iBusiness, 2013, 5, 100-103
http://dx.doi.org/10.4236/ib.2013.53B021 Published Online September 2013 (http://www.scirp.org/journal/ib)
Using Dashboard for Lean Revenue Cycle Management
Jihong Zeng1, John Zhang2
1School of Management, New York Institute of Technology, Old Westbury, NY, USA; 2New York City Health and Hospitals Cor-
poration, New York, NY, USA.
Email: jzeng@nyit.edu
Received July, 2013
Lean methodologies are increasingly deployed by healthcare providers to improve billing and collection process in
revenue cycle management. Measurement on key performance metrics generates large amount of data. Traditional
tabular and spread sheet form analytics are not efficient to support enterprise scale lean improvement sustainability. Th is
paper introduces a new breed of visual dashboard technology and its value as emerging differentiator from traditional
business intelligence, especially in the rapid deployment and usability perspective. We present an exemplary case of
using QlikView dashboard for lean revenue cycle management. Initial evaluation result is promising and indicates the
dashboard empowers end users with intuitive and interactive experience, ad-hoc questions and answers. Integrating
performance dashboard with enterprise data governance, predictive modeling will be evaluated further in future study.
Keywords: Visual Dashboard; Lean; Healthcare Information Systems; Revenue Cycle Management
1. Introduction
The US healthcare industry is in process of transforming
from the fee-for-service to pay-for-performance payment
model to provide patients with quality care at low cost.
This has dramatic financial impact on the healthcare
revenue cycle management. Healthcare provider reimburse-
ments will increasingly be tied to quality metrics and
patient outcomes under healthcare reform [1]. Lean
methodologies are increasingly deployed by providers
for billing and collection processes in revenue cycle
management [2]. While six sigma emphasizes reducing
variance in a process, lean focuses on reducing waste and
improving process flow [3]. Key to lean concept is
measurement. You can’t manage what you don’t measure.
By measuring the predefined performance indicators and
comparing to objectives, we focus on how we are doing
now, how much we have improved over time, what need
to be done next to sustain the improvement. Continuous
measurement generates a large amount of data. Traditional
data analysis and statistics in revenue cycle management
typically rely on tabular and spreadsheet form, which can
be difficult to understand and interpret. Data visionary
Hans Rosling (2007) used an analogy between data and
music notes. In his presentation, Rosling stated that “few
people will appreciate the music if I just show them the
notes. Most of us need to listen to the music to
understand how beautiful it is. But often it’s how we
present statistics: we just show the notes and don’t play
the music” [4]. Therefore, efficient data visualization tools
and techniques are in great demand to help translate
collected data into meaningful, actionable insight in real
time and in a cost-effective manner to support lean
In this paper, we describe the challenge and need for
an efficient performance dashboard for lean revenue cy-
cle improvement in a large healthcare provider organiza-
tion in Section 2. Then we introduce a new breed of vis-
ual dashboard technology and high level application ar-
chitecture in Section 3. We then discuss a use case of
interactive performance dashboard with QlikView in
Section 4. The paper concludes in Section 5 with a dis-
cussion of the next step.
2. Business Challenge and Motivation
Healthcare revenue cycle performance can be evaluated
using many common benchmarks and baseline metrics [5,
6]. Let’s take a look at a challenge at one of the largest
healthcare providers in the US. In late 2007 , th is p rovid er
initiated the use of lean, a standardized performance im-
provement methodology to reduce waste and streamline
workflow process across clinical, operational and finan-
cial dimensions. Steady progress has been made in cut-
ting costs and increasing billing revenue through lean
revenue cycle process improvement. Even with these
achievements, challenges remain to sustain the improve-
ment. In some cases, the improvements were too easily
dissolved when individual project champions would
leave; while in other cases, improvements were isolated
Copyright © 2013 SciRes. IB
Using Dashboard for Lean Revenue Cycle Management 101
and workforce were not properly engaged. The provider
needs to formulate a strategy to foster transparency and
accountability throughout the organization. It is impera-
tive to share the performance data and ensure everyone in
the organization will have the exposure and to be ac-
countable for consistent objectives. Although business
intelligence (BI) has been d eployed as a v alue-added too l
to support lean revenu e cycle management, traditional BI
commonly rely on tabular data displays, which don’t
easily reveal patterns or trends, nor effectively provide
real-time or holistic view of information from multiple
data sources. Queries and reports are pre-determined to
specific requests. Lengthy development cycle for new
report cannot meet the business demand. The front-line
staff needs to focus on business rather than data. With
shift to pay-for-performance and increasing regulatory
compliance requirements, the provider is in serious
demand for a more efficient and effective tool to help
transform collected data into actio nable insight in support
of sustainable lean improvement.
3. Visual Dashboard Architecture
Traditional BI data presentation m ethods requi re conscious
thinking. However, cognitive function of human brain is
slower and less efficient. As pointed out by data
visualization expert Stephen Few (2009) that “approxi-
mately 70% of the body’s sense receptors reside in our
eyes” [7]. For the human brain, visual perception is fast
and efficient. Data visualization takes advantage of our
most powerful sense, helps us think and communicate. A
picture is worth a thousand words. Picture of data can
help make the invisible visible.
Filling the void by traditional BI products and becom-
ing mainstream, visual dashboard tools provide highly
interactive graphic user interface, enable users to develop
and refine views and analyses of data on the fly. Ac-
cording to Sommer (2011), they have the following key
characteristics [8]:
Agile: proprietary data structure that minimizes re-
liance on predefined business intelligence metadata.
