Enterprise

Business Intelligence
in Healthcare
Leveraging Microsoft in Epic EHR Environments

WHITE PAP ER

Executive Summary

Limits of the EHR

In the United States, healthcare information technology

The number and complexity of reports required of hos-

(HIT) spending has surged to tens of billions of dollars each

pitals continue to rise. The U.S. Department of Health &

year. This wave of investment is in response to the American

Human Services requires specific clinical quality reports as

Recovery and Reinvestment Act (ARRA) of 2009, which

part of the MU incentive program, and there are additional

provides $30 billion in financial incentives for U.S. healthcare

quality measures required through the Physician Qual-

providers to implement electronic health records (EHRs).

ity Reporting System (PQRS) and The Joint Commission.

Combined, there are over 400 reports now required of

Ultimately, this massive spending is meant to reduce

hospital organizations and physician groups by federal

overall health costs by incentivizing the implementation of

regulations and incentive programs.

systems and processes that will eventually improve healthcare quality and outcomes.

In addition, as healthcare organizations are shifting towards

health information exchanges (HIEs) and accountable care

From a HIT perspective, EHRs have recently been the lead-

organizations (ACOs)to better manage their business, the

ing centerpiece of healthcare improvement efforts. Epic

need for rich data analytics will continue to grow rapidly.

Systems (Verona, WI) has become among the most sought

These health strategies, especially pay-for-performance ini-

after EHR vendors on todays healthcare market due to

tiatives, will be tied to reimbursements and will require hospi-

robust integration, proven track record, and ability to meet

tals to provide metrics validating improved patient outcomes.

regulatory requirements.
Initially, healthcare organizations turned to their EHR and revHowever, provider organizations realize that EHRs, on their

enue cycle vendors to manage many of these reporting func-

own, will not be enough to meet later-stage Meaningful Use

tions. Many reports were MU-motivated and EHRs had to be

(MU) requirements, nor can todays EHRs easily support

certified in calculating core quality measures and submitting

the plethora of regulatory reporting, data analytics uses, and

that data to CMS. Several EHR vendors began to offer bolt-

quality improvement initiatives which are becoming a critical

on features or new modules for more robust reporting and

component of healthcares long-term strategy.

analytics functions, Epic included. But the future trajectory of

healthcare has highlighted the limitations of an EHR-centric

Given these current and future needs, healthcare organiza-

analytics approach.

tions have turned to enterprise data warehousing (EDW)

and business intelligence (BI) technologies. Microsoft has

Epic has one of the most popular EHR offerings for hospitals

become a leading provider of such data analytics solutions

due to its integrated nature, proven functionality, and ex-

due to low cost of ownership, proven scalability, and tightly

panding set of modules for multiple departments. However,

integrated analytic tools, from the database to the desktop.

healthcare is increasingly focused on activities that occur

Also, Microsoft is a major presence across all industries, has

outside the four walls of a single hospital facility. The advent

a robust product portfolio, and extensive enterprise experi-

of collaborative forms of care has forced organizations into

ence in data management.

multi-facility, multi-EHR entities. This change means that no

single EHR can function as other than a single source system

This white paper explores reasons why a growing group of

within a larger data management strategy, making the enter-

hospitals with Epics EHR and revenue cycle solutions have

prise BI structure, spread across multiple organizations, the

chosen Microsoft for enterprise BI.

de facto central repository for information.

2

WHITE PAPER: Enterprise Business Intelligence in Healthcare

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This requires the integration of data from across the entire

What about non-Epic data? While Epic has created a data

enterprise and from outside organizations. Non-Epic data

warehouse, within the Clarity structure patterned after

must be reconciled to data housed within the Epic data

the Epic data model, to pull in data from non-Epic sources

model, including data from other clinical silos and opera-

for analytics, Epic has also recognized that hospital

tional systems from both inpatient and outpatient venues.

customers would want to use other industry-standard

Dale Sanders, SVP at Health Catalyst, a Microsoft partner,

data structures. For this reason Epic has started support-

agrees, We are a knowledge-delivery industry. Data is

ing Microsoft and SQL for enterprise BI. This includes the

the single most valuable resource in healthcare. It outlives

agreement to standardize Cogito on SQL for EDW. Teams

people, facilities, and vendors now.

from Epic and Microsoft have worked together on several

occasions to ensure a successful adoption of Microsoft
EDW/BI tools within Epic environments.

