Guest post by Michelle Blackmer, director of marketing, healthcare, Informatica.
Several weeks into the New Year, our fitness resolutions are still top of mind. Whether tracking calories or steps, we are asking ourselves questions like “how many pounds have I lost?”, “how many calories did I eat?” and “how many steps did I take?” To take the guesswork out of it and to hold ourselves accountable, many of us put a Fitbit, Nike Fuel or Jawbone on our wish lists. Our physical fitness has become data-driven; these devices create data that provide insight, enable us to visualize patterns and generate millions of bytes of data, which helps account for the anticipated annual 40 percent growth in big data. However, this is only the tip of the iceberg for data-driven healthcare.
Health information leaders must continue to assess their business resolutions and take stock of their healthcare data fitness. This is especially important since an alarming 40 percent of healthcare executives gave their organizations a grade of “D” or “F” on their preparedness to manage the data deluge. What’s more is that none felt their organization deserved an “A.”
Successful transformation to value-driven care requires an investment in enterprise information management. However, healthcare organizations are tightening their belts and bracing for the hit to their bottom lines in response to the health reform law that took effect on January 1, 2014. Instead of scaling back, healthcare organizations must invest in the fitness of their data. After all, if the wrong data is analyzed (i.e., inaccurate, incomplete, missing or even unnecessary), organizations are going to make the wrong decisions. What is the cost of making the wrong decision?
Assess your data fitness. Ask yourself the following questions:
Another interesting infographic, from Dell, that I thought worthy of sharing. It’s comprehensive, as you can see. Essentially, it asks and answers the question of how is healthcare IT changing through and because of its relationship with technology.
Without a doubt, the change we’re seeing, especially in the last 10 years, is monumental. Take a look at some of the figures below. In a nutshell: social media, which truly did not exist a decade ago is changing healthcare, especially consumer engagement with the industry. According to this data, more than 40 percent of patients are affected by the use of social media in the care space and it drives their decision when deciding which facility to give business to. Does this suggest that they want their physicians using social media platforms or to simply have a profile to interact with the office? The data doesn’t say, but it likely implies that they want the ability to be able to communicate through their own channels rather than the more archaic means like the phone and static websites. Patients want the ability to communicate somehow through the use of social and likely want to own more of the relationship with their providers. It is their health after all and they want the process of care to be efficient. This trend will likely only increase.
Another interesting point here is that more than 75 percent of healthcare CIOs believe that their health systems don’t have the infrastructure to support their technological advancement. This is a major issue as these leaders look to make long-term adjustments, keep up with reform and employ systems to drive efficiencies. However, in an ever-changing technological world where advancement never ends, I think this is likely to be an ongoing trend/problem/dissatisfaction. For example, over the last five years so much attention has been given the the use of and functionality of EHRs and how they will improve healthcare as a whole, but many say that the systems are antiquated and simply don’t meet the needs of modern practices and hospitals and more needs to be done to improve them and make them more robust and useful.
HIE expansion about supply and demand? Well, if you read this blog regularly, you’ll know that I spend a good bit of time perusing HealthIT.gov. Though it’s not flashy and overwhelming, the site is informative and actually provides a great deal of information, which says a lot since it’s a government property.
What HeatlhIT.gov does well is provide a nice primer of information about a variety of subjects from meaningful use, electronic health records and health information exchanges.
In addition, the site puts everything in plain and simple language for all the world to understand.
For example, take a look at the reasons why health information exchanges are important to the healthcare landscape:
The ability to exchange health information electronically is the foundation of efforts to improve healthcare quality and safety. HIE can provide:
The connecting point for an organized, standardized process of data exchange across statewide, regional and local initiatives
The means to reduce duplication of services (resulting in lower healthcare costs)
The means to reduce operational costs by automating many administrative tasks
Governance and management of the data exchange process
And for good measure, here are a few examples of how health information exchanges are benefiting the healthcare landscape. Some of these concepts are a bit obvious and overstated here, but still this provides a nice starting point in support for the soon to be possible movement.
