Competing with Analytics: Test the Waters Before You Dive In

Business intelligence and analytics are the new hot topics in healthcare. Significant investments are being made in enterprise performance measurement tools and clinical intelligence, with historic, predictive and prescriptive capabilities being developed for population health management, financial decision support, supply chain analytics and more. To further complicate the matter, there are literally hundreds of vendors in the healthcare space offering tools and technologies. Most organizations have point or departmental systems, and many are thinking about enterprise data warehouses. More advanced organizations are employing data lakes or other leading edge warehousing strategies using sophisticated capabilities such as Hadoop. Often multiple false starts, conflicting vendor approaches and siloed based thinking can lead to organizational frustration.

It helps to “test the waters” before diving in. Key steps to success include:JPGshutterstock_161880092

  • Understand the problems you are trying to solve: Many organizations acquire solutions before they have identified what the organizational “points of pain” are that the solution is intended to impact, and end up with multiple tools or platforms.
  • Evaluate your existing investments in analytics tools, systems and methodologies: There may be opportunities to “rationalize” your BI and Analytics investment, and understand existing vendor road maps and development directions.
  • Ensure data integrity: Source systems (such as your EMR) have varying quality of data – oftentimes data are missing or stored in different places depending on who is documenting patient care. In addition, definitions of data may vary from system to system or even from stakeholder to stakeholder – having a common “Data Dictionary” becomes essential.
  • Before selecting a system, launch a “proof of concept” project so the organization can learn and experiment: Identify a project with limited scope that addresses one of the organization’s key needs (e.g. Sepsis, or ED throughput). Decision making with analytics is different and testing the water through a proof of concept will demonstrate lessons learned and new approaches.
  • Break future BI projects into smaller waves versus a big bang deployment: By treating BI projects as continuous improvement as opposed to a traditional IT project, you can measure value along the way and all can see the impact of both the toolset and the process.
  • Communicate benefits to the organization, including executives: By showing how BI and Analytics initiatives impact strategic goals as well as daily operations, the organization can begin to treat BI and analytics holistically and integrate data-driven decision making at all levels of the enterprise.

Business Intelligence and Analytics are here to stay – the organizations who leverage the strategic value of data to make informed decisions will be the ones who not only survive, but thrive.

What Got Us Here, Won’t Get Us There: Strategic Planning for the Transition

Information and technology is becoming pervasive in all aspects of clinical care delivery and financial management of the health care enterprise.  Healthcare business, clinical and information technology leaders agree that IT is critical to population health management and value based reimbursement.  Yet, for many, day to day problems often keep IT leadership in a fire-fighting mode.  Many CIOs and healthcare business and clinical leaders find it difficult to find time to focus on the future.

Traditional healthcare information technology strategic plans were primarily consisted of a list of vendor applications and infrastructure to be deployed.  The bottom line for most healthcare organizations is that tactical IT road maps will not position the organization for tomorrow.  Segmentation of the IT strategic plan and portfolio into four primary programs can be useful in transitioning IT from a “keep the lights” on functional role to a strategic partner for the transition from volume to value.  Each quadrant has a unique role in maximizing the value IT contributes to the organization.

4 Strategic Plans

See below our thinking on each quadrant and key take-always for senior leadership

1 – Rethinking IT Organization Design & Operating Model:  Traditional IT organization structures, processes and operating models should be reconfigured to consider the healthcare enterprise of tomorrow.  Many IT organizations were founded within hospitals and those models no longer work given the level of consolidation, the requirements to support clinical integration networks, and the expectations of affiliates and partners.  New customer support functions, shared services centers and economies of scale are needed for today’s contemporary information technology services.  Collaboration with informatics, analytics, quality and security professionals is challenging traditional IT cultures and operating practices.

Key Take-Aways:  Have you redesigned the IT, Informatics, Analytics and Quality leadership and organization structure?  Do you have a plan for building new competencies?  What is the 2.0+ operating model?