Extending the Epic Environment

Beyond MU Stage 1
The centerpiece of MU Stage 1 was the implementation of a certified EHR and incentivizing certain basic
uses of the EHR, such as Computerized Physician Order
Entry (CPOE). The later stages of MU are more strongly
Epic, of course, is aware of these requirements and

focused on processes and data usage rather than any

has taken steps to accommodate hospital customers

particular system or tool. Based on the impending MU

who want to move forward with robust EDW and BI

hospital needs, the EHR, on its own, falls short in enabling

strategies. Epic introduced the Clarity reporting plat-

hospitals to reach later stages of MU.

form several years ago, and more recently, the Cogito

Given the huge sums of money required to purchase, in-

analytics solution that allows users to analyze data in

stall, and adopt a new enterprise EHR, hospitals become

the Epic platform.

Figure 1

Source: Microsoft

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absolutely dependent on MU incentives to recoup at

efficiency gains, cost reductions, increased ROI, etc.

least a portion of that cost. However, only a relatively

Meeting this challenge will require a new kind of data

minor portion of the costs associated with the EHR pur-

strategy.

chase is typically recovered in MU Stage 1.

This CIOs story is not uncommon. Rather, it is the norm.
Figure 2 shows a typical Epic EHR implementation experience. The need for a robust data analytics strategy
more fully emerges in the minds of hospital leadership
during Stage 3 as shown in the graphic.

Leveraging Known Tools and

Skillsets
The CIO of a large health system revealed confidentially
that from an EHR purchase and implementation costing

Youll hear over and over again that Excel is the most

nearly $150 million, incentive reimbursements from MU

popular BI tool in the world, states Martin Sizemore,

Stage 1 have helped the health system recover less than

Director of Healthcare Strategy at Perficient, a Microsoft

$70 million. This CIO has been tasked with covering

partner. That refrain is heard repeatedly from profession-

the rest of the cost of the EHR from other areas i.e.,

als across healthcare, and given the statistics regarding

Figure 2

Source: Hitachi Consulting

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the use of Microsoft products in the workplace, it is

This closely mirrors the decision-making strategy of Meriter

certainly not an overstatement.

Health System in Wisconsin. Heidi Rozmiarek, Business Applications Manager at Meriter, relates, Since we own a lot of
For example, the Micro-

Microsoft products, we wanted to leverage what we already

soft Office suite has held

owned like Office, SharePoint, and SQL. Though Meriter uti-

the dominant position in

lizes Epic EHR, they chose to look elsewhere for BI. Alongside

office automation prod-

Microsoft, SAP Business Objects was also considered, but

ucts for years, with a

Meriter found that Microsofts costs were significantly lower.

market share estimated

at over 90%.2 Microsoft

Figure 3 gives an overview of Microsofts BI stack for health-

has also invested heavily

care. As can be seen, the Microsoft BI stack leverages many

in higher-end enterprise

tools already in use at hospitals across the country.

products and services,

as evidenced by the re-

It is important to recognize that Microsoft BI works on a het-

cent announcement that

erogeneous stack as it is not just about SQL Server or Oracle

Windows Azure, Microsofts cloud computing platform,

data sources, but also about integrating with a wide array of

has been adopted by 50% of the Fortune 500.3

data sources including structured, unstructured, internal and

external sources. The BI stack includes a set of Enterprise In-

The majority of hospitals have significant investments in

formation Management (EIM) and BI platform services, like

Microsoft products and infrastructure. We were already

analysis services and reporting services. It should be noted

a heavy Microsoft shop, says John Henderson, Director

that SQL Server is considered the most widely deployed

of Enterprise Systems at Texas Childrens Hospital. Texas

platform (40% unit share) for these platform services.

Childrens is an Epic shop for both EHR and revenue cycle,

and utilizes Oracle (PeopleSoft) for ERP. John goes on
to say, Eighty-five percent of our database was in SQL.

Figure 3

Texas Childrens chose

Microsofts BI solutions,
customized by Health
Catalyst, over those of
Oracle, Cognos (owned by
IBM), and Epic Cogito for
three principle reasons:
1. Maximize their
existing Microsoft
investment, including SQL, Office, and
SharePoint.
2. Take advantage of
data that already exists and propagates
through their various
Microsoft servers
and solutions.
3. Rapid time to initial
value - fast ROI.
5

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Source: Microsoft

Peer60 2013

The top row shows tools and devices that the end users

more staff, some hospital services regularly operated

utilize, whether Excel, SharePoint, or mobile technologies.

at, and sometimes beyond, capacity, going on census

These capabilities are delivered through the productivity and

alert repeatedly. Those census alerts, over the course

collaboration tools that customers are most familiar with,

of a year, was comparable to the hospital not admitting

and in most cases, already have and use, such as Office and

patients for an entire month.

