Trust enhances business reporting using Ardentia’s Activity Flow Analytics

Hosted solution enables referral patterns to be tracked and assessed, supporting robust business planning

George Eliot Hospital NHS Trust has deployed Ardentia’s Activity Flow Analytics (AFA) solution to gain full visibility of patient referral patterns from local practices, improve business reporting and enable more effective management.

The Trust provides medical, surgical and maternity care to a population of approximately 250,000 people in Nuneaton, Bedworth and the surrounding areas. Now implemented, Ardentia’s AFA solution will play a key role in helping the Trust retain its market share and offers managers a more effective method for evaluating referral data to support robust business planning.

The solution provides data from any supplier or provider, showing where patients have been referred from and to which hospital or clinic the referral has been made. AFA also highlights any gaps in healthcare provision to indicate where improvements can be made to optimise referral flows. Ardentia’s system has replaced the Trust’s previous solution, which was felt not to be robust enough for its future needs.

Heather Norgrove, Commercial Director at George Eliot Hospital NHS Trust said:

“It is very important for us to be able to retain our market share, and if we are failing to do this we like to react quickly to make the necessary changes. Ardentia’s AFA allows us to accurately track and assess our referral patterns and perform quick analysis to confirm our market position, which reveals where improvements can be made. We chose AFA for its in-depth reporting capabilities, flexibility and competitive pricing against alternative solutions.”

Ardentia’s AFA is a fully-hosted service that requires no implementation. The solution has an intuitive, browser-based GUI that visualises and geographically maps referral volumes, and enables clinicians and managers to drill down into referral data by speciality, HRG, location, patient age and gender, and time period. This helps in understanding referral flows and case mixes in detail, and supports analysis of how these patterns change over time.

The solution helps healthcare providers discover where local GP practices are referring specific acute care cases and why, enabling them to develop services more strategically and maximise income.

Case Study: Patient Level Costing

Background

Southampton University Hospitals Trust provides local hospital services to some 500,000 people living in Southampton and South Hampshire, and specialist services such as neurosciences, cardiac services and children’s intensive care to more than three million people in central southern England and the Channel Islands.

The Trust is also a major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust.

The Trust’s 7,500 staff treat more than 115,000 inpatients and day patients every year, including 40,000 emergency admissions; they see 350,000 people at outpatient appointments, and deal with around 85,000 cases in the emergency department.

Providing these services costs more than £800,000 every day, and therefore robust financial management is essential to the effective running of the Trust.

The challenge

The decisions that really determine a trust’s financial performance are taken by clinicians, be this the choice of treatment, drug or prosthesis; these decisions all make a difference to whether a hospital runs at a profit or a loss.
The challenge Southampton faces is how to ensure robust financial management while continuing to provide the highest levels of care. The Trust’s goal is to operate as a business-like organisation, with efficiency, financial control and robust management, and as a result to drive up the quality of patient care.

To achieve this requires clinical and finance staff to work together, in order to meet the joint objectives of financial control and care quality optimisation. The challenge Southampton faced was that clinical and management engagement was there, but that they did not have the right tools in place for the job.

The Trust had previously been producing static reports on a service line reporting model, in order to see how departments were performing, and to get an understanding of profitability. However, the limitation of the static reporting is that it did not give staff the ability to drill down further to interrogate data and get the specific information needed to help deliver real improvements, change, and increased profitability.

The solution

The Trust has deployed Ardentia’s Patient Level Costing solution, a comprehensive financial reporting solution developed to meet the real needs and management challenges faced in the NHS, and to help drive change and improvement in healthcare delivery.

The solution is built on actual costs allocated down to patient level, and is fully interoperable with existing in-house information systems, enabling finance and management staff to make the most of existing trust data and the work already done to generate reference costs. In addition, the solution generates service line reports
as well as patient-level costs, helping the Trust to meet the requirements of Monitor.

By taking financial information down to the patient level, the solution creates a link between clinical managers and the finance department to enable evidence-based management, meeting the dual goals of robust financial control combined with care quality optimisation.

The Ardentia solution has been rolled out to all 50 specialties within the Trust, and the goal is to ensure all clinical, management and finance staff are using the system, in order to deliver care that is both effective and cost-effective.

The benefits – A more dynamic approach to financial management

Static reports give trends, top-level info and statistics, but they only show so much. Finance staff and clinical managers need to have the ability to drill down and analyse the specific costs incurred at a patient level, such as ward days and theatre time, and they need to do this for a number of reasons.

