Hospitals and health systems must look to additional data sources for complete patient stories.
Hospitals and health systems rely on data to reveal an accurate and complete story of how medical services impact the health of the populations they serve. Unfortunately, most hospitals have only their electronic health records (EHRs) and infrequent payer reports to support their data needs. As a result, most hospitals don’t see enough of the story.
Relying on EHR data alone is problematic on many fronts because EHRs:
- Do not capture enough information to tell the whole story of individual patients or populations
- Do not deliver the level of data enrichment required for developing and extracting necessary insights
- Do not easily share data with everyone who needs it
Consider all the ordinary clinical activity happening outside the hospital system, such as unaffiliated specialist, urgent care and emergency department visits, each generating valuable data that won’t make it back into the home EHR. Thankfully, this data exists in claims records.
Claims data link patients to every place they receive services, regardless of location or affiliation. Hospitals need this data to understand patients and populations.
Another key element to understanding patients and populations is data enrichment -- the process of taking massive amounts of raw data and creating useful insights to inform clinical action. Analytical models underpin enrichment to:
- Reveal rising risk across patients and populations
- Determine probabilities of medical events and suggest interventions
- Model outcomes for cost and quality of medical services
EHRs lack the advanced modeling technologies required to enrich data and harness its potential. In many ways, this is understandable because EHRs were never designed to support value-based reimbursement. Traditional fee-for-service arrangements work whether clinicians understand underlying cost drivers or not.
As a result, EHRs rarely reflect margins, quality performance, engagement preferences and other related metrics. In contrast, successful population health strategies depend on everyone across the hospital organization’s various departments -- from clinicians to administrators to leadership -- understanding their role in achieving quality, outcome, engagement and patient satisfaction goals that underpin costing information and having insights available to them within their unique workflows.
Understanding and acting on population health strategies points to an absolute need for collaborative care coordination, provisioned with consistent insight and guidance to drive the highest possible standard of patient care.
Today’s world of isolated EHRs and Health Information Exchanges (HIEs) was not designed to handle collaborative patient care across care teams, especially where care teams span multiple health systems. Hospitals and health systems hoping to achieve population health success need to look beyond the EHR to solutions offering a tier of patient data enrichment, modeling, scalability and decision support that can be integrated into the clinical workflow and shared across every cost and care setting.
