is only the muscle. Claims illustrate utilization trends and can provide the best picture of how to contain risk across the revenue cycle. Practices need a strong foundation in traditional revenue cycle. T ey need to be able to gain some margins so that they can start to begin to pay for all the initiatives that they need to launch under the patient-centered medical home (PCMH) or an accountable care umbrella. T ere is no better time than now to clean up fee for service, and it’s the fi rst step. T e second step is looking at your offi ce and asking yourself, “Am I ready to take on anything new?” In many instances, we’ve got nega- tive productivity in healthcare, and we need to fi x that – and we need to fi x that at a micro level. If you can get things fi nancially stable and performing optimally, then you can concentrate on clinical eff ectiveness.
Anil Jain, M.D., FACP, Senior Vice President & Chief Medical Information Offi cer, Explorys Inc.
At Explorys, we recommend that administrators and clinicians
fi rst identify the key strategic imperatives that will help their patients from an overall quality, cost and patient satisfaction perspective – to align themselves on the most important goals of the health system. T e second step is to identify the metrics that will measure progress toward those goals. Fortunately, healthcare leaders have many met- rics to choose from that have been nationally vetted and endorsed by organizations such as the National Quality Forum (NQF). Explorys, for example, has built a library of more than 700 metrics that allow administrators and clinicians to assess performance in a variety of areas from wellness to chronic disease, children to adults, offi ce setting to the operating room, etc. T e third step is to identify existing data sources such as elec-
tronic health records, billing or claims data, patient satisfaction data, etc. T e fourth step is to do a gap assessment to see if any of the metrics require data that is not already being collected or captured in some manner. If there are gaps, projects should be formulated to collect that data either by trained chart abstractors or by pro- viders at the point of care. T e fi fth step is to perform a baseline calculation of the metrics and validate the results (i.e., ensure that the metrics refl ect actual care). T e fi nal step is to share the metrics with providers and administrators, instill a culture of transparency and continuous improvement, and develop a plan to address gaps in quality. After implementing the plan, the process runs full circle, starting again at planning.
Dan Riskin, M.D., CEO, Health Fidelity
T e current approach of scaling manual systems and requiring the doctor to enter more and more information discretely through drop-downs and check boxes just won’t work. T e only reasonable approach is to use technology to do the tedious work. We should return to a rational and clear patient description directly from the physician and require the technology to fi gure out what the informa- tion means. T e technology must work for the clinicians rather than the other way around. Fortunately, vendors are already working on this, and together, they can provide powerful infrastructure to set a health system up for current and future needs.
Eric Mueller, Director, Product Management, Lumeris
Administrators and clinicians are currently collecting the right type of data. Biometric, social history, family history, diagnostic, procedure and medication data at a patient level are collected both in EMRs and, to some extent, through medical and pharmacy claims. T e challenge is integrating all of the available data and having the right tools to turn that data into usable information to enhance critical care decisions. T e key is not just gathering data, but extracting it and using it in a physician’s daily workfl ow. Currently, information is siloed and accessible and understand- able to only the business or IT analyst. It’s up to the analyst to know what information is important enough to send on to a health plan or system executive. We need to break this pattern. We need to use the right data in programs that use advanced analytics to create real-time
reports that can be used and understood by anyone in the healthcare system. In an ideal model, once a decision-maker receives a report about a physician’s generic dispense rate, for instance, they can send that exact report onto the physician. When the physician logs into her dashboard the next day, she sees that her generic dispense rate is low and begins correcting that in her daily workfl ow. Collecting the right data for the sake of collecting the right data does no good. It’s about collecting the right data, aggregat- ing that data and presenting it in a usable format that can impact healthcare decisions.
Bonnie Cassidy, Senior Director of HIM Innovation, Nuance Capturing the right data is central to maximizing an analytics
program, and there needs to be a balanced collection of demographic, clinical, revenue and compliance information. From a clinical per- spective, it is key to capture accurate health information data from electronic health records (EHRs), as well as medical images. T is data is central to recording the clinical codes needed to establish an accurate case mix index (CMI) that refl ects the true severity of illness of a patient population, which is essential for reporting quality measures. From an administrative perspective, capturing claims and cost information is vital to ensuring fi nancial integrity is maintained.
Tony Jones, M.D., CMO, Philips Healthcare’s Patient Care and Clinical Informatics’ Business Unit
Hospitals are already capturing much of the data that they need.
Unfortunately, the data is not in the same systems or easily shared to allow tools and algorithms to take full advantage of an analysis. Much (but not all) of the data that’s available is being captured today. T e next step is to interconnect the data housed in diff erent systems or to replicate the data in a cloud. Once that is done, it will be much easier to apply algorithms that can take advantage of this vast collection of information and detect patterns to guide more clinically and economically valuable decisions.
Karen Handmaker, MPP, Vice President, Population Health Strategies, Phytel
Administrators and clinicians need diff erent data for their re-
spective roles, but everyone needs complete, accurate and timely information. Ensuring that reports are trusted, reliable and actionable requires organizations to have strong policies and procedures related to the following: • Existing data capture. Use consistent locations in EMR for structured and scanned data (e.g., lab results, test orders, patient-reported data).
• New data capture. Create new structured fi elds rather than additional fl ow sheets for specifi c measures (e.g., fall risk as- sessment, Rx in care plan).
• Eliminating free text. Direct teams to use structured fi elds to collect data formerly entered as free text (e.g., tobacco cessa- tion counseling, follow-up for positive depression screening).
• Data clean-up as part of standard work. Assign staff to regularly review provider attribution, invalid data entries, and proper use of new workfl ows to enhance reliability. When practices have confi dence in the integrity of their data and
resulting reports, then they can move forward with taking action on the information. Administrators need to understand the health of their population and have confi dence that they can manage to specifi ed quality measures and savings targets when contracting with payers or considering forming an ACO. T ey also need to be able to easily generate the reports required under value-based care. Providers need to be able to easily identify those patients who are at risk of expensive, life-threatening acute episodes (such as recently discharged cardiac patients with multiple co-morbidities) so they can quickly intervene to maintain their health. And they need automation capabilities that can scale their limited workforce so they can engage as many high-risk patients as possible in the shortest time.
HMT HEALTH MANAGEMENT TECHNOLOGY January 2014 17