Firstly, they need to be able to evaluate the fixed costs incurred by departments and consultants for specific procedures, to get an accurate benchmark figure for the cost of care, and how this compares with the income received.

This data can then be used as a tool for ongoing improvement, serving as a benchmark from which to develop more accurate costings for the future, and also alerting the Trust to individual high costs and enable staff to investigate why they occurred.

According to Fiona Boyle, finance manager at Southampton University Hospitals Trust:

“The ability for clinicians and managers to be able to drill down to the patient level is so important and so critical, because their performance, efficiency, profitability are all measured on the data we have.”

“Staff need to have the reassurance that this data is accurate, and also, crucially, the ability to verify this. They need to be able to drill down to the patient level to see the specific costs incurred, and the treatment delivered, as well as the income received.”

“Patient level costing gives us an altogether better understanding of the business of healthcare.”

A real driver for change

The PLC solution is helping to deliver constant improvement within Southampton, and is being used to help identify where improvements can be made, to ensure best value and efficiency.

Importantly, it’s also about learning from departments and consultants who are performing particularly well, looking to make these examples of best practice, and sharing this information across the Trust.

In this way, the patient level costing data generated is used by managers to evaluate the best clinical procedures to take, and the likely outcomes, in order to meet the dual objectives of financial control alongside the highest level of patient care.

The PLC solution has helped to improve overall data quality within the Trust. Data collection is now more integrated, and captured in a single location. Enhanced accessibility has led to higher quality data and more of it, which has in turn benefited staff Trust-wide.

With high quality patient level data as a base line, reporting throughout the trust as a result is more accurate and more reliable. Clinical coders are getting access to better data, which in turn is also improving service line reporting, delivering constant improvement.

Planning for the future

Patient level costing is one tool within the decision making process; it makes the organisation better informed, and give people the information to make autonomous decisions, based on accurate data and evidence.

The patient level costing solution from Ardentia has been well received by top-level management and senior clinicians within the Trust, supporting evidence-based decision making and ensuring strong financial management.

Patient level costing will give the Trust better quality data and more of it, in order to plan effectively for income, costs and resources and allow for more accurate modelling and forecasting. Better information on past trends and current activity enables better more informed modelling for the future.

Mid Yorkshire Hospitals NHS Trust Turns To Ardentia for Business Intelligence

Improved access to data enables more effective management and better patient care

Mid Yorkshire Hospitals NHS Trust has deployed a complete business intelligence solution from healthcare business intelligence specialist Ardentia to improve data quality, enhance Trust-wide reporting and enable more effective management.

The Trust employs over 7,000 members of staff to serve the communities of Wakefield District and North Kirklees, with an annual budget of £330 million. Operating across multiple sites, the Trust sees an average of 2,500 people pass through outpatients and Accident and Emergency each day and carries out over 235 planned procedures.

To help it better monitor its business performance and delivery of patient care, the Trust wanted a tailored business intelligence system that provided a central source of clinical data, allowing clinicians and managers to make more informed decisions to further improve healthcare provision and optimise financial management.

After assessing the available options, the Trust went through a tendering process and selected Ardentia to help it develop a robust business intelligence system that would meet its needs.

James Rawlinson, Assistant Director of IT at the Trust said:

“It’s critical that clinicians, managers and other stakeholders can easily access and use the information we have in our systems to better plan how healthcare can be delivered and make sure GPs feel assured in allocating resources across a health economy. As a provider, we are receiving a growing number of queries regarding this information and Ardentia has provided us with a complete business intelligence system that enables us to manage those queries, obtain in-depth data quickly and easily, and support robust business planning.”

“Here at the Trust, we wanted to drive organisational agility and efficiency using the technology as a key enabler, allowing clinicians to view and record information with minimum effort, at the point of care.”

The Trust’s Ardentia solution comprises a HealthWare data warehouse, Patient Level Costing solution and Theatres reporting module, specifically designed to help NHS managers and clinicians better manage operating theatre utilisation.

Prior to the deployment, managers and health professionals at the Trust relied on data published in a range of different sources, making the retrieval and updating of records slower and impeding the ability to develop a picture of trust wide performance.

The Ardentia solution enables the Trust to gain quicker, more effective access to data and eliminates any inconsistencies between different data sources, allowing managers and clinicians to make informed decisions. The Trust can also access detailed cost breakdowns, identifying areas where efficiency can be improved or savings can be made, without compromising the quality of patient care.

South London Healthcare NHS Trust chose to deploy business intelligence tools from Ardentia in order to support merger activities and help improve Trust performance.

