-wide in nature – stemming from, say, the use of a brand-name drug instead of a less expensive but equally effective generic version of the same drug. |
| • | The system can be used to run quality assurance checks on facilities and practitioners. Are the proper protocols being followed when a patient presents certain symptoms? Are drugs being prescribed to patients who are allergic or especially susceptible to their side effects? These are the sort of clinical questions REAL can answer. |
| • | Insurers concerned with fraud prevention can run pattern-matching software that identifies aberrant treatment authorizations and claims. |
Although Project REAL did not become available for use in a healthcare setting until well into the second half of 2006, it already has been adopted by a handful of healthcare providers and administrators. One of them, the Omaha, Nebraska-based Ancillary Care Management, oversees treatment authorization and claims processing for a nationwide network of 4,000 providers of home healthcare. The company uses transactional systems to accomplish its processing chores. It relies on REAL's business intelligence capabilities to make certain the treatment ordered and claims submitted are justified. An executive with the company estimates that by keeping a tight rein on the process, the claims submitted to healthcare payers are 30 to 50 percent lower than they otherwise would be.
Customization and cost saving with familiar technology
At its most basic level, Project REAL consists of processes and code sets custom designed for individual users by architects at Microsoft Consulting Services. One of the solution's most appealing aspects is that it leverages existing and widely used Microsoft products. The back-end data warehousing function – the system that captures data from multiple silos and then aggregates and analyzes it – is handled by the database platform and integration and analysis services in Microsoft SQL Server 2005. Front-end business intelligence, displayed for users on a kind of dashboard, is provided by the reporting services component of SQL Server 2005 as well as the ProClarity feature of Microsoft Office Performance Point Server. Meanwhile, because Project REAL runs on the Microsoft Windows platform, security is assured by Windows Active Directory. The importance of this can't be overestimated given the strict regulations governing the confidentiality of patient data.
A reliance on familiar technology means that a reduction in healthcare expenditures is not the only bottom-line benefit of Project REAL. There is also the cost of the system itself. Previously it was not unusual for a company to spend three to four years developing a data warehousing/business intelligence solution. With the assistance of experts from Microsoft Consulting Services, REAL can be brought online in six to nine months, resulting in considerably lower development costs.
Taking the power to the people
Project REAL will have an impact that will far outstrip the number of health care entities that adopt it. Because it is extensible over the Web via Microsoft Office SharePoint Server technology, the solution can be widely shared. This enables Ancillary Care Management, for example, to allow providers in its network Web access so they can do their own “ad hoc analysis.”
Just how broadly REAL intelligence might be disseminated is demonstrated by none other than Microsoft, where individual employees are allowed to access the system and run cost and quality comparisons on the various providers participating in the company's health plan. And somehow, with healthcare costs shifting disproportionately onto individuals, that seems only appropriate.
 | Bill Crounse, M.D., is senior director, worldwide health for Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. |
