DOI: 10.15146/r3x09b
title: Revenue design thinking: implementing enterprise tableau reporting at UC San Diego Health

description: In February 2018, the authors agreed to participate in an Enterprise
 Tableau implementation. There were 17 (seventeen) pilot projects
 identified at UCSD Health. This data pertains to 2 (two) agile data
 analytics projects Atlas of sustainable operations indicators Contracts
 maintenance co operative strategy with other UC medical centers The
 authors committed to becoming certified users of Tableau software
 ('superusers') capable of assisting in a broader use of data
 analytics in ongoing business and clinical operations. The
 organisations represented in the community are all at different stages in
 their design maturity. Some community members are the only designer on
 their team, some are the only designer in a department, and some are
 struggling to move their organisation from design thinking to design
 doing. Our colleagues conceive Tableau dashboards that use data not
 replicated in Epic provided reporting tools. Our hypothesis is that this
 data will quantify several key performance indicators using a
 'distance to frontier' methodology. Consistent
 calculations of these metrics might improve revenue cycle operations
 across a performance spectrum. At one end of the spectrum are UCSD system
 optimisation opportunities and staff focus. In the middle of this spectrum
 are the comparative performance of UCSD contracted vendors. UCSD's
 tiered vendor agreements are designed around a 'race' dynamic
 where the first to collect revenue captures an economic
 advantage. At the other end of this spectrum is
 actual payer payment behavior. Calculations based on
 contracts, denial, ICD-10 coding schema guide the
 relationship. Across this spectrum, revenue cycle operations
 involve combinatorial complexity [1] - many different variables
 are at play  - patient, procedure, location, doctor, sequencing,
 payer, adjudicator, claim editing / acceptance rules. If UC San
 Diego, in partnership with its sister campuses, are likely to discover
 better solutions using data and data analysis techniques in projects like
 this one. This is 'discovery' and 'alpha'
 level work - the future state will involved sharing standardised
 data sets with other UC medical centers, and Tableau data analytics within
 a shared enterprise server environment. This work is currently sponsored
 in a continuous improvement organisation. Not unique to UC - but an
 exciting opportunity nonetheless is the opportunity to bring data insights
 to a workforce dedicated to overcoming social and gender barriers in data
 use. The princple of communities helps us guide leaner operations while
 affording numerous staff development opportunities. Risk literacy and
 statistical thinking is an empowering element of support models for
 operations staff. References 1 Jonathan Symonds 2015. Reverse
 engineering payer behavior to improve denied claims
 management.  Ayasdi Incorporated
 &lt;http://bit.ly/2GM5wkX&gt;. Last accessed 2018 03 20. 2 OASIS
 2017. LegalXML eContracts Version 1.0. OASIS
 &lt;http://bit.ly/2HMHLZm&gt;. Last accessed 2018 03 20.
description: Design principles In conversations, research
 and collaboration, revenue cycle management agreed to a set of principles
 that will attach to every data set issued by its service. UCSD Health is a
 laggard in the impllementation of work place collaboration tools (box,
 trello and slack) so this work is textual (csv, txt, legalxml). Our team
 has created a data catalog (gsheet), data structure definitions (txt) and
 oasis legalxml [2] versions of its payer and vendor agreements.
 Hypothetical data set (relied upon because the requested data
 production cycle is longer than the time allotted for an initial
 presentation) Comma delimited (csv) randomised data
 produced by gsheets and stored as a google fusion table. 
 Discovery data set Pipe delimited (psv)
 extracts from the Epic 2015 electronic medical records system.
 This data was defined by a data description document (txt). It
 was standardised (sdmx statistical data formats, ablebits data cleaning,
 gsheets additional iso reporting intervals. Tableau - in this discovery
 phase of the pilot - links to the data tables on a google drive. The alpha
 solution is to add the data to a sql table hosted by UCSD decision
 support. The beta solution is the implementation of a tableau server
 environment. The tableau work sheets, stories and dashboard was created
 using UC identity and branding guidelines throughout.
description: Produced and disseminated by UCSD Health administrative staff
 ('employees') under the 2015 10 23 University of California
 Presidential Open Access Policy &lt;http://bit.ly/2ptLzaU&gt;. Last accessed 2018 03 20. The authors do not own the copyrights for this work, but grant to the Regents of the University of California a nonexclusive, irrevocable, worldwide license to exercise any and all rights under copyright, in any medium, and to authorize others to do the same, for the purpose of making their articles widely and freely available in this open access repository. See policy text 3(B)(1). There is no embargo period that would delay this publication. See procedures 5(C).