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Study: How are Providers and Payers Using Clinical Analytics?

March 9, 2011
by Jennifer Prestigiacomo
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HIMSS Analytics report studies payer/provider differences, barriers to usage

The top drivers for providers and payers for using and analyzing clinical data were Stage 1 meaningful use criteria, as well as a way to lower clinical costs, according to a new HIMSS Analytics (Chicago) whitepaper based on a 2011 annual study of payers' and providers' use of clinical data (sponsored by the San Diego, Calif.-based Anvita Health, released at this year’s HIMSS conference.

As in the 2010 study, respondents report that they currently use clinical data analytics to enhance patient care cost, safety, and efficiency, but increasingly, the view of quality is being framed within the context of meaningful use. This is leading healthcare organizations to evaluate how they are capturing and analyzing data.

Payers Ahead of Providers
Marc Holland, vice president of market research at HIMSS Analytics, says that findings this year were very consistent with what he and his colleagues have been seeing in the industry, with healthcare organizations using data more effectively to extract real value from it. He admits, though, that payers are still more sophisticated in their usage of clinical analytics than providers are.

“[Payers] have a vested interest in insuring that the care is delivered with a minimum of cost and a maximum of quality,” says Holland. “I think providers are not necessarily ignoring that, but haven’t had the data to do that effectively as the payers have. The payers have a leg up and a lead on the providers, but that gap is closing.”

Marc Holland

Proprietary HIEs Growing Faster
In the health information exchange (HIE) space, Holland says the study finds that policy initiatives by the federal government are showing evidence of spurring activity, and therefore, positively impacting quality of care. Holland notes that proprietary HIEs among health systems and their affiliated practices are growing at a faster pace than community exchanges between multiple hospitals.

Top Barriers to Using Data
Despite the fact that there has been a growth of five percent among hospitals in the past two years, according to data from the HIMSS Analytics Database, only 30 percent of U.S. hospitals presently use a clinical data warehouse/mining solution. Respondents to the study mentioned multiple barriers to using clinical data. The top barriers noted were:

• Getting data into the system: Relevant clinical data runs the gamut from handwritten clinician's notes on paper to codes on medical claims, and manually entering data is resource-intensive.
• Data mapping: Once data is in the system, it must be data-mapped for extraction to be made usable for analytics. Several respondents noted that this is a complex task, particularly when data is not captured in discrete data elements.
• Incomplete data: Respondents expressed concern that some data elements required for analysis might be missing as a result of an incomplete record, resulting in an inaccurate analysis.
• Multiple databases: Data required for a thorough analysis may be housed in multiple databases making the connection between databases a challenge.
• Translating the data into actionable intelligence: Turning clinical data into relevant data that a clinician can act upon and integrating that information into the workflow is a challenge particularly for health care provider organizations.

Holland says that bridging the incompleteness of the data was one of the most important challenges providers need to overcome. “If you have holes in that data, then the kind of analysis that you may need to do—in order to understand those differences in patterns in the data, and the contribution those differences between patients have on outcome, cost or quality—will be compromised if you don’t have all those underlying data to discern those differences.”

“Providers are coming to the realization that there’s this rich source of information that can be derived from these investments they’ve made and that they are looking for increasing ways to harness that,” Holland concludes. “I’m very encouraged by it.”


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