Quality Data from Multiple Systems

South London Healthcare NHS Trust was formed in April 2009 as a result of the merger of Bromley, St Mary’s Sidcup and Queen Elizabeth, Woolwich.  The newly formed Trust serves a population of over one million people, employs over 6000 staff and has an annual budget of more than £400 million, making it one of the largest NHS hospital Trusts in the country.

To support unified and coordinated management within the new enlarged Trust, and to improve the quality and quantity of clinical and management data, the Trust deployed Ardentia’s Data Warehouse, Pathway Manager and NetSearch solutions.

User dashboards give senior management and clinical managers a clear indication of how the Trust as a whole as well as specific departments are performing against the key performance indicators set, to ensure timely intervention if needed.

Tracy Ross Senior ICT Project Manager at the Trust said: “Better quality data is crucial to the smooth running of all Trust operations, and the Ardentia solutions will help us to improve reporting, in order to meet Department of Health requirements.

“We chose Ardentia because of their experience of pulling together multiple systems across multiple sites, in order to create a standard and unified reporting solution for staff to access the clinical and management data needed to make timely and informed operational decisions.”

Prior to the merger, all three Trusts were running their own separate data management systems, which were not interoperable.  The Ardentia reporting solutions provide a single, unified view for information across all three Trusts, enabling staff working at any site to access the information they need on clinical activity, patient pathways, finance and staffing resource.

The Trust will be using Ardentia’s Pathway Manager tool to ensure timely access to care and help the Trust meet the 18-week wait referral to treatment requirements.  Previously, patients needing treatment at the different hospitals were discharged and then readmitted, but in the new enlarged Trust patients are transferred between sites.  Pathway Manager supports real-time reporting, giving clinicians an accurate overview of where patients are on their pathway of care, to help avoid any potential breaches.

The solutions will also help the Trust to meet its Payment by Results requirements by giving managers a more accurate indication of the cost attached to care delivered, and the income received.  This will play an important role in helping the Trust to operate on a robust business footing.

Ashford & St Peter’s NHS Trust has reported on the success of business intelligence solutions developed jointly with Ardentia, which have reduced Referral to Treatment times and ensured more timely access to care for patients.

Pathway Manager Improves 18-Week Wait Performance

The customised business intelligence solution has significantly improved 18-week wait performance, with 95% of all patients treated within the 18-week timeframe, up from 59% two years previously.

Andrew Davies, Information Consultant at Ashford & St Peter’s Hospitals NHS Trust explained: Ardentia’s Healthware Manager generates an email-based waiting list template highlighting patient progress within their pathway.  This is then automatically sent to healthcare managers within the different departments, alerting them to potential RTT breaches at an early stage, and exposing the root cause so they can manage care delivery effectively.

“The Trust now has a powerful tool to interrogate data and to drill down to access specific patient data to aid clinical decision-making.  Better quality data, and more of it, has given us improved visibility of patient pathways and progress, enabling us to improve care delivery and successfully meet RTT and other reporting requirements.”

Ashford St Peter’s information team worked with Ardentia to link its own in-house pathway analysis database with Ardentia’s Cassius and Healthware Manager, using the systems to report on the inpatient, outpatient and A&E contract data collected and then to send it to the Secondary Usage Service.

The collaborative route gave the Trust a reporting solution customised to meet its exact operating requirements.  The intuitive user interface, functionality and flexibility of the Ardentia tools have improved access to data and made it easier for staff to collect and report data.

The Ardentia solution also allows staff to drill down through the email to access patient records using NetQuery, in order to get detailed data on specific patient cases.  The system enables staff to access the forms needed to allow record validation, streamlining the process of managing patient pathways.

In addition, the Trust now benefits from a centralised data repository which can be used Trust-wide to create the reports needed to ensure evidence-based decision making and robust business management.

Staff from departments across both Trust sites can access the web-based centralised data centre to access the information they need for operational performance reports, and can drill down to access information on Trust performance for cancer treatment, MRSA and A&E targets, as well as RTT and other reporting requirements.

Briefing Books Improves Data Accuracy and Activity Reporting for Northern Lincolnshire and Goole, Removing Risk and Optimising Trust Performance

A Picture of the Trust

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust was established as a combined hospital and community Trust in 2001, and achieved Foundation status in May 2007.

As its name suggests, the Trust operates all hospitals in Scunthorpe, Grimsby and Goole. It delivers a full range of emergency secondary care services, including intensive and high dependency care, a comprehensive range of planned services and local provision of secondary care diagnostic services, to a population of 440,000 across a wide geographic area around the Humber estuary. Employing 7,100 staff, the Trust has an annual budget of £275 million.

