Using Metrics and Dashboards to Forecast Business
Dashboard design is not a one-size-fits-all proposition, but a strategic tool to assemble and display data relevant to an organization’s key performance indicators
Data analysis and reporting are becoming critical components of monitoring operations and supporting the growth of businesses. Radiology practices and imaging sites are faced with increased competition and reduced reimbursement rates; these have precipitated the development of monitoring tools for administrative staff, who are, in turn, pressured to increase market share and improve efficiency.
Technological advances in PACS, RIS, practice management systems, and customer relationship management systems provide an abundance of data to analyze. Today’s rich IT provides computing environments with low-cost computing power and disk space, and as a result, access to information is not the issue. The daunting task is to get your arms around the data and determine how to communicate the salient pieces of information that can help steer your business on a profitable growth path.
Business administrators are faced with the task of assimilating data from multiple disparate data systems, and they often lack tools to consolidate data. Dashboard technology can address these issues and facilitate informed decisions. Tools for implementing dashboards are provided by a variety of technology vendors and can vary in cost.
Understanding Dashboards
Dashboards assemble key performance indicators and display them to the user in a clear, concise format. Key performance indicators are used to define and measure progress towards organizational goals. The performance measures are conveyed in a logical, direct manner, with just enough content to be meaningful. Focus is placed on what is currently happening, rather than on what has happened in the past.
Effective dashboards use a variety of methods to display information, including graphs, gauges, and tabular charts. The context of a dashboard should not be oversaturated with color or cluttered with extraneous visual aids (such as grid lines on graphs, legends, and so forth). Dashboards should be aesthetically pleasing, making it easy for the user to read them, as well as capturing attention when appropriate.
Dashboards provide a common ground for management to use in monitoring the enterprise. They tell a story that keeps the management team on task and up to date on how the enterprise is doing as a whole. Dashboards facilitate collaboration between departments, emphasizing organizational performance and how the enterprise is progressing toward goals and against benchmarks.
Defining Users
Traditional approaches to monitoring organizational performance have often been departmental, especially as they relate to revenue and costs. Building an environment focused on performance improvement, however, requires interdepartmental communication. Metrics that make it onto the dashboard should be universal enough to convey organizational goals and should be reliable in their computation (to measure performance accurately).
Dashboards facilitate communication between departments. For example, a particular imaging site might be booked several weeks in advance, causing delays in scheduling appointments. Wouldn’t the marketing manager want the representative for that territory to be aware of that, and to take proactive steps to prevent losing business from referrers? Might the management team want to monitor capacity and workload to determine when additional equipment should be purchased?
While computers can speed the process of compiling and displaying data, determining what makes it onto your dashboard is dependent on its users. The key decision makers, including department heads, need to drive which key performance indicators are on the dashboard.
Determining KPIs
What becomes a key performance indicator depends on the organization’s goals. For example, key performance indicators for a radiology practice might include those shown in Figure 1. Key performance indicators communicate to the organization opportunities for improvement, as well as areas of success. They share good news and point out deficiencies. Through continuous, organization-wide monitoring, key performance indicators provide an avenue for maintaining accountability and performance standards 
Data Into Dashboards
The dashboard provides views into the data from the end-user perspective. How those data are extracted from the source system, scrubbed, and ultimately published on the dashboard is no simple task, however. In many organizations, IT staff members have access to the source data systems and can extract data. Business and operations staff, while often familiar with technology and the underlying databases, are more knowledgeable about the business.
These two resources must work together to assimilate the data and process the information that will ultimately be passed through to the dashboard. There should be a business owner who oversees the decisions regarding how each measure is calculated and how the data are reported. These business rules must be applied throughout the reporting environment to ensure consistency. How often have you requested the same information from multiple people, only to receive different answers?
Consider the example of one indicator: examination count. Does every HCPCS/CPT® code add incrementally to the examination counter? What about add-on codes for computer-aided diagnosis or contrast injection? When an examination generates a split bill, how do you prevent double counting? How would you ensure that services that are posted, corrected, and then reposted under a new charge ticket are only reported as one examination?