2 –  Support Performance Improvement in Acute, Ambulatory & Post-Acute Care:  As pressure on healthcare costs increases and margins become more dependent of value, not volume, clinical and operations leaders will increase their collective focus on the Triple Aim, or care, health and cost.  Health systems will critically examine the clinical process, patient experience, outcomes and efficiency of care each with financial implications.  A myriad of reimbursement programs and contracts from payers will create new incentive and penalty structure for hospitals, physicians and post-acute providers.   From shared savings contracts, to bundled payments to direct to employer, each year additional measures and programs will be added.   HFMA’s Executive Survey: Value-Based Payment Readiness indicates that 30-70 percent of their payments from payers will include value-based mechanisms by 2018.  Health systems need to improve their capabilities in business intelligence, real-time data access, and effective chronic care management

Key Take-Aways:  Have you transitioned from departmental or point enterprise performance improvement systems?  Do you have a plan for creating an analytics center of excellence?  What distinct business intelligence strategies are in place for enterprise performance improvement and population health management?

3 – Enable Health System Growth:  Consolidation, New Markets & Partnerships

Horizontal and vertical consolidation, new geographies, service lines and points along the continuum, and partnerships with other health systems, payers and new market entrants such as retail health are blurring the lines of what it means to be a health system.  Each market is different and each enterprise is different.  One size fits all strategies, or rip and replace with one core vendor are no longer viable strategies.  HFMA’s Value-Based Payment Readiness Survey ranks interoperability readiness as the weakest competency for most respondents.  Yet, it also indicates that 70 percent of financial executives anticipate their organizations will need to be extremely capable in data exchange to support value based reimbursement requirements and new market strategies in the next few years.

Key Take-Aways:  Have you developed an interoperability strategy based on the unique makeup of your enterprise, affiliates and partner readiness? Do you have a plan for identify management, access and referral management, and care coordination?  What is IT’s role in extending the enterprise and connecting the community?

4 – Drive Innovation & Transformation

Cloud computing, mHealth, patient activation and consumer engagement all come to mind when Digital Health Strategy is mentioned.  Billions of dollars have been invested in innovative start-ups and new transformative tools.  Yet, security risks are increasing daily.  Well beyond portals, initiatives such as virtual visits, home monitoring, self-service scheduling and bill payment, open notes, wearables, social health communities, and the list goes on.  A recent Surescripts Survey finds “patients prefer digitally savvy doctors and demand a connected healthcare experience.”

Key Take-Aways:  Have you developed an integrated patient and consumer engagement strategy?  Do you have a patient advisory council?  What are the unique characteristics of key patient populations that could drive innovation?

The Pivot: From Compliance to Strategy

HIMSS16 – billed as the largest and most important healthcare IT conference in the United States occurred last week in Las Vegas.  The message was loud and clear – something is different; the government mandate is over.  Strategy is the new, new.

For years the HIT world has encouraged alignment of enterprise strategy and the IT plan.  Alignment suggests two distinctly different things creating a linkage or connection.  Healthcare enterprise strategy decisions such as which markets do we enter, who do we acquire, which service lines do we emphasize, and what capital investments do we make are explored at executive and board levels.  Operations and financial decisions to support our hospitals and physician practices are made within organizational silos.  Sometimes IT is at the table, but more often than not information systems professionals are called in after the fact to “implement” selected systems and tools.  Sophisticated IT organizations have created IT Strategic Plans, IT Governance structures, IT Road Maps, and IT Champions/Customer Relationship Managers.  Our challenge – separate, sometimes aligned but rarely one.

Uncertainty is the new normal.  Strategies that take years to implement, vendor partners who are all vying for the same space and the challenges of mergers and acquisitions are driving us from 1.0 healthcare – where business as usual no longer is sustainable.  We are at a cross roads.  Those of us in transition must “pivot” our viewpoint from 1.0 volume based thinking to 2.0 and beyond.

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We need fresh, new perspectives regarding the relationship between enterprise direction and the digital strategies required for the future.  New harmonized strategies will:

  • Vary by geographic market and depend on community progress toward clinical integration
  • Necessitate partnerships, alliances and consolidations – no one can fund the investment alone and no one vendor will have all the solutions
  • Require governance models that address horizontal, vertical and virtual decisions making and integrate change across multiple systems of care
  • Move from an applications focus which emphasizes feature, functionaliy to a platform focus, producing highly configurable systems which will drive standardization and enable business strategies simultaneously
  • Redesign our organization structures, leadership competencies and operating models in IT, Informatics, Analytics and Quality
  • Acknowledge our work to create systems of documentation was foundational but not the end goal; systems of insight and behavorial change are the next stages in the evolution
  • Result in convergence of people, process, information, change and technology to rationalize costs, manage risks, realize value and activate patients to become involved in their care

