Decision Making at the Speed of Thought:
Table and chart reporting is a mainstay of hospital clinical information, however clinical users need data visualisations to better understand disease trends and care patterns. Well-designed dashboards and presentations are more intuitive, and can provide the ability for users to answer their own questions
Nelson Marlborough District Health Board (NMDHB) has developed and operated an enterprise data warehouse for the internal Business and Clinical Intelligence team to utilise and leverage richer reporting. Specialised software extracts data nightly from source systems (patient administration, financial, etc), transforms it into specified formats, and then loads the data into user friendly tables. From those tables software such as Business Objects, Crystal Reports, or Microsoft Excel are used to develop and produce reports.
“Tables and charts depict the here-and-now well, but they are less than optimal for presenting and understanding change, trends and patterns,” said Donald Hudson, Business and Clinical Intelligence Team Leader. “Visualisations of data can much better inform users as to what is different over time”.
Data visualisation software has been around for some time, and recently has become more developer and user friendly. The ability to see patterns and changes in hospital provided care, treatment, and intervention has the potential to better inform clinicians and managers as to what may be effective and cost effective.
With the desire to advance the utilisation of the data with more comprehensive end user dashboards, NMDHB called on assistance from their Business Intelligence partner Montage. Montage had a good existing relationship with the team at NMDHB, “They are a trusted partner, they are experts in their field” says Hudson.
Montage is an Independent Business Intelligence Consultancy who works with numerous ‘visualisation tools’, they knew NMDHB and recommended Tableau Software, a dashboard and guided analytics offering renowned for its speed of development and intuitive functionality and best practice dashboard delivery. Montage worked closely with the Business and Clinical Health Team to deliver dashboards utilising Tableau in two key areas for NMDHB.
As part of a programme of delivering enhanced organisational information, the Business and Clinical Intelligence Team undertook to survey hospitalisation information needs some time prior, this provided guidelines for the Inpatient Dashboard development.
Following clinical input and a legacy system example, a hospital events query dashboard was developed using Tableau Software. The dashboard is interactive and allows users to analyse five year trends of activity and cost by patient demographics. Users are able to analyse at consolidated levels and drilldown to specific details and trends. The more analysis completed the more new questions are raised and thus the extensions of the solution continues to evolve.
An accompanying Pharmaceuticals dashboard was also developed, with which users can review five years of prescribing activity, and display prescribing trends. The ability to visualise trends in disease, remediation, and prescribing may prove valuable for validating intervention programmes.
The information enhancement programme encountered a more difficult problem with pharmaceuticals – no model to follow and no data. With guidelines from Chief Pharmacist Graham Parton on desired capabilities, data was sourced from Ministry of Health National Collections. Some initial querying was undertaken with MS Excel, however limitations in how much data could be accessed and analysed soon presented.
Montage developed a datamart using WhereScape RED and again utilised Tableau Software for dashboard development. Users utilise the dashboard for cost and activity trends and queries, and Excel 2010 with PowerPivot is used for specific analysis.
“Tableau allowed us to speed things up, the existing technology wasn’t as flexible and would have essentially taken up to 5 times longer” says Chip Felton, Principal Consultant at Montage. “We were able to introduce a rapid development approach, where we held productive end user workshops using Tableau Software and easily added the amendments to the dashboards as the user requirements evolved”.
The grain of detail is such that data driven health planning is much more feasible, the impact of clinical initiatives implemented over recent years can be readily seen.
Questions such as ‘What’s our experience in dental caries admissions for under 10 year olds the past five years?’ or ‘What are eighty to ninety year olds admitted for?’ can be asked, and costs-activity trends seen within seconds.
Understanding patterns of Pharmaceutical prescriptions has allowed for better understanding and will enable the development of realistic initiatives and considerations.
As with the hospital events dashboard, questions such as ‘How do practices differ in Oxycodone prescribing?’ or ‘What antidepressants are prescribed and how much did we spend on them last year?’ can be asked and answered.
The ability to visualise trends in disease, treatment, and prescribing provides the beginning of understanding of provision of care patterns and their change over time. Viewing trends frequently brings on more detailed ‘what is?” questions, which can be addressed with the tried and true tables and charting.
“The dashboards have provided insights that previously were not considered, we are really just starting to see what is possible” say Hudson.
“The final result was more than we could have imagined. Montage had a free reign, we trusted their capability and they developed a solution that delivered desired results by bringing valuable insights from the first iterations”.Donald Hudson
Business and Clinical Intelligence Team Leader
The throughput, or speed of development that Tableau offers means that other areas of NMDHB are now looking at using Tableau Software to improve their ability to see trends, and make better decisions.
The Inpatient and Pharmaceutical Dashboards has been not only well received internally by the clinicians but also externally at other District Health Boards. Montage is helping to drive this collaboration and the dashboard work at NMDHB has now been replicated by other District Health Boards. The resulting benefits from collaboration are being seen both in time and cost and are aligning to the alliance principles with the public sector.