DMBN: How will ACOs push providers into using BI?

Madsen: The interesting thing about ACOs is the spirit of the "requirements" for ACOs is really metric driven. [Providers] have to prove that care is being approved and costs are being driven down. And what payers and providers are coming together to form ACOs have recognized, the payers are far more advanced in their data management methodologies, their data warehousing capabilities, and their ability to analyze these data. And providers are starting to feel a little bit of pressure to up their game, because they have to come to the table with their corresponding data.


In order for ACOs to be successful, that's a requirement: providers have to improve their data management capabilities. That, along with meaningful use, of course, has certainly forced the issue for providers, and I think that's what we're seeing for health care BI.

DMBN: When it comes to BI, is it harder for smaller hospitals, rural hospitals, clinical groups or imaging centers to adopt these methods - just in terms of having people on staff to implement this? Is it harder to bring to smaller organizations?

Madsen: It is. That's one of the challenges we have as a health care industry, when we start talking about data management, or BI, the majority of our care is delivered through these smaller organizations, at least from the patient's perspective. And these folks don't have the kind of money lying around to create a really large, enterprise-scale BI or IT team, to meet the spirit of a lot of these requirements.

For instance, I've talked to a number of groups that have decided not to proceed [with meaningful use, stage 1]. They've done some analyzing, they realize their Medicare and Medicaid billings don't make up for the gap from a spend perspective, and they decide to hold off for a couple of years, to see where it shakes out, because of the potential change in administration in the next year or so.

I do think it's a real challenge for these small to mid-sized organizations. That's actually where we specialize, where Lancet specializes. I work almost exclusively with small and mid-size companies.

DMBN: What are the failure rates for BI implementation?

Madsen: Well, it sort of depends on who you ask. But it's been quoted as being as high as 70 or 80 percent for the first time out for an enterprise BI program. It's very challenging to do these programs and do them well. It's sort of like boiling the ocean. I don't feel that health care organizations, as a whole, are in a position to boil the ocean right now, with everything going on. And to be honest with you, I think that would have been true regardless of the HITECH Act of 2009. These types of enterprise programs are really tough to do, and I don't know that that's the most efficient way to get things done.

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