The Challenge

As in all Trusts, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust faces the challenge of ensuring all departments and the Trust as a whole operate on a robust business footing.

As part of its business plan, the Trust must look to control costs and deliver services within tariff income levels. This involves taking action on services which are currently spending more than tariff income levels, as well as improving productivity in key areas such as ward and theatre time usage.

Improved access to data and departmental reporting is key to the Trust meeting these challenges, in order to give the Trust board the visibility of where improvements and efficiency gains can be made, and to learn lessons from departments and specialities which are performing well.

The Solution: Ardentia’s Data Warehouse and Briefing Books

The Trust is currently rolling out Ardentia’s Data Warehouse solution to all staff, in order to give them access to their own clinical dashboard with the data relevant to their speciality and departmental activity.

To meet immediate business priorities and reporting requirements, the Trust’s Information team has deployed Ardentia’s Briefing Books to support unified and consistent reporting, and improve access to data across all hospital sites.

Briefing Books is a feature of Ardentia’s Cassius Reporting Suite, and provides a single point of access to groups of related Cassius Reports, web-based Forms, URL links and other non-Cassius files.

Briefing Books have been designed to enable Trust staff to access all the resources required to perform a particular business process or task in an easy and efficient manner.

The Benefits

Avoiding risk and harnessing external expertise

Previously, the Trust had its own in-house reporting solution, but following the merger a new solution was needed. The board did not want another in-house solution which would leave the Trust in a vulnerable position: such systems are developed and maintained by a small number of internal staff and if these key people leave, the knowledge of the system leaves with them. That could put the Trust in a risky situation.

The Trust therefore went through the procurement process and chose Ardentia because of its experience within all levels of the NHS, and its proven robust Data Warehouse and reporting solutions, which are being used by Trusts across the country.

Ardentia manages risk as part of the contact, and the Trust has been able to benefit from the company’s expertise and experience in deploying business intelligence solutions across the complex NHS Trust operating environment.

Single reporting solution for consistent, reliable data

The Trust wanted a single, end-to-end solution from a single supplier to ensure a streamlined approach to data management, and to keep data consistent and reliable – a single version of the truth.

Previously, data was published in multiple sources, over email, the network, or on the Trust’s Intranet. This led to confusion over where the most current data was located, and could impact on the accuracy of Trust reporting.

The information was there, but staff were often unsure where to look or who to ask for the data. Briefing Books have overcome this issue, making data easily accessible to all staff.

Sarah Coombs, Information Business Development Manager at the Trust said:

“With Ardentia’s Briefing Books, all reports and data are located in a single source, accessible via a web link hosted on the Trust’s Intranet. Staff now have the reassurance of consistent and reliable data, and use the module to get the information they need on activity, performance, key targets and patient pathways to create their reports.”

The Cassius Reporting Suite and its Briefing Books module use standard software, making it easy for staff to navigate and access relevant activity data. The module’s ease of ease has freed up valuable internal resources within the Information team, enabling staff to focus on developing the data warehouse solution and to meet the future reporting requirements of the Trust.

Improved reporting and optimising Trust performance

Having one set of data in a single source has meant more reliable and more consistent data for staff, which in turn has improved overall reporting. Finance and budget reports are all included in the Briefing Books, creating a single place for staff to log in to access key targets, operational data, finance, and information on available resource.

Sarah Coombs added:

“The Briefing Books module has been well received by senior Trust directors, corporate level staff and the executive board, who are able to get customised reports on specific areas of activity. Using these reports, staff can identify areas where improvements need to be made, and also evaluate those departments performing well in order to extend these successful management processes Trust-wide, to boost overall performance.”

The Trust board has the ability to drill down to analyse how business units and directorates are performing, to monitor performance levels and look at ways to streamline and improve processes, to ensure services are delivered within income.

Future Plans

The long-term goal is to migrate staff onto Ardentia’s Data Warehouse solution, which will provide them with customised activity and clinical data through a personal user dashboard, as well as additional quality indicators such as patient experience and health & safety data.

The Briefing Books solution meets current reporting requirements and is playing an important role in giving staff the visibility to analyse performance and make targeted improvements. Crucially, it is also freeing up valuable internal resource and giving information staff the ability to develop the Data Warehouse solution, to meet tomorrow’s reporting challenges.

It’s awkward, as every parent of a teenager knows, when one person has to account for money that another spends.