SharePoint.
The hospital decided that a centralized BI solution
The Microsoft BI stack empowers users with self-service

was needed to alleviate these patient flow problems.

analysis and interactive data visualizations. Users at all

The system needed to be accessible to end users and

levels can access and aggregate data from virtually any

administrators across the hospital in order for the cor-

source. Users can create their own reports and analyti-

rect, actionable data to be entered as well as used by

cal applications, share insights, and collaborate with

the entire enterprise. In the case of Texas Childrens,

colleagues. This is accomplished through interactive,

that meant a BI system to be used by 13,000 employ-

browser-based exploration, visualization, and presenta-

ees and associates.

tion capabilities.
Within a year of implementing and using the Microsoft BI

BI Use Cases Leveraging the

Microsoft Stack

solution, the hospital started seeing significant benefits

patient flow improved, wait times reduced, and care
delivered in a more timely fashion. In all the hospital

A growing number of hospitals have turned to Microsoft

has eliminated census alerts by eliminating bottlenecks,

solutions in order to create a robust data management

anywhere from 19 to 51 percent, depending on the key

framework, including Allina Healthcare in Minneapo-

measure of patient flow, including wait times.4

lis, Partners Healthcare in Boston, Indiana University

Health, Northwestern University Medical, Providence

Patient Engagement Utilizing Multi-lingual Commu-

Health System in Portland, and Standford Hospital. Not

nications: An East Coast university hospital system

only are these hospitals able to leverage tools and pro-

searched for a tool set that would enable better

cesses that are largely familiar, but they are also able to

communication with international patients across a

acquire the expertise they need by tapping Microsofts

multi-campus setting. The solution came in the form of

large partner network.

a unified communications tool set, including slates for

translational services.

In interviews with both hospital customers and

partners, success stories were shared that highlight

After implementing Microsoft Lync as the language ser-

the types of achievements hospitals hope to gain by

vices solution and deploying WIN 7 Slates, patient com-

implementing an EDW/BI solution. The following are

munication productivity has increased by 300% along

but a few examples:

with a hard cost savings of more than $600K per year.

Patient Flow Efficiency Gains: Texas Childrens Hospital,

Cost Reductions via Service Line Management: Meriter

in Houston, Texas, strived

Health Services, in Wisconsin, has pushed the technol-

to keep up with the

ogy envelope for years

growth of its commu-

and has earned a reputa-

nity, which had grown

tion for quality, as evi-

by more than twenty

denced by being named

percent over the past ten

a Top 100 hospital by

years. Even with building

Thomson Reuters and a

new facilities and hiring

most wired hospital.

6

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In conjunction with opening a new datacenter,

country is utilizing Predix-

Meriter embarked on several quality improvement

ions predictive analytics

initiatives. Among these initiatives was a desire to

solution, which leverages

extend the benefits of their Epic EHR by making it

the Microsoft BI stack, to

easier for physicians and other clinicians to access

manage readmissions. The

information. In order to make this happen, Mer-

health system stands to be

iter decided on an integrated BI solution based on

fined huge sums of money

Microsoft because it was the most seamless method

if readmissions are not

for providing a self-serve BI environment for physi-

properly managed.

cians and other clinicians.

Population Health Management: ProHealth Care, in
After implementing the BI solution, Meriter has already

Wisconsin, has intensely investigated the available popu-

seen considerable savings. One area in particular,

lation health management solutions. The move towards

orthopedic surgery, saw rapid benefits. Upon gaining

ACO participation has created an urgent need for proper

access to accurate benchmark data, surgeons were able

data analytics to sift through the mountains of clini-

to optimize their decision making for implant devices,

cal and operational data in order to optimize the health

which resulted in nearly $1 million in cost savings to the

systems practices with the end goal of delivering the best

orthopedic practice in only eight months.

possible care for each individual patient.

