With the passage of health care reform legislation last month, attention has now turned from arguing its merits to understanding its practical implications. In the world of health information technology, or health IT, the electronic health record (EHR) is one focus of this attention, but applications that build on their widespread adoption are where the real transformation in health care will take place.
In 2009, there were more than 1 billion visits to physicians’ offices, outpatient hospitals and emergency rooms. Each visit represents a shoebox of clinical data that’s sitting dormant, untapped, and utterly disconnected from any other clinical data that person may have generated.
There are data in stacks of paper files in doctors’ offices and taking up entire floors of hospitals across the country, data in files submitted in medical claims, data in pharmacy claims, in lab records and so on. As clinical data are created, they remain in various forms, stored in isolated silos. The sum total of these data comprises a staggering amount of untapped actionable health intelligence.
But all that is changing. The American Recovery and Reinvestment Act (ARRA) provides $36 billion in incentives for physicians, hospitals and other health care providers to implement a digitized form of medical records. In digitized form, such data can be combined with data from prior visits and used to create a truer, more comprehensive picture of an individual patient. It also can be analyzed in thousands of ways to improve the quality of health care and lower costs.
Digitized clinical data can be analyzed to prevent adverse drug-related interactions, close critical gaps in care, and help those with a stake in health care—from health plans to hospitals to consumers—directly understand the individual and collective health of their constituencies, and create highly personalized treatment regimens.
It’s exciting, but it also can be overwhelming to contemplate both the volume of new data that will deluge the system and its ultimate value to the quality of health care. In fact, many companies I’ve met with – including leading health plan providers, pharmacy benefits managers and more – find themselves paralyzed by the opportunities presented by clinical analytics. Nearly any question they have about their population can be answered by the data at hand, but narrowing it down to the questions that matter most to their—or their customers’—business is the critical step. Prioritization, therefore, becomes the key to success.
The challenge they face is not just when, but how to use this data effectively. Is it important to know what percentage of your diabetic population is adhering to treatment? Is it even more important to understand the reasons behind non-adherence, so that you can build programs to address those reasons? Do you want to leverage patient data for more streamlined prior authorization processes? What potential drug contra-indications exist for your patient population? Where are the gaps in care, and how narrowly can you personalize the corresponding treatment options? The data are at hand to answer these questions, but only some will best serve a particular company’s needs.
Nearly any health care company responsible for a patient or provider touch point – from explanation of benefits to eligibility requests to filling a prescription – can use clinical data to improve the quality of care and to lower costs. And, if a health care company is willing to forgo the traditional boundaries that define its business, the leveraging of clinical data can generate significant competitive points of difference and add forward-looking dimensions to their value proposition. The use of analytics is so nascent that the first-to-market position is still open in most market segments.
At a recent Health Technology Investment Forum in San Francisco, investors highlighted the need to look beyond the EHR to the value that can be created by turning that data into actionable knowledge. As one venture capitalist noted, “If it’s not actionable, it has no use,” and that entrepreneurs need to prove what difference their data makes. That is indeed the challenge and the opportunity. The implementation of EHRs is not the finish line – it’s just the first step in what will be a radical and immensely transformative era for U.S. health care.
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