Rapid application development and deployment to meet
business nee d
Performance: in-memory database and analytics en-
gine that boosts query performance. Enable users interact
with data on the fly
Ease of Use: intuitive interface that enables users to
explore data without much training. Target business us-
ers as a self-service BI rather than information technol-
ogy (IT) profes s i onal s
QlikView is the leading visual data discovery and
dashboard software by QlikTech [9]. Based on its in-
memory data associative architecture, QlikView enables
users gain unexpected insights by understanding how
data is associated. For example, when user selects a data
point in a field, no queries are initiated. Instead, all other
fields associated instantaneously filter themselves based
on the user selection. It enables users to answer qu estions
like: What has h appened? Why did it h appen? What will
happen next? What’s the next best action?
In response to the business challenge, this provider
organization developed visual dashboards using Qlik-
View after proof-of-concept evaluation. Data from vari-
ous sources are extracted in QlikView Data (QVD) file
format by QlikView ETL application. The front-end
QlikView dashboard application aggregates data from
multiple intermediate QVD files. With the associative
data architecture, QlikView is able to achieve data com-
pression ratio 100:1 for the dataset used in this study.
Access to QlikView dashboard is controlled and man-
aged by IT security management. User authentication
and authorization are integrated with Windows active
directory service architecture. Users access the QlikView
dashboard applications through standard web browser.
Only developers use QlikView Desktop Edition for ap-
plication development and enhancement.
4. Result and Discussion
With its highly interactive, ease-of-use graphical inter-
face, visual dashboard is capable of monitoring progress
towards the perfor mance objectives. It is also an efficient
communication and information sharing tool to motivate
additional improvement. For example, one of key meas-
ures of billing efficiency is Total Days in AR (account
receivable), which is the number of days required to col-
lect the charges submitted to payers. In this study case,
the revenue management division keeps tracking Total
Days in AR, which is the sum of In-house Days, DNFB
Days, and Billed Days. Discharged Not Final Billed
(DNFB) Days is the time between patient’s discharge
and the chart coded and final screen completed. DNFB
means lost revenue to hospitals. The lean project team
applied Value Stream Mapping (VSM) methodology for
current state process flow and identified key problems
and interdependencies for DNFB lag. The improved
process flow significantly reduced delays in billing.
DNFB Days dropped progressively while cash flow
increased on fi na nci a l ba l an ce sheets.
Figure 1 illustrates a sample screen of the QlikView
visual performance dashboard for lean revenue cycle
improvement. Users of this dashboard are able to interac-
tively select hospital facility, year, month to view trend,
pattern in various chart styles, and discover key numeric
statistics. For example, the selected hospital facility
demonstrated continuously decrease in DNFB Days from
2004 to 2010. The graphical charts clearly reflect the
hospital’s effort and improvement on billing efficiency.
The dashboard also enables users to drill down to granu-
lar level detail data by clicking on the summary report.
Copyright © 2013 SciRes. IB
Using Dashboard for Lean Revenue Cycle Management
Copyright © 2013 SciRes. IB
tions spontaneously, and forge new drill paths through
data volume of millions of rows in search for insight. The
new dashboard also provides a single consolidated view
of performance across the organization. This enables
hospital administrators to monitor performance at all its
care facilities, identify problems through trend and pat-
tern, and find root-causes through drill down into granu-
lar level data, such as drill-down to facility level and in-
dividual provider or patient level, for process improve-
ment strategy and policy.
Users get the detail report in a familiar tabular style as
illustrated in Figure 2, with highlight on data within
pre-defined performance criteria for easier visual impact
in support of better d ecision making process.
Initial evaluation result indicates visual performance
dashboard empowers revenue cycle management staff
with intuitive and interactive end user experience. The
advantages over traditional BI also include rapid de-
ployment, customizable ad-hoc questions and answers.
Billing staff explores claim data patterns, answer ques-
Figure 1. QlikView dashboard to display account receivable days trend.
Figure 2. QlikView dashboard to display account receivable days drill-down detail.
Using Dashboard for Lean Revenue Cycle Management 103
5. Conclusions
This paper introduces the emerging visual dashboard tool
and presents its value for healthcare providers in trans-
forming massive data into valuable information and in-
sight for lean revenue cycle improvement. Positive feed-
back is received at a large healthcare provider organiza-
tion. Visual data discovery enables end users to navigate
and interact without limit of predefin ed da ta drill p aths or
using preconfigured reports. It helps make the invisible
visible and helps front-line staff focus on business rather
than data. It could also be used as a revenue enhancing
tool through improved billing efficiency. Deploying vis-
ual performance dashboard to enterprise scale fosters a
culture and environment of transparency and account-
ability. It enables the lean initiativ e to continue providing
strong and successful process to reduce waste and
achieve clinical, operational and financial efficiencies
that are measurable and sustainable.
We understand the limitation of this paper. It is im-
portant to keep visual performance dashboard simple so
that they are easy to understand and do not become a new
burden to update. While the initial results from our study
are promising, there are many potential enhancements in
the future. This includes integrating visual dashboard
tool with enterprise data governance, interfacing with
advanced statistic package, and adding predictive mod-
eling. Additional thorough user evaluation with subject
matter experts is also needed and will be conducted in
the future step.
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Copyright © 2013 SciRes. IB