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It's All in the Data

October 23, 2007
by Chris Kryder, M.D.
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How data mining can serve as an interim solution to national health records.

To make intelligent decisions and provide optimal care, physicians need access to each patient's medical history and current medical data. However, as patients increasingly visit with numerous specialists who rarely communicate with their primary care doctor, gaining access to that information becomes more and more challenging.

The onus has fallen on patients to manage their own records, but the average patient may not be able to recite their entire medical history or even the prescriptions they're currently taking — a problem that becomes even more difficult with an aging population.

To rectify this situation, the government has taken the first steps to create standards for electronic national health records, and has set a goal of having the system in — place by 2014. These guidelines would theoretically solve the communications problem by ensuring that data could be shared amongst doctors. However, with the healthcare system in its current fractured state, the number of parties involved, privacy issues, and the outstanding question of who will pay for it all, many believe that realistic hopes for national health records are decades away.

While we're waiting for national health records to materialize, many healthcare organizations are solving the communication gap today by leveraging the data and information that they already have.

More than 260 million individual payers currently fund the system, via payroll deductions or taxes. The health plans and Third Party Administrators that are the fiscal intermediaries between patients and providers hold a trove of data in the form of claims, pharmacy data, eligibility and other important information that can give a comprehensive view of a patient's care. The data just needs to be filtered and unlocked. By aggregating the data and applying predictive analytics and data mining, health plans and TPAs can help physicians do their job and force improved outcomes for their members.

Increasingly, healthcare organizations are adopting these methods in order to provide personal health records to individual subscribers and their dependents, and to enable them to provide preventative care in the form of disease management and care management programs.

As the data is unlocked, analyzed and turned into action, consumers and their agents — providers and case managers — gain a comprehensive view that was not previously available.

In addition, the concerns over personal privacy that come with making electronic health records standardized — one of the many points of contention in making national health records a reality — are no longer an issue. In order to provide a comprehensive view of a patient, preventative care, improve outcomes, and lower costs, that data doesn't need to be shared with other organizations. It just needs to be unlocked by the organizations that already have access to it, in order to pinpoint and act upon the useful information.

To solve the communications issues afflicting the healthcare industry, there is an absolute need for simplicity and for secure record sharing. Waiting for the bureaucracy to save costs and save lives through the implementation of national health records will not be an effective or timely resolution. Examining claims data—the only single source of financial and clinical data that exists in our multi — payer system—and providing top — line snapshots of this data to providers and consumers, with frank discussions on costs and options, can improve the process now.

Chris Kryder, M.D., is the founder and CEO of D2Hawkeye. He remains active as a clinical instructor at Harvard Medical School, and is a lecturer on the faculty in the HST Medical Engineering and Medical Physics program at MIT.