The healthcare industry is undergoing a massive change as it transitions toward a connected network of clinical and administrative services, with the goal of improving patient quality and clinical outcomes. However, as demonstrated through electronic health record systems utilization, an interconnected network can be a complex endeavor.
The rush to deploy EHR systems was driven largely by the Centers for Medicare and Medicaid’s Meaningful Use federal incentive program. Huge financial incentives helped speed the transition from paper to digital records. While great strides have been made in this transition, a new light has been cast on EHRs and the significant interoperability challenges that continue to exist.
Technology is rapidly advancing, and vendors have learned a lot from EHR deployments. Arguably, the biggest lesson is to address the continued need to easily share data between disparate systems. After all, no matter how much data is captured within a system, its value is greatly diminished when it can’t be shared with other systems, groups and organizations. When left in their separate data silos, resources, outcomes, revenue and other areas are negatively impacted.
As the industry looks for ways to enable true EHR interoperability, there are other areas of healthcare that can benefit from the lessons learned from EHRs’ shortcomings. One such area is provider data management.
Provider data management is a complex process involving many departments and individuals. The following is an example of how most hospitals manage their provider data today.
The first provider data-rich department is the managed care department, the main task of which is to negotiate risk-based and fee-for-service contracts with payers. After contracts have been negotiated, the business development department hires providers or acquires them through mergers and acquisitions. After providers have been acquired, the human resources department manages any and all employment contracts for the newly hired or acquired providers.
Once hired, the medical staff services department, which is responsible for conducting all primary source verification services, conducts all vetting processes to prepare the providers for privileging. Once privileged, the provider enrollment department enrolls the providers with payers with which the managed care department contracted the provider or health system.
Ironically, after the provider enrollment application is received by the payers, those entities conduct primary source verification services similar to those conducted by the hospital to grant the provider access to their panels. Additionally, the purchasing department conducts all contract renewal processes related to the providers.
Despite significant overlap in data management, these departments historically never speak to each other, they typically use different systems, and none of the provider’s data is integrated into a single platform.
As evidenced by the fragmented health system example above, there is a significant need to tear down all provider data silos. However, this can only be accomplished by conducting a change in mindset. Namely, provider data management can no longer be viewed as series of individual departments, systems or tasks that do not speak to each other. Rather, it must be viewed as a lifecycle that can only be managed through a single, integrated, provider data management approach.
The importance of utilizing an integrated provider data management approach cannot be understated. Viewed as a lifecycle, an integrated digital backbone can help an organization by facilitating the collection, management and collaboration of provider data for every department that shares this data.
While each department may manage their respective tasks independently, utilizing an integrated digital backbone will allow each department to holistically view and manage where their provider is in the provider data management lifecycle.
The data within this hub can be easily accessible through advanced business intelligence by which any department can quickly and easily extract data for analysis. Analysis is essential to understanding where the provider is at any given point within the provider’s data lifecycle and can provide opportunities to improve both processes and revenue.
Hospitals and health systems have a unique opportunity to learn from EHR interoperability mistakes and get it right with provider data management. With the right mindset and integrated technology in place, data silos don’t have to exist.
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