Benefits of health information exchanges:
Provide a vehicle for improving quality and safety of patient care
Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations
Stimulates consumer education and patients’ involvement in their own healthcare
Helps public health officials meet their commitment to the community
Creates a potential loop for feedback between health-related research and actual practice
Facilitates efficient deployment of emerging technology and healthcare services
Provides the backbone of technical infrastructure for leverage by national and state-level initiatives
I’m not alone in the belief that I feel HIEs’ most important role is one of creating interoperable opportunities to connect physicians and their patients to a web of other care givers and health community members.
It seems that the closer we get to HIEs and their overall acceptance in healthcare, doesn’t it seem like we take two steps back?
What are some of the hurdles keeping HIEs from reaching their full potential? Glad you asked.
Cost has to be the clear front runner. As I’ve previously stated, the questions remain – who’s going to pay for them? The government clearly wants a healthy HIE community because it is believed that they will lead to greater adoption of EHRs while vendors want part of the action so they can charge physicians to transfer data through the networks. Vendors can’t figure out a financial model for them and until they can get someone to pay for them, there may be little movement here.
Another hurdle of HIEs is that for those that exist, the data often exists in silos. Problem with siloed data is that the data doesn’t go anywhere. Sounds a lot like an EHR, but an EHR may be more user friendly and robust. Just saying.
Finally, lack of standards impede their advancement. More development for standards is required for the variety of HIEs to be able to communicate. Profiles, like the need for structured data in EHRs, will help advance the cause and promote their development.
Ultimately, HIE expansion will most likely come down to basic business 101: supply and demand. When the population demands it, we’ll see the supply increase and in so doing, we’ll see cost containment, industry wide standards and completely interoperable systems that will completely open up the health IT market place.
As health IT continues to mature and providers continue to adopt technologies like electronic health records, the data collected from their use in the care setting becomes the most obvious reason so much energy is being put behind getting practices to implement the systems.
Judy Hanover, research director of IDC Health Insights, recently told me, though, that one of the biggest challenges faced by ambulatory and hospital leaders is that the data entering the electronic systems, in most cases, is unstructured, which makes it almost useless from an analytics standpoint.
Without structured data, Hanover said, quantitative analysis across the population can be complicated, and little can be compared to gain an accurate picture of what’s actually taking place in the market. Without structured data, analytics is greatly compromised, and the information gained can only be analyzed from a single, siloed location.
“There must be synergy between the data collected,” Hanover said. “We’re entering the period of structured data where we’re now seeing the benefits of structured data but still need to manage unstructured data.”
In many cases, critical elements of data collected — like medications, vitals, allergies and health condition — are difficult to reconcile between multiple data sources, reducing the quality of the data, she said. Unstructured data proves less useful for tracking care outcomes of a population’s health with traditional analytics.
For example, tax information and census data are collected the same way across their respective spectrums. All the fields in their respective fields are the same and can be measured against each other. This is not the case with the data entering an EHR. Each practice, and even each user of the system, potentially may collect data differently in a manner that’s most comfortable to the person entering the data. And as long as practices continue to forgo establishing official policies for data entry and requiring data to be entered according to a structured model, the quality of the information going in it will be a reflection of the data coming out.
Lack of quality going in means lack of quality coming out.
“In many cases, structured data is not as useful for analytics as we’d hoped,” Hanover said. “There are inconsistencies in the fields of data being entered in to the systems; and that affect data quality as well as results from analytics.
“As we move into the post EHR era, how we choose to leverage the data collected is what will matter,” she said. “We’ll examine cost outcomes, optimize the setting of care and view the technology’s impact.”
As foundational technology, EHRs are allowing for the creation of meaningful use, but once the reform is fully in place, the shift will focus on analytics, outcomes and benefits of care provided.
Currently electronic health records define healthcare, but health information exchanges (HIE) will cause a dramatic shift in the market leading to further automation of the providing care and will change how location-based services and clinical decision making are viewed.
Though some practices are clearly leveraging their current data, others are not. For them, EHRs are nothing more than a computer system that replaced their paper records and qualified them for incentives.