Liability Prevention and Reduction: In 2012, a provi-

After much investigation ProHealth decided to base their

sion of the Affordable Care Act (ACA) went into effect

EDW/BI strategy on the Microsoft stack, much of which

that penalizes hospitals according to the number of

they already owned and operated in-house. By leveraging

patients, above the national average, who are admitted

Microsoft, ProHealth is also leveraging tools and pro-

to an acute-care hospital for heart failure, heat attack, or

cesses known to staff and clinicians across the enterprise,

pneumonia, and then readmitted within 30 days.

turning the BI solution into an end-user, self-reporting

mechanism for the entire organization.

The maximum penalty is 1% of a hospitals base Medicare payment, and that maximum penalty is scheduled

Christine Bessler, CIO at ProHealth Care, believes that

to rise to 3% by 2015. This provision has caused read-

there is a lot of noise around population health manage-

missions management to become one of the hottest

ment. She says, We went down a lot of rabbit holes

areas of healthcare data analytics.

investigating many of the one-off solutions. Heres the

lesson we learned: With the right focus and a skilled

In order to tackle this issue, Carolinas Healthcare Sys-

staff, you can do wonderful things with the Epic EHR and

tem, a network based out of Charlotte, North Carolina,

the Microsoft BI stack. We will deliver a true population

decided to implement a Microsoft-based predictive

health solution more quickly, and more frugally, than if we

solution from Predixion Software.6 Predixions predic-

had implemented some other best-of-breed product.

tive analytics system, which is built on the Microsoft BI

Conclusion

stack, allows Carolinas to evaluate enormous amounts

of data in order to identify those patients most likely to
be readmitted after discharge.

The purpose of this white paper is to present reasons why

healthcare organizations utilizing Epics EHR are turning to

Readmission Analytics and Management: Given that

Microsoft for their enterprise BI and data analytics needs.

lowering and managing unnecessary readmissions is

one of the most urgent issues facing U.S. hospitals

EHRs were never meant for in-depth reporting and data

today, one of the largest academic health systems in the

analytics. While MU Stage 1 centered on the implementa7

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About Peer60

tion of certified EHR technology, later stages of MU are

much more about the use of data and improving out-

Peer60 helps B2B companies gather better, faster and

comes. In this respect, an EHR-only strategy falls short.

more frequent market intelligence. Its cloud-based solu-

An increasing number of hospitals utilizing Epic EHRs are

tion, Reaction, has enabled some of the worlds most rec-

turning to Microsofts EDW/BI stack in order to move on

ognizable brands to reach executive decision-makers and

to challenges beyond MU Stage 1.

influencers to discover more market insights faster than

any other solution. To learn more, visit www.Peer60.com.

Given that hospitals typically have a lot of Microsoft

infrastructure and products already in use, Microsoft be-

Even though Peer60 is a software solution company, from

comes a natural consideration for a BI strategy. Hospitals

time to time we encounter something interesting in the

that choose Microsofts BI strategy find that the cost for

industry and choose to share it with friends and col-

implementing the solution is much lower than competi-

leagues by writing about it.

tive strategies because most of the tools are already in

place. Microsoft-based solutions, for enterprise health-

Peer60

care products, tend to be lower cost than competitive so-

50 Red Pine Dr.

lutions.7 Also, given that the tools are familiar to staff and

Alpine, UT 84004

clinicians, the entire organization can participate in the BI

+1-801-692-1537

strategy in a self-serve fashion, and do so more quickly

www.peer60.com

than if a brand new, unknown solution was installed.

At the end of the day, the real benefits are the successes
which customers are experiencing. A large number of use
cases have emerged from better efficiency and higher
revenues to reduced costs and improved patient care,
Microsofts BI stack is proving to be an intelligent solution
for the future of healthcare.

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Sources
1.

http://www.informationweek.com/healthcare/electronic-medical-records/healthcare-it-spending-to-reach-40-billi/229500682

2.

http://www.dailytech.com/Office+2010+to+Launch+Today+Microsoft+Owns+94+Percent+of+the+Market/article18360.htm

3.

http://blogs.msdn.com/b/windowsazure/archive/2013/06/14/50-percent-of-fortune-500s-using-windows-azure.aspx

4.

http://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000011356

5.

http://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=710000001182

6.

http://online.wsj.com/article/SB10001424127887323838204578654152046151798.html?KEYWORDS=hospital

7.

http://peer60.com/2012/08/06/the-total-cost-of-ownership-of-electronic-health-record-systems/

WHITE PAPER: Enterprise Business Intelligence in Healthcare

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