Another decision to make is which source system will supply data for the key performance indicator. Continuing with the examination-count example, should these data come from the billing system, scheduling system, or PACS? Again, you need to understand how your operational systems create and store data and to be consistent in the definitions chosen.
When creating a key performance indicator that will be compared with an external benchmark, develop the measure with guidance from the professional organization you will be using for comparison. Often, these benchmarking resources will provide detailed specifications that outline how each measure is calculated. Not only will this save you time in developing the logic within your systems, but it will give an accurate representation of how your organization compares with the benchmarks.
Choosing Dashboard Content
Typically, a dashboard should fill a single screen and should not require the user to scroll. Users must be able to identify areas that need their attention quickly. Just as a vehicle’s indicators warn the driver to add fuel, your dashboard should provide you with timely and specific alerts. The indicators must provide just enough information for the user to decide whether the issue needs immediate attention. Be conservative in deciding what triggers an alert, for users will begin to ignore alerts if they go off too often.
A dashboard should not be cluttered with unnecessary information. If using the dashboard becomes too arduous, people will stop using it. In designing a dashboard, the context in which the indicator is reported needs to be thought through carefully. Should you break down information by location, modality, payor, or marketing region? What visual representation best communicates the indicator? What time period will the data represent? How will the indicator measure comparison with benchmarks, comparison with goals, and trends or variance percentages?
Unfortunately, given the variety of chart/graph functions available, it is easy to become sidetracked. Be careful not to get caught up in the glitz factor and lose sight of the purpose: conveying pertinent data.
Determine whether the key performance indicator should be compared with goals or with benchmarks. Goals may be set based on the past performance of the organization, whereas benchmarks integrate external data from professional organizations, such as the RBMA, CMS, the Medical Group Management Association, and the AMA.
Predicting Use
It is important to consider what action a user would take upon viewing the dashboard and seeing an alert going off for a key performance indicator. For example, if there is an alert for days in accounts receivable, is a particular payor causing the problem? A payor might have implemented new claim edits or new authorization requirements, or might have recently changed claims-processing systems. Myriad reasons could cause delays in payor claim adjudication. Have there been delays in charge entry? There may be certain physicians holding charts that delay claims. Understaffing of the billing department may also lead to delays in data entry. Is the problem directly related to the volume of patients seen? At smaller imaging sites, a decrease in volume due to a broken machine or a physician on vacation may increase the days in accounts receivable due to the reduced amount of money sitting in the range of 0 to 30 days.
If a dashboard alert indicates that referrals from one of the top referral sources have dropped 25%, is there a particular modality or payor for which this source has stopped referring? A drop in a particular modality might suggest that the referrer has invested in his or her own equipment. Perhaps the decrease in referrals is limited to just one payor (which might happen because the referrer’s contract status with that payor has changed). An overall decrease might trigger the marketing manager to send a provider-relations representative to visit the referrer’s office.
A key component of the dashboard-design phase is working closely with users to gain a detailed understanding of their needs. Learn their business goals and decision requirements, and obtain a basic understanding of their workflow. Users bring insights and experience to the project. They know what needs to be measured and which data they need to make the departments they represent successful.
Conveying a Clear Message
Before you can effectively determine how to present the indicators, you must learn what the measure means. Step back and consider what you need the dashboard to tell the user. You will identify useful clues concerning how you think about the message that you want to convey. This exercise will require you to use creativity to craft messages and design a supporting graph or chart.
Are examination volumes on the rise? It is not enough to report that examination volume is up because not all examinations yield the same revenue. What is it about the examination-volume trend that should be conveyed in the dashboard? Have you discovered that while examinations volumes are on the rise, the revenue increase is slower? Consider adding a second indicator that displays the ratio of low-tech to high-tech studies (Figure 2). 
