On September 8, at the California Radiological Society’s 2012 Annual Meeting & Leadership Summit in San Francisco, Paul Chang, MD, presented “Developing and Deploying Business Dashboards and Scorecards in Radiology.” Change, who is professor and vice chair of radiology informatics and medical director of pathology informatics at the University of Chicago School of Medicine, says, “The only meaningful validation is how [your vision] works in the real world.”
He adds, “We need to measure effectiveness at accomplishing our mission and vision. One of the criticisms I have of medicine in general is that we create visions in which we think we’re doing things, but we actually don’t have tools to measure how effective we are in accomplishing our goals or our vision.”
Chang explains, “We’re so inefficient that we haven’t truly leveraged these tools, and we’re wasting so much time because these tools are suboptimally addressing our issues. We get trapped in the tactical and can’t think about our higher strategic or lofty goals. There are ways to embrace, address, and leverage the mundane, the technical, and the IT to achieve these lofty goals.”
Survival Beyond Fee for Service
Chang, an imaging informaticist, outlines the development and application of analytics through three generations of IT solutions embraced by the tech-savvy specialty. Although radiologists were comparatively early adopters of IT solutions aimed at meeting their clinical and workflow needs, the specialty is just arriving at the point where these solutions can also be used to support the business sides of practices, he says.
As imaging IT solutions become less specialty specific and more enterprise focused, Chang notes, the focus has shifted from improving workflow to supporting the value proposition of health care in general. That evolution is an interesting test case for the future of the health-care enterprise, he says. “We’re now approaching a different kind of age: Meaningful innovation for meaningful use,” he notes. “No longer is fee for service guaranteed. We are going beyond the enterprise to the cloud, with an emphasis on the value proposition. We’re going to be valued and reimbursed for care management.”
With that imminent shift in mind, Chang believes that the use of analytics to help guide practices is no longer optional. “The real goal is measurable improvement in efficiency, productivity, cost effectiveness, quality, and patient outcomes,” he says. “[Practices need to develop] performance modeling based on key performance indicators. If you can’t demonstrate that you have manifested your vision in the real world, it’s all philosophy.” Examples of meaningful indicators could be those that demonstrate quality, patient care, or patient satisfaction, he says.
Dashboards Versus Scorecards
Chang observes that merely having the information serves no purpose; it must be reviewed and applied by practice stakeholders and clinicians. “Reviewing dashboards and scorecards must be more than just using weekly or monthly static reports,” he says. “It requires a comprehensive, strategic perspective and appropriate modeling; otherwise, it is easy to get seduced by pretty pictures and graphs.”
Chang notes that the two most common terms used in analytics are dashboard and scorecard, and he is careful to distinguish between them—too often, he says, the terms are used interchangeably, despite describing very different concepts. “Dashboards are tactical; scorecards are strategic,” he says, “and this is the fundamental misconception people have about business intelligence and analytics (and the biggest mistake they make). You need to understand that there are two kinds of tools, when you talk about business intelligence and analytics, and those are dashboards and scorecards: 90% of the time, when vendors say dashboard, they mean scorecard.”
He continues, “Dashboards are real-time performance0monitoring tools. They are tactical and operational in scope. They are data-dimension–reduction tools to provide tactical situational awareness. Scorecards are performance-management tools sharing metrics relative to explicitly defined goals. If dashboards are about winning the battle, scorecards are about winning the war.”
Chang adds that one is no good without the other. “You need both,” he says. “It’s ridiculous just to have scorecards showing red, yellow, or green. A tactical dashboard shows, in real time, the appropriate business logic to address errors proactively. A proper, real-time tactical dashboard will prevent you from showing a yellow or red next month. Scorecards address your global vision.”
Summarizing the value and importance of analytics with respect to the future viability of practices, Chang says, “The group that defines and provides the data and evidence is going to win. You cannot improve a process unless you can measure that process.”