 

Beware Best Practices

Almost twenty years ago, in 1996 after publishing “America’s Health in Transition: Protecting and Improving Quality”  the Institute of Medicine launched a long term, ongoing concerted effort on assessing and improving the quality of healthcare.  “To Err is Human” further galvanized the national movement to improve the quality and safety of our healthcare practices by putting the spotlight on how tens of thousands of Americans die each year from medical errors.   The “Quality Chasm” report underscored the importance of a dramatically improved information technology infrastructure to support a 21st century health system.  Building blocks for such a system include an electronic health record system and national standards.  Progress has been made, the federal government has paid out over 30 billion dollars in Meaningful Use incentives as of March 2015 and impressive examples of quality improvements are frequently quoted in the literature.  Yet, most would agree that the results to-date have been underwhelming.

It is important to recognize that most implemented EHRs with a “check-the-box” mentality order to comply with Meaningful Use.   When Meaningful Use was initially launched, our team suggested that we were “enabling the dinosaur”.  And while not prehistoric, the design of today’s healthcare system does have ancient roots.    The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C. (Heinz E Müller-Dietz, Historia Hospitalium, 1975).  In the U.S., the number of hospitals reached 4400 in 1910, when they provided 420,000 beds (U.S. Bureau of the Census, Historical Statistics of the United States 1976).  So clinical information technology was about automating existing clinical processes in hospitals (Stead 2005) rather than transforming clinical decision-making and work processes across the care continuum” (Brown, Patrick, Pasupathy 2013). 

 Separately, quality and performance improvement departments focused on deploying best practice – a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. (Wikipedia).  While best practices have their place, it is important to recognize the risks associated with emulating others when the practice depends on an antiquated business model such as hospital care. JPGshutterstock_159756653

As health systems transition from 1.0 – Bricks and Mortar Healthcare to 3.0 – Digital, Value Driven Connected Health and Healthcare, we encourage a focus on emerging practice.  A concept born in “systems thinking”, emerging practice assumes:

  • We cannot copy other organizations, use it in our organization and expect it to work given the number of variables at play
  • Intentional design of care management and business models will result in disruption of today’s best practices
  • Collaboration and integration of clinical teams, business leaders, information technology experts and data analyst will create new value
  • Big bang, long term projects are giving way to agile, experimentation where we learn to work in new and different ways
  • Rather than using our intuition or past experience to drive improvement, data driven innovation can often have more remarkable results and new practice will emerge

So, the next time someone mentions “best practice” challenge their thinking.

 

Business Plans for Affiliated Provider Solutions & Services

Despite the healthcare consolidation trend and the health system strategy to build a “System of Care” across the healthcare continuum, affiliated providers continue to be an essential element of the care delivery process in most communities. Even with strong referral management processes and systems, physicians will still refer patients to providers outside the “owned assets” of the IDN, patients will self-refer and primary care providers and specialists will create orders to be delivered outside the integrated delivery network. While most health systems are developing strategies to actively manage referral practices, even the most horizontally integrated health systems will be on a constant search for high-quality and low-cost affiliated providers to compete effectively in a value-based environment.

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Affiliated provider programs at many health systems have struggled, even with the relaxation of the Stark Laws through the Safe Harbor provisions. Simply offering a donated EHR often fails to address the expanding scope of provider organizations (e.g., practices, skill nursing facilities, home health agencies, etc.) and often ignores the evolving demands of clinical integration and accountable care models which place greater emphasis on services and technologies that complement the EHR. Providers need effective application support services, enabling technologies such as telehealth, and a health system who is continually evaluating new innovations such as wearable technologies, mHealth, analytics, etc. that work with a myriad of EHR environments including donated EHR, web/portal/HIE, call centers, cloud based scheduling, fax and direct.

Developing a Business Plan that includes services and solutions for your affiliated providers doesn’t need to be overwhelming.