Figure 2. Facsimile of a dashboard used by a Trellis Healthcare client. An effective executive dashboard should include data reporting on the organization's key performance indicators, as well as the other mission-critical information. How is your capacity planning working? Have you noticed that the overall examination volume has increased, but the imaging site that recently opened is decreasing examination volume from other established sites (Figure 2)? If you created a graph that displayed overall year-to-date statistics compared with goals, critical information might have been lost. At a high level, the measure appears to be on target. Without a clear understanding of what the message should be, however, the graph might be telling just half of the story. Before you start crafting a graph, gain a clear understanding of the measure and how it will be used and monitored. Choosing Display Types Different styles of graphs are designed to communicate different types of messages (Figure 3). Don’t force all data into pie or bar charts. Since there are so many chart options available, be careful not to choose a graph option just because it looks good. Remove any unnecessary visual aids (including legends, titles, and grid lines) because they clutter the screen and are distracting. Your users will appreciate clean, practical graphs.
Figure 3. Common uses of various charts. Keep in mind that not all data belong in a graph. Some data are best communicated in a tabular form. Tables work best when you need to communicate exact values, have multiple units of measure, or have data points that are widely dispersed. Getting Started Start with the key decision makers because they understand the vision, strategy, and goals of the organization. Identify what needs to be measured to support operational performance improvement. Involve key staff members in the design because they provide valuable insight into how the information will be used. Effective dashboards gather disparate data, distill the information into measures to monitor, and communicate key information in a clear, effective, and timely manner. A logical and clean design will communicate information to users and make it easy for them to use. By providing an avenue for sharing a common vision and communicating performance information, dashboards are an efficient and effective tool for the proactive monitoring of business performance and the improvement of operational efficiency.
Data Into Dashboards
The dashboard provides views into the data from the end-user perspective. How those data are extracted from the source system, scrubbed, and ultimately published on the dashboard is no simple task, however. In many organizations, IT staff members have access to the source data systems and can extract data. Business and operations staff, while often familiar with technology and the underlying databases, are more knowledgeable about the business.
These two resources must work together to assimilate the data and process the information that will ultimately be passed through to the dashboard. There should be a business owner who oversees the decisions regarding how each measure is calculated and how the data are reported. These business rules must be applied throughout the reporting environment to ensure consistency. How often have you requested the same information from multiple people, only to receive different answers?
Consider the example of one indicator: examination count. Does every HCPCS/CPT® code add incrementally to the examination counter? What about add-on codes for computer-aided diagnosis or contrast injection? When an examination generates a split bill, how do you prevent double counting? How would you ensure that services that are posted, corrected, and then reposted under a new charge ticket are only reported as one examination?
Another decision to make is which source system will supply data for the key performance indicator. Continuing with the examination-count example, should these data come from the billing system, scheduling system, or PACS? Again, you need to understand how your operational systems create and store data and to be consistent in the definitions chosen.
When creating a key performance indicator that will be compared with an external benchmark, develop the measure with guidance from the professional organization you will be using for comparison. Often, these benchmarking resources will provide detailed specifications that outline how each measure is calculated. Not only will this save you time in developing the logic within your systems, but it will give an accurate representation of how your organization compares with the benchmarks.
Choosing Dashboard Content
Typically, a dashboard should fill a single screen and should not require the user to scroll. Users must be able to identify areas that need their attention quickly. Just as a vehicle’s indicators warn the driver to add fuel, your dashboard should provide you with timely and specific alerts. The indicators must provide just enough information for the user to decide whether the issue needs immediate attention. Be conservative in deciding what triggers an alert, for users will begin to ignore alerts if they go off too often.
A dashboard should not be cluttered with unnecessary information. If using the dashboard becomes too arduous, people will stop using it. In designing a dashboard, the context in which the indicator is reported needs to be thought through carefully. Should you break down information by location, modality, payor, or marketing region? What visual representation best communicates the indicator? What time period will the data represent? How will the indicator measure comparison with benchmarks, comparison with goals, and trends or variance percentages?
Unfortunately, given the variety of chart/graph functions available, it is easy to become sidetracked. Be careful not to get caught up in the glitz factor and lose sight of the purpose: conveying pertinent data.
