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Jonathan Rothman knows the value of information, and, as an executive in the emergency services field, he also places top priority on issues of safety and security.
Rothman is the director of data management for Emergency Medical Associates, of Livingston, N.J.
The information that his company collects in its Oracle Corp. data warehouse can help facilitate everything from a patient getting the correct medication to measuring the quality of care in an emergency room to EMA getting new business.
EMA has been gathering and crunching data for about 17 years. Those years of work were crucial when the federal government reached out to the medical community after the Sept. 11, 2001, terrorist attacks in New York and Washington.
The task: help the government prepare for medical emergencies ranging from biological attacks involving such weapons as anthrax to tracking outbreaks of such new diseases as SARS (severe acute respiratory syndrome) and West Nile virus.
EMA would eventually enlist the help of systems integrator Sapphire Consulting Services Inc. to assist in bringing this information onto the Web and to help EMA safeguard that sensitive data.
EMA is an association made up of more than 220 doctors who manage 16 emergency rooms in greater New York City and northern New Jersey. With more than a decades worth of collected data and the business intelligence tools to manipulate and analyze the data, EMA was in a very good position for this type of work, Rothman said.
“After Sept. 11, there was a lot of talk from the federal government … about what can be done with the data and who in the health community can supply the data to detect an anomaly,” Rothman said. There was a limited number of databases available containing relevant information. But Rothman said it made sense to look at where EMAs physicians did their work for signs of an impending epidemic.
“What location would patients go to if there was a problem? They would go to their doctors office or the emergency room, and the most common place for patient complaints would be made available there,” Rothman said.
That, of course, raised a new set of challenges related to protecting the integrity and privacy of collected data, since the EMA databases are fed directly from individual physicians and operating hospitals.
EMA installed its first emergency department management systems on computers at hospitals that had contracted with the company. The systems were used by doctors, nurses and other staff to house such information as lab data, prescriptions, doctors notes and discharge instructions, Rothman said.
The collection of data continued to evolve over time, and, in 1994, the company pulled the patient demographics—such as gender and patient needs—into its billing system.
EMA soon found it needed more BI and security tools to help it manage, analyze and protect the data, Rothman said. In 2000, the company moved away from giving physicians access to unique data sets for them and their sites and moved toward reporting and report distribution by analysts, which called for integrating information from inside and outside the data warehouse.
Rothman contacted various data warehousing software vendors to see what products they offered.
As a result of that process, EMA undertook a six-month pilot with Business Objects S.A. After the test, Rothman said EMA adopted the San Jose, Calif., vendors BusinessObjects software suite.
Business Objects BI technology enabled EMA to consolidate billing and clinical data into a single data warehouse. It also gave EMA greater control over the data, which, given the amount of patient information that was included, was crucial—particularly when HIPAA (Health Insurance Portability and Accountability Act) regulations took effect in 1996.
“The goal was to try to use the information that was consolidated to support the operations of the emergency departments,” Rothman said.
“Prior to 1998, we had no business intelligence [regarding the data]. It became a requirement for us. … The goal of the data warehouse at the outset was just to keep us afloat and help us survive. Now we can use it for more efficient care, better customer satisfaction and to prove our worth to clients.”
Pat Morrissey, worldwide marketing director for enterprise development management at Business Objects, said EMAs use of the BI software improved the groups operation.
“Their view of the world is that they can provide better quality of patient care and are absolutely certain they can back it up with the numbers,” Morrissey said.
After the 9/11 attacks and the ensuing worries over bioterrorism, Rothman said he knew that EMA needed tools to help use the clinical and billing information it was gathering from patient contacts to help it track medical problems before they blossomed into epidemics.
The need was to include massive amounts of data from individual patient records in a database that would reveal only general health care and patient injury trends to group members accessing the information.
Next Page: Business Objects provides the solution.
Business Objects Provides Solution
EMA and Sapphire, which has since been acquired by Miami-based Adjoined Consulting Inc., deployed Business Objects BusinessObjects Application Foundation.
The goal was to take information on complaints from patients—such as headaches, vomiting or specific pains—and diagnoses from doctors, feed the data into the warehouse, and determine how the data compares with the norm using the EMARS (Emergency Medicine Analysis and Reporting System) dashboard.
“In syndromic surveillance, you dont care about [data on] the single patient, unless its smallpox or Ebola [virus],” Rothman said. “Syndromic surveillance is about the subtle things. … In our data analysis, were not interested in statistically valid information from an individual. Were more concerned with 20 or 30 patients because then you can see an anomaly.”
Last year, Rothman wanted to move his BI capabilities, including syndromic surveillance, onto the Web. It was through Business Objects that Rothman came in contact with Sapphire. Sapphire worked with EMA on implementing Business Objects BusinessObjects Performance Manager and Dashboard Manager technology, which included a set of dashboards that could be used to find the necessary information in the data warehouse and analyze it.
Susan Richards, an officer in the BI practice at Adjoined Consulting, said that working with EMA has been eased by the fact that the doctors group had spent so many years collecting the necessary data—it was more a matter of organizing it in such a way that the Business Objects tools could take advantage of it—and that Rothman knew the goals he wanted to reach. From there, it was simply a matter of putting the tools in place to accomplish the tasks.
To develop a prototype, Richards had to help Rothman redesign the data warehouse, moving from straight data collection for EMAs various sites to a warehouse organized for greater analysis. Within a few months, EMA moved from the prototype to the first production application, Richards said.
Rothman said Business Objects has done a good job implementing features that he has needed as hes built up his data warehouse and BI capabilities.
EMA and Adjoined currently are beta testing the next version of the BusinessObjects suite, called BusinessObjects XI Release 2. Business Objects Morrissey said the company is making the software more intuitive, enabling users to analyze and interact more easily with the data theyre collecting.
Security continues to be a priority for EMA, and it is built into all applications, Rothman said. For example, the group can ensure that physicians get access only to the data for which they are authorized, and that authorization is centrally controlled by Rothmans office.
Richards said a key in Adjoineds continued relationship with EMA is Rothmans clear understanding of what he wants the dashboards to do. Rothman said he is working closely with Adjoined and Business Objects to ensure that the software vendor continues to implement features critical to his business, such as better data visualization.
Morrissey said EMAs syndromic surveillance capabilities highlight what can be done with better analytical capabilities. “This is a clear instance where improved information has saved lives,” he said.