Suggested steps include:

  • Step 1 – Recognize that your provider solution and service offering may start with physician practices, but will grow to include other provider settings. This may take time. While most markets share several similarities, there are unique factors that will determine when the business conditions of your market will support expanding the business plan and associated strategies to include additional care settings
  • Step 2 – Develop a standardized services and solutions catalog that your customers need, is easily understood and can be delivered with a high degree of reliability. The services and solutions may be tiered or packaged to appeal to specific groups and level of integration, and specific variations may be designed-in to allow “localization” of based on unique requirements of specific entities, markets and specialties. Yet, the important point is that it is standardized, which by definition will produce a modest set of services and solutions. When a health system allows customizations, the services and solutions catalog expands and operating costs soar
  • Step 3 – Resign yourself to the fact that your organization can’t do it all. Sourcing selected services and solutions from the catalog to value added resellers, Internet Service Providers, hardware providers, etc. will be important. The goal is to create a variable model that reduces risk, creates economies, and ultimately provides exceptional service
  • Step 4 – Determine the business (i.e., operational, organizational, & financial) model that is right for your organization. There are a number of different models that can be used. What is right for your organization will depend on its operating strategy. Key questions include:
    o Do you provide services through existing IT departments or management services organizations?
    o How are the services provided to employed providers and owned entities?
    o Is a separate services organization necessary to provide the services? Do you run the business as a profit center or cost center?
    o Are multiple entities using the services and how do you share oversight and management?
  • Step 5 – Create the go-to-market plan. Communicating the value proposition and earning the trust of customers can be the most challenging component of any business plan. This is particularly true if previous attempt to align with affiliated providers have not been successful at your organization or neighboring health systems. Pre-emptively addressing concerns, demonstrating how services have been tailored to better meet needs, illustrating the executive support, and painting a long-term vision are all required for the program to thrive.

Maestro Strategies uses our collective experience gained assisting health systems with their provider programs as well as our work launching new companies, affiliations and agencies to help explore key strategies and associated operating implications to create a vision, build a business plan and design a road map for affiliated provider services and solutions. Please contact us a insights@maestrostrategies.com to discuss the unique needs of your provider community and how the steps above could be tailored to create a Business Plan for Affiliated Provider Services and Solutions to benefit your health system.

 

Organization Design – Emerging Models for IT, Informatics, Analytics & Quality

“IT in healthcare is no longer a hero’s game” indicates one executive. CIO in healthcare stands for “Chief Infrastructure Officer” and in the future it must stand for “Information, Integration and Innovation” says a CIO who comes from outside the healthcare industry. Our “clinical informatics leaders must think more strategically” indicates a CEO. All quotes from recent interviews of executives from 60 leading health systems conducted by Maestro Strategies CEO Pam Arlotto. CEOs, CMOs, CIOs and CMIOs all indicate new leadership and organizational models are needed as the industry transitions from volume to value. As senior leadership teams tackle consolidation, clinical integration, population health management and a variety of new strategies. Traditional silo based organization structures will not drive value in tomorrow’s health and healthcare enterprise. Emerging themes include:

  • The ability to work across entities, geographies, points in the continuum, service lines, etc
  • Clinical integration is driving new organizations structures and operating models
  • Informatics is being formalized and is pivoting from a focus on technology adoption to information, people, process and change
  • Analytics skills and competencies while not new to healthcare, must evolve to meet the demands of today’s enterprise
  • Convergence of informatics, analytics and quality is needed to manage the health of populations

See a short video (~15 minute) Research Summary of the emerging organization design trends for IT, Informatics, Analytics and Quality. A more in-depth virtual or in person briefing is available for leadership teams.

 

 

ROI and Vendor Sales Strategies

Maestro Strategies has worked with numerous vendors over the years to measure and document return on investment (ROI) to support vendor and service company sales efforts. Our approach has focused on providing an objective, independent and analytical perspective on the value of the solution from the view of the healthcare customer – health system, clinician, financial executive, etc. Typically, we validate hypotheses developed in conjunction with the company, in a number of real-world customer settings and create a model that can be used to project quantitative and qualitative benefits for prospective customers. Much of our work has been focused on expanding the conversation to examine both financial return on investment as well as strategic and process value – tangible and intangible. As one would imagine, over the years we have seen products implemented that were not used by their customers, solutions implemented on top of broken processes, systems whose users resisted mandated components of the applications, and complex modules whose capabilities were only partially configured and deployed – along with products and services that drove significant value for their customers. However, in all cases, potential benefits of the solutions and ROI were not fully realized. The reasons were many – health systems implemented without redesigning processes, executive sponsors didn’t remove barriers, projects weren’t managed well, and oh yes, sometimes the products didn’t deliver promised results.

