Data: The gateway to improving health care quality and value

Depending on your perspective, the controversial EMR can be a trusted friend

By Mark Wendling, MD, Executive Director of Valley Preferred, and a family medicine physician

“The goal now is to understand as much about a patient as possible, as early in their life as possible – hopefully picking up warning signs of serious illness at an early enough stage that treatment is far more simple (and less expensive) than if it had not been spotted until later.”

How Big Data Is Changing Healthcare – Forbes

Data is abundant these days, especially in health care. Many patients are accustomed to members of their care team entering information into a computer during a conversation, both in an inpatient or outpatient setting. The electronic medical record, or EMR, has become as common in the office as the blood pressure cuff. However, EMRs are not popular among all practitioners.

Some say that it can take two hours to record all the vital information related to a one-hour patient visit. Clinicians often end up entering these facts after hours, when they should be enjoying some down time. Fortunately, health care decision-makers are working on ways to mitigate the pressure and time demands that accompany EMR data collection. These efforts are forging solutions that will reduce the volume, spread the responsibility, and allow clinicians to focus on their own well-being while not in the office.

A method behind the madness

Despite its critics, the EMR is today’s connective tissue between health care’s many arms that move together to help a patient in need. Looking at the overall picture, you could say that the ability to sustain health care as we know it comes down to data, universally housed in the EMR.

It all starts in the physician’s office or in the hospital room. This is where a patient is seen and intervention, improvement, and insurance risk calculations begin. Sophisticated health care data analytics may incorporate the additional dimension of claims data, which when combined with EMR data, is capable of producing a 360-degree view of the patient’s health, including medical history information that the caregiver may not have already had.

Higher level insights into a physician’s patient panel are possible through the richness of data from the EMR/insurance claims combination. Clinicians can see where there may be gaps in care, if they are coding accurately, standard costs for an entire episode of care, and which patients are considered high risk and rising risk. This kind of targeted care certainly benefits the patient, and in the long run, helps optimize the health of a certain population as a whole.

Catching and correcting problems

As an example of how data can work directly for patients, let’s anonymously look at two patients, we’ll call them Mr. and Mrs. Jones. Mrs. Jones, 48, had a major heart attack, and while still in the open-heart unit, suffered a massive stroke. Meanwhile, Mr. Jones, who was the caregiver for his wife, had heart disease and ended up in the hospital at the same time she did.

When they were discharged, Mr. and Mrs. Jones’ medications were reviewed. To the caregivers’ dismay, the medications on record with the insurer were different than what was on their medical charts and were also different from what their primary care doctor had recorded. The discrepancies were discovered only because of data sharing. The lack of agreement in the respective records instantly raised a red flag. Upon review, it was discovered that the couple was taking multiple drugs that had the same drug classifications and shouldn’t be taken at the same time. As you can imagine, this could be harmful, if not potentially deadly.

In addition, it came to the team’s attention that Mr. Jones could not read the labels on his pill bottles. They helped him get an appointment with a retinal specialist who discovered severe bleeding at the rear of his eye. This was likely caused by the duplicative blood thinners he was taking. The specialist was able to stop the blood thinner and treat his eye, saving Mr. Jones from even further serious conditions such as significant bleeding and blindness.

Everyone in that chain of events was able to help Mr. and Mrs. Jones more effectively due to sharing data that allowed them to spot a problem sooner rather than later.

We’ve only just begun

With all the potential unlocked through EMR, the evolution needs to continue to enable optimal care of patients – and of physicians. Data has added significant time and administrative complexity to the physician’s day; however, its intrinsic value has multiplied the caregiver’s capabilities.

Through innovative sharing of patient records and collaboration between people and organizations, health care data pinpoints disease, disease risk, intervention opportunities, tracks results, and can highlight problems that could otherwise go unnoticed. This is how steps toward improvement are identified and acted upon, and consequently, how higher quality health care is achieved.

The cumulative result of this process is value based, higher quality, targeted care and reduction of unnecessary tests and procedures. This is also the path to shared savings with payer partners and positive value-based outcomes for hospitals and other health care organizations. And those actions combined, according to many industry experts, are the key to a sustainable health care system.