In hospitals and physician practices across the country, the implementation of electronic health records (EHRs), computerized physician order entry (CPOE), and other technology has brought on hope of increasing quality of care and decreasing cost. And to date, approximately 80 percent of the nation’s doctors are now using EHRs, a sure sign of progress when it comes to the adoption of health IT in the U.S.
Now, a new information source has begun to emerge in healthcare: patient-generated health data (PGHD), which is any medical data that a patient inputs electronically. During Health Datapalooza in Washington, D.C. earlier this month, Jay Nagy, associate principal of corporate strategy for The Advisory Board Company, headquartered in D.C., discussed how providers can take advantage of data coming from patients in between their encounters with clinicians, and what they can do with that data to improve care processes and outcomes.
Certainly, as healthcare moves from a fee-for-service world to a value-based world, opportunities will arise for PGHD to be worked into clinicians’ workflows. Nagy recently dug deeper into this issue with HCI Associate Editor Rajiv Leventhal, discussing the aforementioned points as well as how providers can build a successful partnership with patients on this data, the industry’s readiness for PGHD, what the future holds, and more. Below are excerpts of the Q&A interview between Nagy and Leventhal.
How “real” is PGHD at this point?
It’s still the early days. If you think about data getting collected through wearables, you can see that the market is very immature right now. Rock Health [recently reported] that Fitbit, Jawbone and Nike’s bands account for 97 percent of sales. In terms of being able to collect and share the data, which is the key, it’s really early, but the potential is enormous, especially if you think about the 5,000 hours between periodic encounters with patients. This amount of time refers to when sickness and health happen, which is outside the clinical setting, for the most part. If you’re able to quantify that somehow, it will lead to not only better treatment and diagnosis, but ultimately better outcomes where you don’t have to be in the doctor’s office and hospital because you got the right interventions. And there are case studies of having dedicated apps to get information back on specific conditions.
Regarding the number of hours between encounters with patients, what can providers do with the PGHD they receive in that time?
One of the basic elements would be to understand symptoms and what is actually happening. Zero in on the diagnosis and things that are tracked repeatedly, For a congestive heart failure (CHF) patient, for example, weight is a huge indicator. Another example could be with diabetics tracking their glucose.
A second area of benefit is adherence to the treatment plan. One of the big open questions that is more and more concerning to providers as they bear more risk for outcomes of the patient is, Are they following the treatment advice? To the extent that they’re not, what can we do to improve the chances that they will? What can providers do to communicate more effectively? And how can we better partner together to make sure they get the best help possible? If you track these metrics for CHF patients, for example, you can develop filters. So you won’t have a provider looking through day- by-day weight, but rather you can set up filtering mechanisms so you can get alerts when they matter as opposed to randomly sharing data. Providers are not sitting around waiting for more data to come in—they’re busy folks. So you need to make it valuable.
So how can the provider-patient partnership improve to ensure value on both sides?
From a patient perspective, if providers give better advice to get them on a better treatment plan and know when the patient’s health status is declining, patients will benefit directly. The missing link is how do providers directly benefit? That has been asked a lot. Of course, they benefit knowing that patients are in good health and adhering to the treatment plan, but in terms of a financial incentive, it’s not really there yet. In a fee-for-service system, so much of the financial benefit comes from patients being in the office. Going forward, with healthcare reform, from a practical perspective, it will be beneficial for providers not to have those patients in the office. You can’t ignore that missing financial link, though. There is a phrase in healthcare: no margin, no mission. So that is a big missing piece; there is no way through the normal reimbursement channel, whether Medicare or private insurance, to get providers compensated for what is going on outside of the clinic. There are lots of initiatives that are moving us in that direction, but there isn’t a clear incentive today to work with patients in this way.
It’s clear that PGHD makes more sense in value-based healthcare world. So what do providers think about all this?