Tag: population health management

From Data, to Knowledge to Action: Leveraging Clinical Analytics to Impact Patient Outcomes

Thomas Van Gilder
Thomas Van Gilder

Guest post by Thomas J. Van Gilder, MD, JD, MPH.

Electronic health record (EHR) technology has become truly transformative for the healthcare industry; prepared or not, healthcare teams are increasingly relying on new information technologies to improve the delivery and management of care. EHRs have enabled faster and easier access to patient information, and hold the promises of improved workflows, efficient sharing of information across communities and reduced costs for many physicians and hospitals.

But now that nearly 80 percent of physician practices in the U.S. today have EHR systems in place and the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program is well underway, it is time to look to the next stage of health care technology and innovation. Health care teams must now move beyond the first step of digitizing patient records to transforming this valuable data into meaningful and actionable knowledge that will help care teams make more informed decisions at the point of care and ultimately, improve outcomes.

For this impact to take place at both the individual level and at the population level, care teams need to leverage clinical analytics that will provide visibility into important clinical trends across the entire population. For example, being able to review trends in diabetes care or readmission rates across a population represents an opportunity for specific, meaningful change to improve care delivery and outcomes.

For a practicing clinician, “population health management” means being able to see where an individual patient is within the clinician’s or clinic’s population (e.g., whether the individual’s chronic condition is above or below population benchmarks) and to take action at the point of care, as well as being able to refer to relevant population health metrics.

For a patient, clinical analytics presumes trust, not only in the competency and care of the physician, but also in the security of his or her information. Population health management and analytics tools must ensure that patient information can be gathered, stored, and used in a way that is demonstrably secure.

Care teams should consider four key elements when exploring clinical analytics tools for population health management:

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The Right Prescription for Effective Population Health Management, Improved Outcomes

Guest post by Diane D. Homan, MD and Adam Lokeh, MD.

As the healthcare industry unwraps the next phase of population health management (PHM), providers are increasingly embracing its promise to drive success with healthcare’s triple aim of improving population health, enhancing patient experiences and reducing costs. It’s a 180-degree shift in thinking for many providers who have been conditioned to long-standing fee-for-service models, one that will require a coordinated care effort and an advanced technological infrastructure to support decision-making based on the latest industry evidence.

As regulatory initiatives, such as meaningful use and value-based purchasing converge to up the ante on improved outcomes, the proactive premise of PHM will be critical to success. A foundational component to effective implementation of a PHM model is a clinical decision support (CDS) strategy that drives standardization of care based on best practices.

For Rush-Copley Medical Center, the first step in this process was deployment of evidence-based order sets and a complete clinical content management solution— ProVation Order Sets, powered by UpToDate Decision Support. The decision to leverage evidence-based order sets at the point of care has proven advantageous on many fronts, from supporting recent responses to public health crises to raising the bar on outcomes improvement and laying a foundation of accountability across the continuum.

Reducing Variation for Improved Response

Getting clinicians on the same page and helping them to adopt industry best practices in their day-to-day workflows is certainly a key element in bending the quality curve, but ensuring that variations are minimized in a public health crisis is absolutely critical to success.

A 210-bed hospital serving the greater Fox Valley region of Illinois, including the state’s second largest city, Aurora, Rush-Copley uncovered an outbreak of tuberculosis (TB) in late 2009 following two admissions over the course of two months. In cooperation with the Kane County Health Department, an investigation traced the outbreak back to a homeless shelter, which, in turn, presented a considerable challenge to containing the outbreak as the population was highly transient.

With evidence-based order sets and an advanced clinical content management solution already deployed to address standardization of care, the clinical team was able to quickly deploy a point-of-care strategy for identifying at-risk patients, apply isolation management tactics and develop collaborative efforts throughout the community to minimize exposure. The strategy was three-fold: 1) contain the epidemic, 2) provide highest quality treatment based on industry best practices and 3) avoid duplication of services.

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Real-Time Clinical Messaging Supports Quality Care

Brian O'Neill
Brian O’Neill

Guest post by Brian O’Neill, president and CEO, Office Ally.

As healthcare reform rolls out nationwide, medical providers at all points across the care continuum are acknowledging the critical role that practice management systems play in population health management. Moving onto an electronic medical record is an important first step. Maximizing the digital capabilities these systems provide is a close second priority – and one that can yield big dividends in enhanced communications and better patient care.

One of the stars in the pantheon of indispensible functionality is real-time clinical messaging. Similar to texting but on a grander scale, real-time clinical messaging notifies medical providers before, during or after patient encounters of the recommended procedures that will improve patient outcomes. The two-way messaging can come directly from outside sources, such as third party administrators, IPAs, health plans or accountable care organizations, as well as other parties important to the care of patients. Studies have shown that such real-time digital communication significantly improves quality of care and allows for better outcomes in disease management patients. It can also result in fewer hospitalizations and a reduction in serious medical errors.

Clinical messaging can also facilitate direct communication between the medical provider’s office and a health plan’s case manager. This uninterrupted linkage improves the timeliness of the care provided, allowing case managers to contact the physician’s office prior to a member’s appointment to discuss procedures to be provided. Clinical messaging also enables the electronic two-way transfer of documents between the physician and the health plan, while allowing the case manager to communicate with the provider’s office while the patient is present in ways that maximize the efficacy and efficiency of that visit.

Most important of all clinical messaging helps to improve quality, which is the reason the healthcare exists in the first place. It can accurately capture all of the mandated HEDIS preventive care measures, demonstrating compliance with HEDIS and NCQA standards in a manner that can improve the “Star Ratings.” Both have become standard measures of quality throughout the healthcare industry and are increasingly becoming tools that employers and individuals use in selecting healthcare providers.

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