- Slow and uneven progress towards seamless health data interoperability is making it difficult for healthcare organizations to access the data they need for population health management, according to the 2018 CHIME Most Wired trends survey.
The survey, previously conducted by the American Hospital Association, found that adoption of care coordination and population management tools has been relatively slow, hampered by data aggregation issues and interoperability concerns.
As a result, providers are having difficulty identifying gaps in care at the point of service, generating actionable insights into value-based care, and comparing quality and performance to evidence-based standards.
Integration and interoperability are key pain points for many organizations, although the industry has made progress over the past few years, CHIME says.
Using desktop applications, providers can easily access patient histories, nursing notes, order sets, operative notes, medication reconciliation data, imaging data, CPOE data, clinical summaries, discharge instructions, and care plans.
However, only half of physicians can view these data elements on the go through mobile applications.
And leveraging these data assets for population health management and care coordination isn’t always easy.
Only a quarter of participating organizations have the capability to combine clinical data, billing data, health information exchange (HIE) network data, and patient registries into a comprehensive patient snapshot at the point of care, the survey found.
“Adoption of technology to help with value-based care has been slow in both the clinical and the financial arenas, though more progress has been made on the clinical side,” the report says.
“As organizations have explored what is possible with population health management, many have learned that there is more work to be done to truly achieve value-based care.”
Engaging in population health management becomes more difficult when less data is available, the poll found.
Organizations with access to clinical, billing, HIE, and patient registry data were able to complete a majority of core tasks, such as risk stratification and identifying patients for outreach, highlighting gaps in care, creating community health records, and aligning clinical and financial risk measures.
But when registry data wasn’t available, fewer providers could identify care gaps, compare quality and performance, and gain insights into value-based care metrics.
With just clinical and billing data on hand, most organizations could still conduct risk stratification, but less than 70 percent of providers could engage in more advanced population health skills.
Operationalizing effective chronic disease management programs is also slow going, the survey found, due to the widespread inability to integrate patient-generated health data into the health IT ecosystem.
Even organizations with real-time care management tools and automated ingestion of data from internet-collected home monitoring devices have only developed robust at-home chronic disease management strategies for a handful of high-impact conditions, such as diabetes, congestive heart failure, hypertension, and COPD.
Less than a quarter of organizations without these advanced collection strategies can offer at-home chronic condition monitoring programs for the vast majority of common conditions, including behavioral health needs.
Organizations are also struggling to ingest data streams from business partners across the care continuum.
More than 80 percent can consume discrete data elements from external hospital systems and physician practices, but the success rate tapers off sharply for home health agencies and skilled nursing facilities.
Just 60 percent of providers can consume data from long-term care facilities and home healthcare entities, leaving worrisome gaps in information for patients with complex conditions and chronic care needs.
Integration with substance abuse monitoring tools such as state-level prescription drug monitoring program (PDMP) databases is also on the low side.
Only 48 percent of organizations have connected their e-prescribing tools to their local PDMPs, limiting visibility into potential misuse or overuse of opioids and other dangerous substances.
Organizations are also finding it challenging to gain insights into the financial components of value-based care.
While three-quarters feel comfortable with their retrospective financial analytics capabilities, only 43 percent are able to identify or track patient conditions related to value-based care contracts in real-time.
Managing bundled payments is also difficult for around 60 percent of respondents, even though 70 percent stated that they have the capability to calculate total cost of care across care settings.
A lack of training and education about how to work with data may be contributing to some of these shortfalls, the survey indicated.
Nearly all of the participants have training programs for how to use EHRs and CPOE tools, yet only 63 percent of organizations offer data analytics training to their clinicians.
On the brighter side, however, patients are being given access to their own data – and they know how to use it.
Meaningful use has effectively driven adoption of patient portal technologies, resulting in near-universal access to test results and visit summaries.
Seventy-two percent of patients can share hospital admissions information with another provider through their portals, potentially helping to close some gaps, while just over half can provide medical history elements that can be automatically added to the EHR.
Ninety percent of organizations now offer mobile patient portals to their consumers, and 73 percent can securely message with patients through cell phones and tablets.
Convenience features such as online prescription renewals, online bill pay, and self-scheduling for appointments are also becoming increasingly common as patient portals become more mature.
Providers will need to continue to develop both patient-facing and provider-facing data integration and access tools if they are to succeed in a population health environment.
“Key capabilities that the industry has the opportunity to increase adoption of include integrating clinical and claims data, tracking quality of care across networks, aggregating data to create a community health record, using analytics to measure value-based care, and synchronizing clinical and financial risk measures,” CHIME says.
“By investing in robust infrastructures that can support and facilitate communication in the complex healthcare environment, organizations can make better data-driven decisions and achieve greater outcomes.”