Healthcare providers and payers face complex challenges when trying to maximize the value of their clinical data, but their expectations for clinical analytics vary significantly, according to a new study.
"Can Organizations Maximize Clinical Data," was conducted by HIMSS Analytics and sponsored by San Diego-based clinical analytics company Anvita Health.
HIMSS Analytics conducted a focus group study of chief medical officers and chief medical informatics officers at payer and provider organizations. The study examines how members of each group define clinical analytics, how they analyze clinical data, which tools they use to analyze the data, and the challenges of using clinical data to improve their business.
"Anvita Health sponsored this study to gauge the readiness of the payer and provider markets for the onslaught of new data that will come from rapid adoption of electronic medical records and medical devices," said Anvita Health CEO Richard Noffsinger.
"We wanted to uncover the disparities in the understanding and use of available data today, and bring to the surface the shared pain points between the two groups."
Limited expectations
Most of the study participants indicated they are collecting and leveraging clinical and/or claims data to enhance patient care, cost, safety and efficiency, and data are examined on a variety of levels:
Evaluating a specific patient or member
Evaluating a population
Evaluating a specific provider or provider network
Evaluating prevalence or treatment of a specific condition, such as diabetes or hypertension
"A key finding for us was that both payers and providers had limited expectations for how clinical analytics could improve the quality of patient care – especially at the point of care – and lower costs through that improved quality," said Noffsinger. "Comprehensive real-time analytics can take these stakeholders beyond just evaluation, and provide a blueprint for action by physicians, care managers and others in the care continuum."
Hurdles to better use of data
When asked about obstacles for better use of clinical data within their organizations, participants provided a core list of common challenges:
Payers:
Clinical data exists in multiple codes and formats resulting in the need to map varying administrative or claims codes to a common language for analysis.
The process of clinical analysis, from data input to data integration to data analysis was perceived as cost-prohibitive, with the benefit falling short of the expense.
Providers:
Clinical data appears in multiple places, including notes on paper. Capturing discrete patient data and entering that data in a format that's computable was perceived as a daunting, resource-intensive task.
Some critical data elements for sound clinical analysis are missing because they were captured in incompatible formats (e.g., lab values captured off-site not seamlessly transferred to an on-line system).
"These challenges are consistent with what we've seen and heard from our payer and provider customers," said Noffsinger. "Interoperability of data is a hurdle, but it's not insurmountable."
Little use for decision-making
The two groups reported that most clinical data was analyzed retrospectively. In addition, the study found little use of data for real-time decision making, even with significant interest in using clinical data to drive a clinician's decision in real time at the point of care. The implementation of meaningful use guidelines will begin to address this challenge.
Both groups perceived clinical analytics as a tool to manage risks as reimbursement structures shift toward an outcomes-based focus and away from volume of care.
And while both the healthcare provider and payer participants recognized that ARRA-based incentives and related meaningful use requirements will drive the need for more sophisticated clinical analytics, the payer group, in particular, expects that that this next generation of clinical analytics will generate information that will drive high quality, cost-effective care.
"The ability to access and interpret clinical data in real-time can help clinicians and other healthcare professionals evaluate and enhance patient care, healthcare costs and overall efficiency," says John P. Hoyt, executive vice president, organizational services at HIMSS. "The results of this study identified areas of improvement for data capture and data access so that clinical analytics become a more valuable tool for healthcare organizations."
