Inside INSIGHTS

No More Spreadsheet Nightmares

June 2011

 

Healthcare organizations are rapidly discovering that, in addition to adopting best practices for budgeting, forecasting, and reporting, they also have to make changes to the information technologies used to support their business process. To fulfill their mission, hospitals must learn to organize, manage, and access information more proficiently and overcome a variety of information technology challenges:

 

• Maximize return on investment (ROI)
• Manage IT resources efficiently
• Assure rapid deployment of technologies
• Enhance data and operational security
• Guaranty flexibility and maintainability
• Ensure scalability
• Constantly gain needed functionality

 

A central IT issue for healthcare organizations is successfully managing financial decision support data. Currently, hospitals reply on one of two different and widely used data management systems to handle this critical task: spreadsheets or database management.

 

Spreadsheet Management System

In many hospitals, spreadsheets and similar file management systems and applications are still the predominant financial planning and budgeting tool. However, a recent CFO Magazine research study found that 60 percent of finance executives surveyed believed the process takes too long to complete. Likewise, the majority of respondents agreed it also is riddled with errors.

 

Though effective as personal productivity tools, spreadsheets—including MS Excel—have basic limitations. They are not collaborative planning applications, nor are they designed to handle large volumes of data. Planning for and managing a healthcare facility demands the secure, accurate consolidation of large amounts of disparate data, while supporting collaboration across a geographically dispersed enterprise. This is where spreadsheets such as Excel fall short.

 

The majority of database solutions in any healthcare enterprise are relatively simple. As systems handle larger problems, however, the number of applications the healthcare organization has or can afford decreases. At the low end, flexible and rapid application development solutions like Excel are commonly used. Life cycles are short, bureaucracy and structure are limited, and mistakes are not life threatening to the organization. Cost per solution is relatively low.

 

But, as solutions become more sophisticated and critical and the number of users increases, security and reliability become more important and solutions need to scale. Maintainability is more important, because systems are built by many people and continue beyond their participation. More time is spent designing systems, because more people and issues are touched and the organization's survival depends on them. When changes are made, the complexity and critical nature of the system requires longer implementation, testing, and documentation. All this increases costs and mistakes become more expensive.

 

From a logistics and performance standpoint, spreadsheets, like Excel, are fundamentally unsuited for a complex, dynamic, shared process such as financial decision support and planning at a hospital. A quick survey reveals a serious list of limitations:

 

• Does not support multi-user environments well—it is nearly impossible to manage and incorporate the input of more than a handful of users.
• Accuracy is always in question. Most data is editable, (despite password protection) and links are easily broken. Formulas can be changed, both intentionally and inadvertently, and version control is nearly impossible.
• Provides little or no security, has no built-in audit trail, and can compromise access to and the security of sensitive financial data.
• Report development is quick and nimble, but poorly suited for large scale distribution.
• Cannot easily manage or consolidate large volumes of data.
• Not suited for use across a geographically dispersed enterprise.
• Not designed to retain and display extensive data on one screen and cannot support dashboards.
• Has great difficulty supporting varying levels of consolidations—along organizational or product hierarchies.
• Lacks workflow management functionality, including processes for controlling review and approval cycles.
• Attachment emails are often returned, forwarded, or forgotten—leaving planning managers with limited ability to measure or control the planning cycle.
• Merging multiple versions of spreadsheets is a time-consuming and error-prone manual process.

 

Such inherent weaknesses undermine the accuracy of the entire planning and management process. Finance is viewed as pushing "bad" information and loses credibility. Managers' confidence erodes and they become less engaged in the process.

 

Clearly, spreadsheets are not the best way to manage a top-notch financial decision support, budgeting, and planning process. They simply cannot support the kind of planning needed in a changing business environment, namely collaborative, enterprise-wide activities that deliver reliable, real-time results.

 

Advanced Database Solutions

Healthcare enterprises that effectively deploy and manage advanced database management give their organizations a competitive edge both financially and in their ability to respond to changing industry conditions and user requirements. By relying on products such as Structured Query Language (SQL), paired with SQL Server and .net architecture, they can take advantage of the strengths of these industry-leading products to deliver successful financial management under today's most demanding business conditions:

 

• Performance with a large number of users—SQL Server databases scale well across multiple users and are appropriate for high-volume situations with 25, or more, simultaneous users.
• Different types of clients—SQL Server has the ability to handle multiple applications that need to share data.
• Critical need for security—SQL Server or mainframe databases are far more secure than data in file management systems such as Excel. SQL Server offers 128-bit and greater encryption methods and storage in a remote location from the user and application. Combined with Web services, SQL Server allows distributed data in a controlled and highly secure manner.
• Database maintenance and integrity—SQL Server's built-in features of automated repair, transaction logs, triggers, and stored procedures ensure the database remains healthy and changes are properly processed and audited.
• More complex solutions required—SQL Server is better suited to more complex solutions and offers the critical back-end database that allows organizations to scale their important databases securely.
• Web-enabled solutions—SQL Server supports web-based applications that can be accessed from a web browser, a capability not available in Excel.
• High volume of data—SQL Server supports more users and traffic, not only through its limited bandwidth traffic, but also because organizations can improve performance by investing in more hardware—memory, CPUs, computers. This option is not available for file management systems like Excel.
• Need to scale—Although several Excel databases can be combined into one, if the size, security, or other requirements exceed Excel capabilities, SQL Server is a better option. Having one large repository offers the potential for using Business Intelligence (BI) tools to capitalize on significant business and operational opportunities.
• Limited bandwidth—A well designed application using SQL Server can significantly reduce the amount of data moving across the network, because only the requested records are passed from the database to the application. File management systems such as Excel pass the whole table (or at least the index) across the network. This may not be significant for small files, but performance suffers as the data grows.
• Tracking and auditing—SQL Server's built-in features and triggers support the ability to discover who modified what data and undo changes. An Excel application can try to replicate the tracking of changes by managing user interaction with the data. However, this cannot be managed at the core data level. Mistakes in the application or other applications in contact with the Excel data can cause data changes that are not documented. There are also no rollbacks in Excel after a transaction is committed.

 

The Debate Decided

A spreadsheet such as Excel is a very powerful tool, but is it not meant to be used as a database. Retrieving historical data, form entry of data, mass changes of data, and presentation of quality reports are difficult to accomplish. The functional focus is more on spreadsheet accounting calculations, while SQL Server is more focused on huge business database solutions. For hospitals and healthcare organizations, spreadsheets and similar file management systems and applications simply do not offer all the features, scalability, performance, reliability, and security of more sophisticated solutions that are available from database management systems like SQL Server.

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