Authors: Robert Connely and Jon Zimmerman
Over the past decade, the healthcare industry has been on a wild ride of digitization and financial reform. Electronic health records (EHRs), new pay-for-performance models, and the pressures of consumerism have fundamentally altered the way payers, providers, patients, and regulators work together.
While we have made a great deal of progress in some areas, none of these stakeholders can yet claim indisputable success with achieving their goals. That is because the industry is still struggling with the basic definition of “value” and how to deliver it.
Across the industry, there is still a lot of waste, confusion, and frustration. Fortunately, there is also a lot we can do about it.
The first step is understanding the root cause of waste, poor experiences, and missed opportunities to get ahead of rising risks and unnecessary utilization. Health data fragmentation is at the core of the problem. Without the ability to access and act upon relevant, complete, timely, and targeted data, providers and payers cannot deliver high quality care in a proactive and personalized manner.
To overcome data fragmentation and generate better outcomes across the care continuum, we must reassess the way we interact with health information so that we can get truly actionable on behalf of patients and start delivering value across the board.
Defining the meaning of “value” in healthcare
“Value” is the belief that the resources invested in a task are worth the outcome. Right now, healthcare stakeholders put an enormous amount of resources – including time, money, and cognitive effort – into the healthcare process, but the outcomes are not what they should be.
Healthcare spending runs into the trillions of dollars each year, consuming 18 percent of the United States’ annual gross domestic product (GDP). Close to a third of this spending can be considered wasteful, including more than $200 billion spent on clinical care failures and $265 billion spent on administrative complexity.
Wasteful spending translates into poor health outcomes for patients. Despite dramatically higher spending than other developed nations, the US ranks lowest in life expectancy and highest in the burdens of chronic disease and avoidable deaths.
Healthcare providers are also struggling with the status quo. Despite billions of dollars spent to implement EHRs and other health IT tools, user experiences ratings are often dismal. In one recent usability survey, physicians overwhelmingly gave an “F” grade to their EHRs and directly linked their poor experiences to burnout.
To achieve value, we must raise the bar. Healthcare stakeholders must work together to align incentives to reduce waste and improve the experience of delivering care – then translate those changes into better outcomes for patients.
Understanding the role of data fragmentation in healthcare’s fight for value
Accountable care organizations (ACOs) and other value-based care strategies have started to move the industry in the right direction by bringing providers and payers in line with shared financial goals. However, providers still lack a simple, intuitive way to engage with actionable clinical data to make informed decisions and meet their quality and spending benchmarks.
Data fragmentation is largely to blame.
Fragmentation is a function of the way the healthcare system began its digitization journey. In the early 2010s, the EHR Incentive Programs focused on convincing providers to eschew their stagnant paper filing cabinets and replace them with very similar computerized filing cabinets instead.
The first wave of EHR implementations happened several years before we started to build momentum behind value-based care models that require comprehensive insights about patients and populations. The lag created a challenging disconnect between what EHR technology was designed to do and what we really need it to do today.
Despite a heavy emphasis on improving interoperability and implementing standards in recent years, key data elements remain siloed and inaccessible in little pockets across thousands of entities nationwide.
In 2019, the Center for Connected Medicine found that only a third of survey respondents believe they can successfully exchange data with other health systems and industry partners. Only 59 percent feel they are interoperable with their payers. Perhaps even more remarkably, just 69 percent can access all the data they need from within their very own organization.
At the same time, data analytics algorithms and artificial intelligence tools have advanced at light speed, creating attractive opportunities to apply evidence-based guidelines to care and effectively manage populations at scale. But without the rich data assets required to feed these innovative models, even the best analytics will fall short of expectations.
The result is a strange sort of limbo for providers, payers, and patients. While the potential to reduce waste and achieve value exists close at hand, data fragmentation keeps it tantalizingly out of reach. However, once we build the right bridges between the current state and our vision for a higher-value future, healthcare will be able to win the battle against wasted effort and unacceptable clinical outcomes.
Identifying the solutions to heal healthcare’s data fragmentation woes
Solving the value problem in healthcare requires a two-part solution.
The first task is to break down the walls between data siloes and create smoother pathways for data to get where it needs to go in a private, secure, and appropriate manner. The second is to generate value by turning that data into actionable, precision insights delivered when and where they are needed.
To the credit of regulators, health IT vendors, and a cadre of very dedicated individuals from across the industry, interoperability has come a long way in a relatively short period of time. Standards are starting to take hold in the right places and key players are adapting their business strategies to embrace a more interconnected environment.
The lynchpin for widespread success, however, lies in the second part of the solution. It simply won’t do to trade insufficient access to information with unmanageable information overload. The data must be curated and presented in a way that actively supports easier, quicker, more informed decision-making.
What healthcare providers need is a “personal assistant” that can anticipate their information needs, retrieve data intelligently from wherever it resides, and present the results in a personalized, contextualized data stream without effort on the part of the user. The automated virtual assistant must work effectively within the organization’s current health IT environment while going beyond the basic functions of existing systems.
This approach will reduce wasted time and effort spent on identifying data needs, combing through multiple portals or databases for the information, and manually synthesizing the results into a usable conclusion. As a result, providers will have the tools to get ahead of health issues, close gaps in care, reduce unnecessary or duplicative services, and create better experiences for everyone involved in the care process.
Health IT solutions companies will play a critical role in bringing this vision to life by adopting innovative strategies for augmenting the user experience with smart data delivery tools. When EHRs begin to marry more comprehensive data access with intuitive, contextualized user experiences, clinicians and patients will benefit immediately.
Healthcare is ready to take its next great leap toward value. By focusing on healing the deep wounds of data fragmentation, we will be able to cut down on waste, fully leverage new technologies, and foster a more productive, coordinated, and valuable healthcare system for all.