There are so many challenges that it is hard to know where to begin. For those providers (hospitals and large physician practices) that have already attained a basic degree of automation there is an obvious next step - performance improvement. For example, if an enterprise is operating eClinic Works (ECW) or similar run-your-provider EHR system, then it makes sense to take the next step and get one's hand on the actual levers and dials
that drive revenues and costs.

Hospitals (and physician practices) often do not understand their actual costs, so they are struggling to control and reduce the costs of providing care. They are unable to say with assurance what services are the most profitable, so they are unable to concentrate on increasing market share in those services. Often times when the billing system drives provider performance management, the data, which is adequate for collecting payments, is totally unsatisfactory for improving the cost-effective delivery of clinical services. If the billing system codes the admitting doctor as responsible for the revenue, and it is the attending physician or some other doctor who performs the surgery, then accurately tracking costs will be a hopeless data mess. The amount of revenue collected by the hospital may indeed be accurate overall; but the medical, clinical side of the house will have no idea how to manage the process or improve the actual delivery of medical procedures.

Into this dynamic, enters River Logic's Integrated Delivery System (IDS) Planner (www.riverlogic.com). The really innovative thing about the offering is that it models the causal relationship between activities,
resources, costs, revenues, and profits in the healthcare context. It takes what-if analyses to new levels, using its custom algorithms in the theory of constraints, delivering forecasts and analyses that show how to improve performance (i.e., revenue, as well as other key outcomes such as quality) based on the trade-offs between relevant system constraints. For example, at one hospital, the operating room was showing up as a constraint, limiting procedures and related revenues; however, careful examination of the data showed that the operating room was not being utilized between 1 PM and 3 PM. The  way to bust through this constraint was to charge less for the facility, thereby incenting physicians to use it at what was for them not an optimal time in comparison with golf or late lunches or siesta time. Of course, this is just an over-simplified tip of the iceberg.

IDS Planner enables physician-centric coordination, where costs, resources, and activities are tracked and assessed in terms of the workflow of the entire, integrated system. This creates a context of physician decision-making and its relationship to costs and revenues. Doctors appreciate the requirement to control costs, consistent with sustaining and improving quality, and they are eager to do so when shown the facts. When properly configured and implemented, IDS Planner delivers the facts. According to River Logic, this enabled the Institute for Musculosketal Health and Wellness at the Greenville Hospital System to improve profit  by more than $10M a year by identifying operational discrepancies, increase physician-generated revenue over $1,700 a month, and reduce accounts receivable by 62 down to 44 days (and still falling), which represents the top 1% of the industry.  Full disclosure: this success was made possible through a template approach with some upfront services that integrated the software with the upstream EHR system, solved rampant data quality issues, and obtained physician "buy in" by showing this constituency that the effort was win-win.

The underlying technology for IDS Planner is based on the Microsoft SQL Server (2008) database and Share Point for web-enabled information delivery.

In my opinion, there is no tool on the market today that does exactly what IDS Planner does in the areas of optimizing provider performance.River Logic's IDS Planner has marched ahead of the competition, including successfully getting the word out about its capabilities. The obvious question is for how long? The evidence is that this is a growth area based on the real and urgent needs of hospitals and large provider practices. There is no market unless there is competition; and an overview of the market indicates offerings
such as Mediware's InSight (www.mediware.com/InSight), Dimensional Insight (www.dimins.com) with a suite of the same name, Vantage Point HIS  (www.vantagepointinc.com) once again with a product of the same name. It is easy to predict that sleeping giants such as Cognos (IBM) and Business Objects (SAP) and Hyperion (Oracle) are about to reposition the existing performance management capabilities of these products in the direction of healthcare providers. Microsoft is participating, though mostly from a data integration perspective (but that is another story), with its Amalga Life Science offering with a ProClarity frontend. It is a buyer talking point whether and how these offerings are able to furnish useable software algorithms that implement a robust approach to identifying and busting through performance constraints. In every case, all the usual disclaimers apply. Software is a proven method of improving productivity, but only if properly deployed and integrated into the enterprise so that professionals can work smarter. Finally, given market dynamics in this anemic economic recovery, for those end-user enterprises with budget, it is a buyer's market. Drive a hard bargain. Many sellers are hungry for it and are willing to go the extra mile in terms of extra training, services, or payment terms.