On Aug. 28, a team of researchers in the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices, a division of the Falls Church, Va.-based CSC, published a new report, “Coordinated Care: Assembling the Patient Information.” The report, authored by Jane Metzger, Rebekah McLear, and Jordan Battani, examines what accountable care-type organizations, referred to in the report as “coordinated care delivery organizations,” or “CCDOs,” are facing with regarding to the data and information requirements needed to facilitate coordinated care or accountable care.
As lead author Metzger, principal researcher for the group, and her colleagues, write in their report, “Critical to success for any CCDO is assembling patient-specific information that provides a foundation for care and care coordination across the continuum in line with the new expectations. Thanks in large part to the HITECH [Health Information Technology for Economic and Clinical Health Act] incentive program, the pace of adoption of electronic health records (EHRs) has accelerated to the point that many hospitals and physician providers forming or participating in coordinated care delivery organizations are capturing important medical record information online and integrating EHR features such as clinical decision support and electronic patient tracking into patient management.
"This is a critical building block for the HIT needed for care that is coordinated across the continuum,” the authors note. “In many cases, however, electronic patient information captured locally in a hospital or physician practice (or medical group) is stored and managed separately in a local EHR,” and with patients regularly moving back and forth between and among hospitals, physician offices and clinics, nursing homes, and in-home care, the challenges embedded in accountable or coordinated care are thus many.
What’s more, the authors contend, even as many in healthcare are heralding the emergence of big data and data analytics as supports for coordinated or accountable care, the reality of leveraging data and information in still-fragmented landscapes remains profoundly challenging. As the new report was released, lead author Metzger spoke with HCI Editor-in-Chief Mark Hagland regarding the goals, revelations, and implications of her group’s important new document. Below are excerpts from that interview.
How did you start down this path looking at external sources of patient information?
In any conversation or publication about accountable care or coordinated care, everyone is talking about “data analytics” or “population health analytics.” We all know quite a bit about what EHRs are likely to contribute today and when providers achieve HITECH Stage 2, but we also know that won’t be enough because patients will often cross institutional and, therefore, also EHR [electronic health record] boundaries. So we decided to look under the covers of the most likely other sources of information.
You’ve spoken of the “arm-waving” around data analytics. Obviously, analytics are important. But you believe that many healthcare IT leaders are underestimating the challenges involved. And obviously, it’s a very complex landscape out there, correct?
Well, I think it’s complex in many different ways. In any different coordinated care delivery organization, hopefully, all the clinical partners are participating in HITECH; but they aren’t all going to reach Stage 1 or Stage 2 at the same time; and even if they do, they won’t all have approached any given stage in the same way. So you’ve got a mix of conditions there. And then, even looking at a limited set of the most likely external sources that we looked at, you’re going to have a mix for different patients of what’s available and not available. Just to give one example, the eligibility verification information is really one of the only ways to know about patients who are showing up somewhere else, and they’re in trouble. And that isn’t even available for Medicare fee-for-service patients, because it’s not a requirement of that type of insurance coverage that there be any eligibility process.
The card the patient presents basically says they’re eligible. So the more deeply we got into this, the more we realized that, for any group of patients, there’s going to be a somewhat unique mix of external sources available to you. Also, getting access to some of those sources—for example, getting claims data from FFS Medicare—might be easier than with regard to a private insurer that’s not set up to give out that kind of information or doesn’t want to. So that’s a second type of mix.
And thirdly, if you think of patients in terms of their different health risks, you’re going to want information on them in different ways. In some cases, you’ll have such an urgent need that you’ll call people outside the organization; in other cases, you’re going to want to set things up so that someone calls you. And in the third instance, you may have an external source that is perfect for that need; let’s say for example, that you decide that it’s really critical for all your high-risk patients to know what their treatment compliance is. And one indicator will be whether they pick up their medications or not.