How to get the data right to advance collaboration, build trust

Through mandating transparency of medical records, the reality of interoperability is credibly on the horizon.

In the decade has since the Affordable Care Act was enacted, adoption of electronic health records has broadened significantly, and technology has exponentially increased the amount of information healthcare professionals have about their patients.

Through mandating transparency of medical records, the reality of interoperability—the ability to efficiently and effectively share patient information with patients and everyone on their care team—is credibly on the horizon.

The incentives are aligned; the technology exists. Now is the time to accomplish our goal of shared patient, provider and payer access to health information—and the onus is on us to get it right.

Giving a care team real-time access to a patient’s complete medical history, health insights and treatment options provides a more accurate body of public health data. Beyond that, it improves care coordination, patient safety and experience—while also reducing costs and maintaining or improving privacy, security and productivity.

In fact, interoperability is so important that the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have introduced proposed rules that address “information blocking” and transparency, requiring more access to core data to achieve a “more holistic understanding of an individual’s interactions with the healthcare system.”

But beyond mandated open APIs, how can we ensure that we win the hearts and minds of providers to build trust and achieve our collective goals of better care for more people at a lower cost?

Before anything else, we need to do two highly dependent things.
  • Make sure our workflows are easy to use and reduce work for clinicians.
  • Foster absolute trust that data is consistent and accurate.

Only with these pieces in place can we drive the adoption needed to leverage data to improve outcomes and lower costs.

Electronic health records (EHRs) are a blessing when it comes to capturing patient data. But many a clinician has cursed as they click through multiple screens to enter information. Workflows are getting better at being simpler and faster, but still they add hours to a clinician’s day, taking away valuable time spent interacting with and caring for patients. As the caretakers for people’s health, every interaction a clinician has with an EHR system should provide a clear benefit to their patients.

Patients are still entering the same information on multiple forms and repeatedly explaining symptoms. In some cases, information scrawled on paper patient questionnaires may not be inputted into their digital chart. Deeper interoperability could help patients avoid these frustrating, repetitive interactions and also lead to better, more coordinated care by including more historic information.

But there is room for improvement across the data capture and sharing process—and not just at the initial point of care.

Most EHRs are now able to factor in payers as part of the care team. Having payer data, such as coverages and reimbursement rates, available at the point of care can give patients and providers more information to make informed decisions. This is especially helpful for patients to understand out-of-pocket costs on treatments outside of their plan coverage.

However, one factor that currently erodes trust is that different functions—administrators, nurses, doctors and payers—may not see the same data set. They each have different views that restrict them from seeing the whole picture, which is an issue especially for value-based partnerships dependent upon more risk sharing.

In some instances, alerts and recommendations for preventive screenings that are designed to help improve population health and meet joint payer-provider quality measures miss the mark. For example, if an EHR system recommends that a male patient be screened for ovarian cysts, a clinician may be more likely to disregard other alerts. The fastest way to lose a clinician’s buy-in is to have inconsistent or incorrect data.

Where we see people succeed in value-based reimbursement mechanisms is when they have the most complete data, meaning a combination of structured clinical data, claims and unstructured data. Synthesizing those data streams to produce a holistic, accurate picture of a patient’s health enables providers to address clinical gaps. It also can help providers to be reimbursed appropriately and more quickly. From Optum’s own experience working with providers, this can mean a difference of as much as 20 percent in risk score accuracy and complete clinical record for those doing it well.

As we near the top of the hill, the road ahead for data sharing is in sight. As our data and systems improve, we will see greater impact in terms of better patient and business outcomes. It’s time to get serious about removing barriers, improving workflows and fostering trust so we can fully deliver on the promise of health care data.

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