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As ‘Obamacare’ Open Enrollment Ends, Data-driven Healthcare Ramps up

The first week in April was no “April Fool’s Day” prank for the healthcare industry as reality started to sink in following a set of changes that will undoubtedly affect the industry for some time to come.

The U.S. Senate voted to pass a House-approved measure that would implement a temporary ‘Doc Fix’ for Medicare’s sustainable growth rate formula—a scheduled 24% cut to Medicare physician reimbursement rates—and delay the ICD-10 Coding System for one year, pushing the compliance deadline to 2015.

The week also marked the official cutoff for insurance enrollment under the Affordable Care Act (ACA). President Obama announced last Tuesday that more than 7.1 million Americans signed up for health coverage under ‘Obamacare’ for 2014.

But just as the rollout of health insurance coverage under the ACA came to an end across the country for 2014, the realization of what data-driven healthcare will have to become moving forward, ramped up.

More Americans are gaining insurance coverage. More patient data is coming.

With all the benefits that extending health coverage implies in terms of healthcare access and financial protections, so too is the sheer amount of data that it will create, not only for payers, but specifically for providers. As healthcare organizations face this new challenge, however, they are already experiencing a rapid growth in the volume of all forms of information.

Their current applications and older legacy systems are bursting with information—patient data, clinical and administrative documents, voice recordings, and medical images—which, for most organizations, has continued to raise several serious challenges with cost management, compliance and legacy system preservation.

Unfortunately, the problems with organizing and managing patient information are only just beginning as more American’s with access to health insurance start to flood the market seeking healthcare services.

Transforming care delivery.

As a result of healthcare reform and other long-standing drivers in healthcare, the stakeholder landscape is evolving. New care delivery and reimbursement models will require healthcare organizations to transform how they deliver care across the continuum of care to place greater emphasis on quality and prevention.

We are, undeniably, moving into an era where healthcare will be hugely data-driven, and to beat any of the challenges we face as an industry, we’re going to need access to information more than we ever have before. More directly, though, healthcare organizations are going to need comprehensive patient health records. These records, as a recent IDC Health Insights study noted, will enable healthcare organizations to provide their clinicians “with a longitudinal view of the care their patients received across the continuum of care and include(s) health information from multiple healthcare IT (HIT) systems managed by various stakeholders.”

But simply making a mental note of technology needs won’t enough for today’s healthcare organizations given that providers will be reimbursed based on quality care measured against patient outcomes. As such, organizations will have to not only leverage current IT investments, but also invest in integrated patient-centric record solutions to improve care team collaboration and care coordination. Increasingly, though, organizations will also have to invest in solutions that allow them to share data across the continuum of care.

Transitioning to data-driven healthcare.

Healthcare organizations globally have made significant investments in electronic medical record (EMR) systems to manage structured information as they look to meet the challenges of improving health outcomes for their communities while carefully managing operational costs. And more specifically to Meaningful Use efforts here in the U.S., EMR technology has offered the basis for improving clinical and population health outcomes, enhancing patient care, and increasing efficiency.

Rapid adoption of these systems has certainly offered boundless potential for the advancement of patient care, quality, and safety—all of which support a foundation for collaborative care and help clinicians and organizations alike meet evolving patient expectations. But for all the benefits they have brought the industry, EMRs still fall short of a complete patient-centric view—with only 25% to 50% of a patient’s health information typically available for view in an electronic format. This results in majority of the content that comprises the patient record residing outside of the EMR system due to several key challenges:

  • Multiple Formats and Systems: Volumes of information are locked in multiple formats and numerous healthcare information systems, paper-based documents and processes, and non-machine readable documents—all which are not aggregated.
  • Information Silos Prevent Sharing: Patient health information is trapped in numerous siloed repositories without easy access or facility for electronic sharing, making information exchange difficult or non-existent.
  • Incomplete Patient Records: Electronic records are incomplete, forcing clinicians to make diagnosis and treatment decisions, and run duplicate tests, due to inadequate access to a complete view of patient history.
  • Paper-Intensive Industry: Paper is not going away as quickly as expected with as a majority of documents used in healthcare today remaining paper based. Paper volumes are increasing year after year, and the inadequate availability of this information in clinical systems continues to result in medical errors.

These challenges have plagued healthcare organizations by way of increased costs and decreased efficiency at a time when reining in costs and improving efficiency could not be more urgent. And the approach many organizations have taken with managing patient information introduces a whole host of problems, from increased risk, quality and privacy issues, and difficulty conforming to regulatory compliance.

To put this in a slightly different perspective, according to IDC Health Insights, 18% of medical errors are the result of patient information missing from the patient record—such as medication history, lab results, known allergies, or blood type.  The percentages likely only get more disastrous as additional critical information is inadequately available for clinician review.

But as Dr. David Denton noted last week in commentary within NewsWeek, “technology isn’t enough to improve healthcare. Doctors must be able to distinguish between valuable data and information overload.” So the challenge we are really faced with is ultimately transforming how we view, organize, access, manage, and use patient information to create efficiencies and optimize patient care.

Stay tuned for our next blog post where we will complete this topic and talk more about why simply having information is no longer enough for organizations to succeed. It now must be organized and managed for use in delivering better healthcare.

 

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