Just as previous generations did not fully consider the wide-ranging environmental implications of their actions regarding pollution, so too has healthcare been historically mired in siloed thinking.
Healthcare providers have traditionally operated independently and without visibility into what others were doing and the repercussions of those interventions for patients’ clinical outcomes and care costs. As such, providers rarely shared patient information.
More recently, this mindset is starting to change as emerging reimbursement models and evolving regulations urge providers to work together to achieve better clinical and financial outcomes. Unfortunately, even though the desire to share information may be growing, the logistics of enabling this work continues to thwart cross-continuum communication. Data exchange between hospitals and physicians remains limited, and it is even more rare between ancillary providers, such as skilled nursing facilities, home health agencies and pharmacies.
Why the continual barriers?
The rapid pace of technology adoption and evolution in healthcare—while in many ways a good thing—has had some less-than-ideal consequences. Organizations were so eager to adopt systems to meet federal meaningful use requirements that they did not stop to develop a consensus on how to effectively share highly-regulated protected health information (PHI).
At the same time, competition grew between vendors as the demand for EHRs accelerated. Although some competition is healthy to drive innovation, it can result in roadblocks as companies aim to protect their market share.
The fallout from these dynamics is that some vendors offered systems that weren’t capable of sharing data with other platforms, while others refused to allow information sharing unless organizations paid extra fees. These policies, as well as the proliferation of platforms and wide variety of data sources within healthcare organizations, create barriers to interoperability. The ultimate consequence of these factors is that smooth information exchange via the EHR has never been fully realized, and healthcare organizations are forced to use multiple tools and reports, severely limiting their ability to understand the holistic state of their data and operations.
Nowhere are the challenges of information sharing more apparent than in the accountable care organizations (ACOs) and clinically integrated networks (CINs) that have emerged in response to value-based care initiatives. These organizations must monitor where and when patients receive care and what care they receive to keep tabs on quality and costs. For individuals with multiple chronic conditions who must interact with a wide range of specialists and ancillary care providers, the size and scope of the healthcare ecosystem can be massive. Further, various healthcare sectors may naturally provide less data than others, making it even more difficult to obtain similar data points from across the care continuum. For example, an organization may have vast amounts of data and information from a patient’s internist, but less readily available – or actionable – data from a behavioral health specialist.
For these reasons, most ACOs and CINs struggle to monitor how patients interact with the ecosystem. In theory, technology should help; however, as previously mentioned, many solutions fall short in effectively sharing information across platforms.
Cleaning up population health management
Although EHRs are slow to facilitate seamless information exchange, there is other technology making strides in this area. Intelligent, highly-automated population health management platforms can provide greater transparency into the healthcare ecosystem by easing access to relevant knowledge. These solutions enable smooth data sharing between providers, ancillary organizations and other IT vendors to create a complete and fully collaborative medical record.
When the technology is used to link all providers and facilities within a preferred network, information can be shared automatically no matter what the underlying EHR. After the patient completes an appointment with a preferred provider, for example, the system notifies the network that care was completed and data from the appointment is electronically transferred. This alleviates care managers from manual follow-up by phone and/or fax. Although patients do have the option of seeing providers outside of the network, which makes things more complicated, knowing that network providers are easily connected and exchange information with one another can encourage individuals to remain in-network for their care.
The technology also fosters communication through automatic alerts, signaling physicians or care managers when a patient arrives in the emergency department (ED). Moreover, the technology can e-fax the relevant ED with physician contact information in case the triage nurse or attending physician determines the patient’s condition does not warrant hospitalization or emergency department resources. The ED staff can refer the patient to the physician for needed care, and in some cases, set an appointment.
The technology can also build engagement by supporting patient outreach. When a patient doesn’t complete a referral appointment as scheduled, for instance, the population health management tool can send a text message, phone call or secure electronic message to the patient about the missed appointment. This outreach reinforces that the organization cares, while at the same time helps the provider learn more about potential care obstacles, such as lack of transportation or care-plan education needs.
Next-generation population health management tools not only enable stronger cross-continuum communication, but they leverage artificial intelligence to deliver information—such as spending, cost, and care quality data—within existing workflows, so providers don’t have to hunt for it. An intelligent browser assistant offers the information while the provider is in the EHR, eliminating the need to log into a different portal. By clicking on the browser icon, providers can drill down into network- or practice-level data as they wish. For example, clinicians can see details about costs, open care gaps and admissions in a way that lets them address the needs of each individual patient on the day’s schedule. Similarly, a network administrator can see potential new revenue opportunities at a glance with the capability to drill down into the data behind the numbers.
Shifting the mindset
Just as various entities came together to limit the negative impacts of pollution on the environment, different healthcare groups—providers, patients, vendors, and so on—must continuously work to shift the paradigm of siloed thinking and promote greater collaboration in healthcare.
While cultural and industry changes are prompting greater data sharing, the work is still in its infancy. However, by using AI-driven population health management technologies, ACOs and CINs can overcome many of the challenges inherent in data exchange and more easily view the information necessary to make the best clinical and financial decisions.