The transition from volume to value by the healthcare industry will change the rules for both solution companies and their customers. Features, functionality and demonstrations will no longer be enough to drive sales, industry consolidation will reduce the number of customers, and ultimately solutions companies that don’t produce value over the entire life cycle of their product or service (e.g. beyond sales to include implementation and support) will be replaced by those who drive value creation, realization and results. Many solutions companies are developing ROI and value realization measurement tools and methodologies. Maestro’s experience in working tells us that often solution companies and their healthcare provider clients have different goals for the relationship, different perspectives on the value question and different language in explaining benefits.

Presentation1 Different Definitions of Value

 A Joint Value Management Plan that maps out agreed upon initiatives, value targets, milestones and accountabilities is essential to drive successful adoption, use and value creation/realization. Sometimes separate initiatives are occurring in parallel with the implementation and attribution becomes challenging.  Maestro works with both the solutions provider and their client to define common definitions of value and ROI, validate actual realization, understand key levers and accountabilities that will ensure ongoing value.

Ebola and Workflow: Blame the EHR or the Care Providers?

The Wall Street Journal, in their Weekend (Oct. 4-5) OPINION section noted, “It is less than reassuring that (Texas) Health Presbyterian (THP) claims Mr. Duncan’s travels and other early warning signs weren’t transmitted to physicians due to a ‘workflow’ glitch in its electronic medical records.” Within hours after  Modern Healthcare reported that, THP issued another statement backing off that explanation, “As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow,” the statement read. “There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.” Yet, other than care giver error – no other explanation was given. Others have piled on, the Dallas Morning News examined publicly reported readmission, ER wait times and other performance data to draw attention to a larger problem, failures in medical practice and quality of care.  While the attention is focused on THP, the healthcare industry recognizes these issues cross every site, discipline and organization.

Since the IOM’s first Crossing the Quality Chasm report in 2001, part of the promise of EHRs and other advanced clinical systems has been the reduction of medical errors and improved patient safety. The Ebola case and the associated performance data is a finite example. The promise has not been delivered – many are beginning to question if it ever will be. Rather than pointing fingers, let’s start with a general misunderstanding and a visible player in the Ebola case – Workflow.

Understanding Workflow

The concept of workflow is easily understood by healthcare professionals – the flow of work. Fundamentally, it is about the organization of work. The tasks, roles, rules and procedures which allow care providers to complete their care activities.  As early as the 1970s, when information systems began to automate work, initial focus was on automation of the paper forms and documentation and the exchange of this information with others in support of the tasks associated with our daily work. As enterprise systems, such as electronic health records, have become more sophisticated, these workflow tools have expanded to help prioritize and manage work. Multiple workflows, systems and processes all converge to drive the very fabric of day to day operations in most health systems. Yet, as the Ebola finger pointing illustrates, the health care industry and the US government have spent billions of dollars on EHRs and we still struggle with medical errors and patient safety problems.  Basic communication, a “check-off the box” culture, understanding of the value of technology and information to the individual care provider, all seem part of the problem.  Indeed, the way we work is at the heart of the challenge.

Re-Imaging Work

There is little argument that the design of the healthcare system is flawed: too specialized, too fragmented, too silo-ed…. Yet if workflow is about the organization of work, and the organizational model we have used is flawed, then it should not be a surprise when information systems built with workflows that mirror yesterday’s way of working produce the same errors and problems of the past. We all know Einstein’s definition of insanity is “doing the same thing over and over again and expecting different results.” So rather than sending out hordes of teams to “optimize the EHR” and “build workflows”, the healthcare industry needs business model designers and care model architects to re-imagine a future where the singular focus is on creating value. One where the Triple Aim keeps us aligned and where instead of the technology tail wagging the dog, we challenge our thinking about the way we work. Information and technology can then become the platform for that change.  Innovative designs may be based on:

  • Coordinating care processes across distances, times and multiple care team members
  • Stratifying patient groups and designing processes specifically for their unique needs
  • Influencing patient and provider behavior
  • Streamlining and eliminating human labor from processes
  • Monitoring care in real time and providing decision support to clinicians
  • Designing systems to avoid mistakes
  • Simplifying complex work practices; and reducing non value added work steps, waste and the number of intermediaries
  • Synchronizing and allowing care providers and patients to collaborate across multiple processes

The transformational opportunity comes not from implementing systems or improving workflow; it comes from experimentation, imaging and creating new ways of organizing work so that new, more contemporary workflows can support very different ways of working.