Determine whether the key performance indicator should be compared with goals or with benchmarks. Goals may be set based on the past performance of the organization, whereas benchmarks integrate external data from professional organizations, such as the RBMA, CMS, the Medical Group Management Association, and the AMA.
Predicting Use
It is important to consider what action a user would take upon viewing the dashboard and seeing an alert going off for a key performance indicator. For example, if there is an alert for days in accounts receivable, is a particular payor causing the problem? A payor might have implemented new claim edits or new authorization requirements, or might have recently changed claims-processing systems. Myriad reasons could cause delays in payor claim adjudication. Have there been delays in charge entry? There may be certain physicians holding charts that delay claims. Understaffing of the billing department may also lead to delays in data entry. Is the problem directly related to the volume of patients seen? At smaller imaging sites, a decrease in volume due to a broken machine or a physician on vacation may increase the days in accounts receivable due to the reduced amount of money sitting in the range of 0 to 30 days.
If a dashboard alert indicates that referrals from one of the top referral sources have dropped 25%, is there a particular modality or payor for which this source has stopped referring? A drop in a particular modality might suggest that the referrer has invested in his or her own equipment. Perhaps the decrease in referrals is limited to just one payor (which might happen because the referrer’s contract status with that payor has changed). An overall decrease might trigger the marketing manager to send a provider-relations representative to visit the referrer’s office.
A key component of the dashboard-design phase is working closely with users to gain a detailed understanding of their needs. Learn their business goals and decision requirements, and obtain a basic understanding of their workflow. Users bring insights and experience to the project. They know what needs to be measured and which data they need to make the departments they represent successful.
Conveying a Clear Message
Before you can effectively determine how to present the indicators, you must learn what the measure means. Step back and consider what you need the dashboard to tell the user. You will identify useful clues concerning how you think about the message that you want to convey. This exercise will require you to use creativity to craft messages and design a supporting graph or chart.
Are examination volumes on the rise? It is not enough to report that examination volume is up because not all examinations yield the same revenue. What is it about the examination-volume trend that should be conveyed in the dashboard? Have you discovered that while examinations volumes are on the rise, the revenue increase is slower? Consider adding a second indicator that displays the ratio of low-tech to high-tech studies (Figure 2). Figure 2. Facsimile of a dashboard used by a Trellis Healthcare client. An effective executive dashboard should include data reporting on the organization's key performance indicators, as well as the other mission-critical information. How is your capacity planning working? Have you noticed that the overall examination volume has increased, but the imaging site that recently opened is decreasing examination volume from other established sites (Figure 2)? If you created a graph that displayed overall year-to-date statistics compared with goals, critical information might have been lost. At a high level, the measure appears to be on target. Without a clear understanding of what the message should be, however, the graph might be telling just half of the story. Before you start crafting a graph, gain a clear understanding of the measure and how it will be used and monitored. Choosing Display Types Different styles of graphs are designed to communicate different types of messages (Figure 3). Don’t force all data into pie or bar charts. Since there are so many chart options available, be careful not to choose a graph option just because it looks good. Remove any unnecessary visual aids (including legends, titles, and grid lines) because they clutter the screen and are distracting. Your users will appreciate clean, practical graphs.
Figure 3. Common uses of various charts. Keep in mind that not all data belong in a graph. Some data are best communicated in a tabular form. Tables work best when you need to communicate exact values, have multiple units of measure, or have data points that are widely dispersed. Getting Started Start with the key decision makers because they understand the vision, strategy, and goals of the organization. Identify what needs to be measured to support operational performance improvement. Involve key staff members in the design because they provide valuable insight into how the information will be used. Effective dashboards gather disparate data, distill the information into measures to monitor, and communicate key information in a clear, effective, and timely manner. A logical and clean design will communicate information to users and make it easy for them to use. By providing an avenue for sharing a common vision and communicating performance information, dashboards are an efficient and effective tool for the proactive monitoring of business performance and the improvement of operational efficiency.