Data Integration is Critical to a Value-Based Transformation

As the healthcare industry begins to transform to the new Value-Based model, there is now much greater emphasis on quality patient care. The effort by current health plans, health systems, and providers to deliver quality patient care based on current available data is difficult at best and is almost impossible to directly measure in terms of diagnostic and treatment effectiveness. Despite a heavy investment in information systems and electronic health records (EHRs) over the past 25 years, we still have not achieved the level of data integration over the continuum of care that is necessary to improve patient outcomes.

In the new Value-Based model there is considerable focus being placed on using analytics technologies and population health information in order to create better patient outcomes and deliver more intelligence to the provider. While this is a worthy goal, there remains the problem of how to integrate patient data stored in a practice’s EHRs with the appropriate claims systems data and then aggregate it based on a specific patient population at the practice level. This is easier said than done, but the successful conversion of data into meaningful information would effectively lead to better care at a lower cost.

I submit that current healthcare data for the most part resident in the practice EHR, the hospital (facility) patient record, and the health plan subscriber/member database is neither sufficiently integrated nor properly validated to be effectively used to achieve the Value-Based Model vision of delivering a higher quality of patient care.

I further submit that the industry needs to define a common healthcare patient data model (not a record format) that is reliable, complete, and valid. If this can be successfully addressed, then the healthcare industry can achieve the desired vision and results by delivering more comprehensive information for provider diagnostic decision support, leading to a higher and more successful level of patient care.

Therefore, we would like to begin a dialog around the following:

  • What can the industry do to move health information technology vendors toward common open data standards for effective clinical and administrative information integration?
  • How does the data and information integration gridlock move to the forefront of Value-Based Care transformation planning?
  • Why hasn’t the CMS Health Information Technology Standards committee addressed the mandated interoperability between Certified Electronic Health Records, which is one of the root causes of this problem?

Please join me in this much needed dialog. Do you agree that we need a common healthcare patient data model? If so, do you think CMS, hospitals, providers, or payers should be responsible for designing it?

HCIM President and CEO Michael Wilson provided his insight into this healthcare data challenge in a Healthcare Tech Outlook Magazine article entitled “The New Health Information Integration Challenge – Opportunity or Obstacle?

If you’d like help transitioning to Value-Based Healthcare, read about HCIM’s Strategic Consulting services.

Dr. Bill Bysinger

Bill Bysinger, Ph.D., MBA
HCIM Sr. Strategic Adviser

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About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.