Effective population health management (PHM) requires information be available and easily shared among all stakeholders – physicians, care navigators, other clinicians, family, care givers and even supporting friends – in a patient’s chain of care. Unfortunately, major barriers to data interoperability are frustrating post-reform initiatives to implement new models of data-driven, proactive care management and consumer engagement.
Many healthcare organizations are committing talent, accelerating technology investments and making the cultural changes needed to support collaborative care models to keep people healthy-especially those with chronic disease. The transition from reactive transactional sick care, to realize the full benefits of advanced PHM and achieve Triple Aim goals requires data inside a physician practice electronic health record (EHR), a hospital HIT system and an integrated delivery network’s (IDN) private health information exchange (HIE). While efforts to implement advanced PHM strategies are encouraging, they won’t work until the industry liberates data from the “walled gardens” of proprietary technologies and departmental silos.
Overcoming the Challenges of the Walled Garden
Other industries overcame the parochial arguments defending closed systems: the compelling catalyst for adoption of standards is that open systems reduced costs and drove commerce. Banking/financial services and retail sectors stand out as examples of how standards-based data exchange makes it possible to compare, select and pay for countless products online and virtually anywhere in the physical world, at a transactional cost of 2-3% – an order of magnitude lower than the payment processing costs of healthcare services.
That said, we’ve all heard the refrain “healthcare is different than other industries”, and that is true. In our industry, health information exchange not only reduces transactional processing costs, drives better quality and enables lower total cost of services – it also saves lives. Most recently, the Ebola virus outbreak in the summer of 2014 was not initially contained because of a systems failure to share timely and relevant information about an infected patient within a single IDN!
Interoperability is also quickly becoming a significant competitive and operational differentiator imperative to success in the business of healthcare. Like many other industries that had to overcome the wrong mix of resources and shed overcapacity, healthcare is now dealing with an over-supply of acute care hospital beds in many regional markets and an under-supply of primary care physicians. Acquisition of physician practices and regional consolidation of health systems are nearly daily news that will likely accelerate in the next few years. The speed of business – and evolving healthcare revenue models that are still in flux – make interoperability a top priority for any major health system or payer in the country. For example, organizations need systems agile enough to support the business opportunity to close on the acquisition of a multi-location physicians practice on an afternoon and have them up and running in the clinically integrated network the next morning.
Best Practices to Break Down the Walls
The first step toward total interoperability is a solid foundation of standards to support health information exchange. National initiatives are well underway to support reliable data transfer and analytics; both providers and vendors need to embrace these opportunities by making it a priority to conform to and innovate these standards of practice in order to make them useful and successful.
Second, infrastructures must be built and deployed to support codified data at the highest level possible. Also referred to as “structured content,” this approach ensures that needed data resides in fixed fields and can be easily located, identified and understood – simplifying the process of integration, sharing and analytics. Doing so enables information to be more easily shared and interpreted into actionable knowledge.
Third, technical advisors and users must recognize the value of EHRs as essentially just documentation transaction systems, not platforms designed for advanced PHM. To be sure, EHRs are an important initial investment in clinical integration, but they are not designed to support the data sharing, risk stratification or data analytics required for wide-area care team coordination or advanced PHM initiatives across sites and among independent providers. Simply put, the EHR is not enough for successful advanced PHM.
Fourth, healthcare IT strategies need to look beyond the right “plumbing” for data movement, security and best in class point solutions. To build a new generation of prediction and risk modeling, data mining and discovery tools, future systems must be designed to push and fetch data, both structured and unstructured, in and out of internal and external targets, comprising disparate sources of clinical, consumer, demographic and financial data to equip providers with the information needed for advanced PHM initiatives.
Finally, these “big data” science technologies will help us gain a deep understanding of population risk and enable us to create tailored data-driven and individualized plans of care. But, applying these data-driven insights to the care management work process, to change the work to reflect what we know now about the patient and to do it at the time and setting where it can deliver the greatest value depends on compliance with interoperability standards. The potential is there for open standards-based systems and effective data exchange to prevent avoidable hospitalizations and unnecessary ER visits, with better outcomes and at a lower total cost.
Liberating Data, Caring for Populations
Advanced PHM strategies that improve patient health and outcomes require data exchange protocols be implemented to support Triple Aim goals. Interoperability is critical to successfully navigating new coordinated care models, and the walled gardens that bound too many healthcare organizations today cannot continue to stand. Commerce drove adoption of standards in retail, automotive, aerospace, banking and finance. It’s time for technology buyers across the healthcare industry to tear down the walled gardens, to require vendors to do more than pay lip service to regulations and deliver real world data interoperability with any authorized entity to support collaborative advanced PHM strategies.