Many healthcare organizations on the path to population health management face the same question: How do we better integrate our IT systems with our clinical workflows?
Under population health, hospitals and health systems focus on preventive services, patient education and wellness to prevent health conditions from presenting or getting worse. To do this, hospitals must aggregate patient data in real-time, then sort and filter this data to ultimately identify the right populations to drive outcomes based on predictive analysis.
"Population health happens when clinicians harness information technology to transcend gaps that currently exist within healthcare," said William Gillespie, MD, executive vice president of population health and CMO of Medecision, during an executive roundtable at Becker's 2nd Annual CIO/HIT and Revenue Cycle Conference in Chicago on July 27.
Hospitals, health systems and physicians make up only one component of population health. These provider organizations are in need of a solution that seamlessly feeds data among them as well as the other components — payers, employers and consumers — all while simultaneously enabling real-time interaction with EMRs, pharmacy benefit managers, labs, medical devices, benefit administration systems and mobile devices.
"The challenge in population health is how hospitals and health systems use finite resources to improve quality of care while practicing fiscal restraint," said Dr. Gillespie. As part of the roundtable discussion, hospital administrators from health systems across the country shared their thoughts on challenges their organizations face in aligning clinical and health IT functions.
People, Process and Technology
Technology alone is not a magic bullet for any organization looking to drive population health initiatives. Even the most advanced data solutions will underperform when layered over broken processes and used by an untrained workforce, said Dr. Gillespie. Hospitals and health systems seek a solution that works within its workflow through ease of use to ultimately improve productivity, thereby allowing providers to care for more people.
The senior vice president and CIO of a large health system in Pennsylvania stated that as her hospital system ramps up population health initiatives, it has focused on teaching care managers how to build and use chronic disease databases and other analytics tools. "Tools are nice, but you need people and process in place to drive change," she said. Delivering insight care managers need to develop efficient and effective intervention strategies and laying the foundation for best practices early ensures hospitals see ROI on their IT investments.
Cultural, Technological challenges to Data Sharing
Successful population health initiatives depend upon healthcare organizations using the most comprehensive data possible, said Dr. Gillespie.
Unfortunately, the exchange of claims and clinical information between payers and providers is still challenged by a culture of distrust. The chief innovation and strategy officer of a large nonprofit hospital in Chicago expressed frustration that a lack of HIE infrastructure has left the hospital's EMR database relatively isolated from other hospitals. At the same time, payers have refused requests to share their claims information with the hospital until payers gain access to the EHR data. As a result, the data he needs to support the hospital's population health efforts is incomplete. "I've got loads of gaps in care," he said, making it much more difficult to take on risk or implement new population health initiatives.
Other administrators noted how the manual prior authorization process continues to burden physicians and cause inefficiencies in care delivery. Some EHR software systems have begun to incorporate electronic prior authorization capabilities, but not all. Vendors have acknowledged this functionality can improve clinician workflow and quality of care, but it is not yet a standard offering.
A CIO from a medium-sized heart hospital in South Carolina said she has seen patients' treatment delayed for days due to difficulty with prior authorization. Even with a robust EMR system in place, she is frustrated the hospital cannot speed up its prior authorization processes.
Although both providers and payers continue to face data-sharing challenges, hospitals can use IT systems to make existing data workflows more efficient and advanced.
Using Technology to Close Gaps in Care
Medecision is on a mission to close information gaps with software that facilitates increased connectivity and data flow across healthcare entities. Health systems can implement these population health modules individually or in combination for a customized workflow.
Next-generation technology can help hospitals build a more complete vision of their population's health, said Dr. Gillespie. Christiana Care Health System in Newark, Del., for instance, uses Medecision's Aerial™ population health platform and applications to create a unified clinical record, collected in real-time from healthcare systems across the state. Aerial pulls information from various systems, parses the data and develops workflows to address patient needs with custom interventions divided among care team members.
And even though this data focuses on the big picture — Christiana initially set out to improve outcomes for the 20 percent of its patient population that incurred the greatest costs — it also empowers physicians on an individual level. Medecision's platform ingests data from Deleware’s HIE, keeping physicians updated when patients check in at a healthcare facility outside of their network. This enables attending physicians to better monitor their patient across the continuum of care and build the most comprehensive clinical database possible.
Medecision's modular Aerial platform solves a variety of issues causing the gap between hospitals' clinical and health IT systems. For instance, hospitals can layer Medecision applications over existing EMR systems to add or augment service capabilities that are not baked into their solutions, Dr. Gillespie said.
Conclusion
Many hospitals and health systems do not have the technology or data in place to support the transition to value-based care. EMRs currently on the market are designed for a fee-for-service world, making it difficult for providers to understand the composite picture of their population's health. Fortunately, hospitals can leverage valuable experience and best-in-breed solutions from partners like Medecision to begin building the databases and relationships necessary to thrive in a population health environment.