But no-one blinks an eye over exactly this state of affairs inside hospitals. Most spending decisions are taken by clinicians. Quite properly, they decide what care each patient needs, and their prime concern is health need, not cost implication. However, away from the clinical arena, management and finance staff have to account to the Trust Board for the financial consequences of those decisions.

Now more than ever, Trusts need a robust reporting system capable of quickly costing individual patient records across all departments, to get a clear indication of the overall financial position of the Trust and to ensure that clinicians and managers have a shared understanding of the resources they use.

Cost analysis and reporting is becoming increasingly crucial for Foundation Trusts and also those working towards Foundation status. So how can finance managers ensure they are able to calculate treatment costs accurately and get a clear indication of whether care is being delivered within income?

Service Line Reports and Reference Costs: Only Part of the Picture

The ability of finance managers to do so is currently strictly limited. Increasing numbers of Trusts are able to provide service line reports from existing data sources, meaning they can see where in the hospital a problem may have arisen, for example in Orthopaedics or Gynaecology. Unfortunately, they can’t drill down further to find out which specific patients received the care that caused any excessive costs to be incurred, or understand the details of cost structures to support sharing of best practice. As Chris Watson, Head of PbR Development at the Department of Health points out, the HRG tariff covers a range of patients within each HRG. Trusts need to understand the detailed variation across that range.

Of course, Trusts can use their own internal Reference Costs to get below the level of the speciality. But Reference Costs are averages and the whole point about analysing exceptional costs is to concentrate on deviations from the average. An additional problem with Reference Costs is that they are calculated annually: when they first come out, they’re a little out of date and as the year goes by, they become older and less useful.

Taking a more strategic approach to financial management

What we need to get to the source of a problem is to have costings attached to the records of the patients who incurred them. At the heart of a patient level costing application is a mechanism that identifies cost and indeed income items that can be directly attributed to patients, and assign them to the right records, and then take all the other financial values and apportion them across patient records using such measures of resource usage as bed days, nursing hours, theatre minutes, etc. That means that clinicians can see for themselves exactly which activity brought in what income and led to what costs. With that information, we can understand if and how a specific problem arose and what action needs to be taken to prevent it occurring again.

So, service line reporting reveals a problem, but it takes patient level costing to identify the solution. Because it also provides a basis for dialogue between finance staff and clinicians, it becomes the means to make management of healthcare more transparent and more effective.

Southampton University Hospital Trust and the case for patient level costing

Southampton University Hospital Trust was already carrying out a detailed review of financial management when a manager pointed out a single item in Orthopaedics. A £10,000 invoice for a single knee prosthesis was the first indication to the finance department that such costly devices were being used in the Trust: previously, these costs were buried within invoices for multiple devices, disguising exceptionally expensive elements. The immediate concern was that the National Tariff would note even cover anything like the cost of the prosthesis alone.

In this case, it emerged that the prostheses were only very rarely used, on patients who were on a first or second revision of the operation, and who were young enough to need a prosthesis that would last for decades. In other words, there were excellent clinical reasons for using the device.

Given the good clinical justification, finance managers were able to negotiate with Commissioners off-tariff reimbursements to cover the cost of the prosthesis, as the item was tailor-made for the individual patient. But it took a chance item and a lot of investigation by finance into the clinical sphere to find all the relevant information.

The dialogue between finance and clinicians is precisely the model of collaboration that the Trust is hoping to encourage – a collaboration which guarantees quality of care but eliminates the losses that were previously being incurred, and favours more effective use of healthcare resources.

Adopting a more intelligent approach to financial planning

However, Trusts clearly cannot afford to rely on chance discoveries of this nature. What’s needed is a system which can identify both the problem and its cause, in a systematic and rigorous way – and that means service line reporting linking through to patient level costing.

To address this need and gain access to strategic financial information, finance managers at Southampton have chosen to deploy a patient level information and costing system from Ardentia, as a key component in their management armoury. As well as highlighting to finance managers when there is a problem, the system will crucially show them where to look for its solution.

So instead of monitoring service performance on the basis of broad average costs allocated in a top-down way to services, Southampton will be able to work with more accurate costings based on actual interactions and events related to individual patients and the associated costs.

This approach will help Southampton not only to deliver sound and controlled financial management and consequently to make the best use of healthcare resources, but also to ensure closer collaboration between finance staff and clinicians to ease the task of managing healthcare delivery and matching capacity to demand.

So for once the teenager will be working with the long-suffering parents to make sure everyone gets the most from what the family spends.