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Population health management: Technology interoperability is key

INSIGHT ARTICLE  | 

The following article is the second part of our discussion on key technology considerations related to population health management. To learn about critical tools and strategies, read  Population health management: Enabling technology strategies.

The regulatory changes and drive to effectively manage the care for a population has resulted in several different approaches from information technology (IT) vendors with respect to tools and solutions that help providers in this effort. Some electronic health record (EHR) vendors have created their own set of population health management solutions and modules which layer on top of existing EHR functionality. A significant number of IT vendors have emerged as providing a comprehensive population health management platform that is EHR agnostic, while some other IT vendors are creating niche solutions which enable a best-of-breed approach to components within the population health management framework.

Health information exchanges (HIEs) still play an important part in data sharing. The decision for any provider organization relies heavily on the ability to identify the network, understand the complexity of the different systems that house health records for that patient population and determine the best approach forward, while emphasizing the need to access any relevant patient information on demand and at the point of care. Some of the key challenges with the existing population health management solutions include:

  • Disjointed workflow with EHR – Outside of the large EHR vendors, the population health management solutions in the market today currently function as separate modules, most of which require a second sign-on and a different user interface. This leads to a broken workflow for end users and often impedes training and adoption efforts.
  • Lack of health data standardization – The health data which is aggregated across different systems is often not standardized. The vocabulary and formulas for calculation are different and the same data elements don’t mean the same thing in many cases. This results in a need for careful curation of the data that is consolidated before a normalized health record can be achieved.
  • Restricted data liberation – Despite regulatory mandates to free health data, the concept of ownership of health care data is still ambiguous. IT vendors, HIEs, health care organizations and individual providers all claim stake to their ownership of the data. Trust and competition are two of the largest factors that influence claims on data ownership and efforts to block access to it. This results in a cumbersome and, at times, costly process to liberate this data and utilize it in a meaningful way. The U.S. Department of Health and Human Services (HHS) has asked for health care providers to attest for their support of data interoperability as part of the new Medicare Access and CHIP Reauthorization Act (MACRA) regulation and the IT vendors have joined a pledge to avoid data blocking and not interfere with the act of information sharing among providers.
  • Unreliable patient matching – Creating a master patient index and matching patient information efficiently to be able to query data regarding a patient while reducing the creation of duplicate records is a technology challenge that has plagued the industry for many years. This becomes even more important to address with the exchange of data between different systems while managing a patient population that spans a care network greater than the reaches of what the individual provider organization can control. CommonWell Health Alliance and the Carequality initiatives are looking to address this on a national scale for those that participate in data exchange through those initiatives.
  • Fragmented patient portals – Patients deserve a single point of access for their health records which may currently be split across different systems and EHRs. Health care organizations currently often have multiple patient portals depending on where care is provided. For example, they may have a separate patient portal for their inpatient episodes of care, separate from what they use for their primary care physicians or specialists, and yet another portal for their bill pay. This results in a confusing interface for patients and a fragmented health record. A successful approach would consolidate access to all health records and related functionality through a singular portal for the patient. The Office of the National Coordinator for Health Information Technology’s blue button initiative was developed to encourage third-party patient portals to create this single point of access to the health records.
  • Immature telemedicine strategy – Telemedicine and telehealth technology have yet to be clearly defined by most health care providers. Some key decision points to enable this strategy include identifying the supported services, scheduling of and access to care provider resources, technical infrastructure requirements to enable this strategy and reimbursement models for virtual consultations.

Looking ahead

Population health management relies on health data mobility and interoperability within different systems. The reach of interoperability is greater than just for enabling a population health management platform for the provider. The ultimate goal for interoperability is to enable a learning health system with a comprehensive set of patient-centered health data available to the right people at the right time for the most optimal care and outcomes. When devising a long-term strategy, a sequential approach is ideal when considering an interoperability framework for a provider organization. Note the following key elements.

  • Integrate disparate EHRs and data from other sources using the population health management platform.
  • Leverage state and regional HIEs to manage the health of a patient population and enable data exchange.
  • Achieve nationwide data exchange with access to a larger network like the Sequoia Project’s eHealth Exchange network or through interoperability enabled by the CommonWell Health Alliance and Carequality frameworks. The ultimate success of a population health management and interoperability initiative will be when all the relevant information is available to the entire health care team, including patients, and enabled by a strategic use of technology.

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