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White Paper — From the Playing Field to the Pressbox: The Strategic Role of the Chief Health Information Officer (CHIO)

Based on dozens of interviews with health systems across the US and additional research, this report looks at where CHIOs and their teams are headed amid tumultuous change in healthcare. Originally seen as the stewards of CPOE and Meaningful Use — and known as the Chief Medical Informatics Officer — the Chief Health Information Officer is now tasked with ambitious information technology initiatives spanning the health continuum, retail health and consumer engagement, and population health management. Historically, limited in its authority and with few resources for support, this emerging role is a key player who must collaborate with Chief Innovation Officers, Chief Transformation Officers, and CIOs to drive clinical integration, care coordination and value realization.

To download your copy of the white paper, click here:  From the Playing Field to the Press Box.

Reduce Complexity and Deliver Value: Lean Business Intelligence & Analytics

Health executives have realized for a long time that future success is tied to the quality of their information.   Finance organizations have worked with costing, budgeting and financial decision support systems for years.  Supply chain executives have created reporting tools to manage inventory, distribution and cost.  Operations leaders have reported quality, productivity and performance improvement metrics.  Yet, as we move from fee-for-service to value based care, many are challenged with the terms Business Intelligence, Analytics and Population Health Management.  With hundreds of new vendors entering the marketplace and knocking on health system doors, we have moved to a new “wild, wild west” – one that can be very confusing. Most health systems already have an extensive array of capabilities around analytics including point systems (e.g., what their surgery system can report), multiple data repositories with duplicate but often conflicting information, and capabilities provided by existing core vendors. Additionally, there are oftentimes hundreds  of data analysts across the organization that are managing and massaging scorecards, gathering and interpreting data from multiple internal and external sources, and creating literally thousands of excel and other “one-off” analyses.  This creates a complex assortment of information for decision makers, and begs the question: “What is truth and where does it lie?”.  To further complicate the situation, the mergers, acquisitions and the rapid deployment of electronic health records and other advanced clinical systems in recent years have made the identification of real “knowledge” a continuing challenge. And the sad fact is that most organizations spend the majority of their time collecting data and very little time analyzing that data. As we move from volume to value, it will be critical that organizations have a way to quickly collect the data, dedicate a more thorough effort to understanding what the data means and then acting on the data to produce results.  In other words:  Organizations must become data-driven in the decision they make at both the strategic and operational level. What most health systems don’t have is a comprehensive plan for data. They lack organizational accountability for data management or a process for ensuring data integrity, standards for collecting, aggregating, normalizing and presenting the data, and governance approaches to reducing duplication, complexity or political arguments over control.   A Business Intelligence and Analytics Strategy can help address some of these challenges, and should begin with answers to four questions:

  • What are the important enterprise business drivers and priorities that information must support?
  • How are strategic and operational decision made today and what changes must occur to move to an information driven decision making process?
  • How will you launch an early stage data governance and stewardship process?
  • What leadership input is needed to oversee and coordinate Business Intelligence? What talent is currently available within the enterprise and what is needed? Is the function centralized, decentralized or a hybrid structure?

Then, and only then, can a strategy around architecture, tools, and technology be defined. Depending on the evolution of your enterprise strategy and the level of risk managed, the requirements and investment vary. Rather than adding further complexity through new layers of tools, technologies and systems, the development of an enterprise Business Intelligence Strategy can provide a short term (12-18 month) plan to ensure that overall gaps are identified, existing systems are leveraged, skills of existing analysts are utilized, decision making structures are fine-tuned, and additional tools are selected in a rational manner.

Evolution of Business Intelligence Requirements & Investment  Evolution of BI Requirements and Investment chart 2