Data and Information Management in a Pioneer ACO Environment: a ThedaCare Perspective

The irony—and Keith Livingston, our CIO, can articulate better than I can—is that it was doctors’ peers being tired of having to fax things to them, that pushed some of the lagging doctors towards EHR [electronic health record] adoption; they said, we want you on Epic. Their peers were threatening to stop sending their patients to them. So that moved their colleagues forward.

What are the big-data challenges and the data analytics challenges?

One major challenge is that not everything we do from a clinical perspective gets into an EHR; not everything that is entered shows up on a claim; not everything that shows up on a claim gets paid. So you have to understand the perspective and context. At first, everything was focused on trying to analyze claims data. Now, the service data—when did something actually happen—becomes the most important. The question becomes, how many patients did I actually see yesterday? We average about 15 percent of our cases month to month not getting coded from previous months; typically, there’s a three day lag. I’m talking about in an ambulatory setting. The entire financial structure is driven by posting. And some of that data gets kind of squishy because it’s not coded yet. We know the activity happened, it’s in the EMR, but it still has to get coded. So the real-time data and real-time analytics become a challenge if you haven’t yet optimized your processes around documentation.

Isn’t it also tough that you are having to go through the transition to the new ICD-10 coding system while you’re doing all this other process and data work, and change?

Longitudinally, yes. It’s an analytical challenge; it’s really not a data challenge. You set the rules. CMS actually created the crosswalk to them, but in the case of one to many, you’ve got to pick one. Now, the good news is, the people who have really studied this have said, among the old codes, they only used a small percentage of the codes. They’ll probably end up using among the most frequent codes they’re already use; and ICD-10 is far more specific, of course.

I’m actually going to be more worried about the payers than our providers. Medicare a few years ago put in preexisting conditions—2010—documentation. December 1 was the date it was supposed to go live; almost every payer wasn’t ready; the government was.

What should CIOs and CMIOs at other organizations be doing right now to prepare for all the kinds of work that you and your colleagues have already undertaken?

I think you can’t lose focus on why we’re doing this. This is about the patient, and about delivering better care to the patient. At the end of the day it’s about, are we doing a better job taking care of patients? And we also can’t lose focus on the people who provide the care. It’s not about the technology, but about the caregivers and the workflow.  And when you look at an EMR, it’s designed to deliver care and get a claim paid; it’s not actually designed for care management.