In the very near term, the technology will have to have more capability than simply serving as a repository for information collected, but will become a database of reference material that will have to be drawn upon rather than simply housed.
“Health reform is the end game,” Hanover said. “And there can be no successful reform without EHRs. They are the foundational technology for accountable care.”
The data collected in this manner will lead to a stronger accountable care model, which will once again bring the practice of care in connection with the payment of care.
Evidence-based approaches will continue to dominate care when the data suggests certain protocols require it, which means insurers will feel as though they are working to control costs.
Unfortunately, all of the regulation comes at an obvious cost at the expense of the technology and its vendors, said Hanover. EHR innovation continues to suffer with the aggressive push for reform through meaningful use as vendors scramble to keep up with requirements.
“There’s little or no innovation because all of the vendors are being hemmed down by meaningful use and certification requirements,” she said.
Product standardization means there are far fewer products that actually stand out in the market.
More innovation will likely only come following market consolidation in which only the strong will survive. Hanover suggests that in this scenario, survivors will focus on innovative product research and development and will take a leadership role in moving the market forward
Though vendors will suffer, users of the systems will likely face major set backs and upheavals at the market shifts and settles. Especially as consolidation occurs, suppliers disappear or change ownership, practices and physicians using these systems face the toughest road as they’ll be forced to find new solutions to meet their needs, learn the systems and try to get back to where they were in a meaningful way in a relatively short period of time.
Likely, deciding which system to implement may bear just as much weight as deciding how to use it.
EHR structured data begins to make a play for importance as health IT moves into Stage 2 and we begin to require useful and useable information. It’s not a new topic, but one, much like ICD-10 I suppose, that has had many a practice leader hoping to push off until later.
Unfortunately for many, the days of structured data are upon us. Hoping that the data you dumped into your system when you implemented won’t be a problem for you in the future may now begin to start causing you some nightmares.
For many practices, as they begin to look at their data and hope to find a treasure trove included, they may be surprised to find much of the information worthless, as least when trying to compare to health information as a whole.
Why? Well, according to Computerworld, there’s just not enough EHR structured data. For example, pieces of data like problem lists, medications and allergies are inconsistent between the varying EHRs and the codes are often different between the different products.
Perhaps most importantly, though, is during the initial set up of the EHR. Practices looking to get their systems up and running, they often simply dump data in and move on to the next step of the training process. This, according to Computerworld, means a lack of protocols, standards or proper charting of the data.
As we’re now finally beginning to see is that the data that goes into the EHR must come out in a standardized and useful way so that it can be reported through meaningful use and exchanged through HIEs and electronic health records.
From Computerworld, “EHR structured data is required to aggregate, report and transmit the collection of data at the point of care, it is often perceived by physicians to inhibit their ability to practice medicine and document in a fashion they feel is most effective.”
Again, the lack of proper protocols and creating a culture of success can sink a practice in the long term. Simply dumping the data and letting providers practice as they see fit is a lot like public companies with their eyes on short term, end of the quarter returns rather than trying to build a successful foundation to create a stronger organization even if it means a slower, more steady return on their investment.
In fact, a case might be made that suggests that the loss of productivity physicians face when first learning their EHRs could be related to their use of structured data. Creating a process for them to follow from the beginning will pay huge dividends in the long run. In the near term, though, there will be a minor fall off in productivity.
There are some solutions for streamlining your data structuring process:
Create a committee to police standards to maintain clinical information in your EHR and HIE
Educate physician on the importance of capturing structured data, but allow the some ability to customize how they capture notes, for example
Spread the workload for capturing structured data among your staff and allow physicians the ability to focus on providing care and maximizing their productivity
Prepare your technology solutions for extraction, and utilizing, structured data. An EHR along may not be the only solution you need to get the data you need. Plan ahead and remember that one size fits all rarely does.
Follow these, and perhaps few of your own, and the value of your data will be worth a whole lot more for your organization in the long term than any unstructured attempt you make.