Becker's Hospital Review

42 Managing the Who, Where and When of Data — 3 Keys to Success in Value-Based Care By Brooke Murphy A s healthcare organizations begin to ap- ply analytics to care delivery, data has become a hospital's most valuable asset — and one of the most challenging to manage. Today, technology is driving new avenues of communication, which support the trans- formation of fee-for-service healthcare into collaborative medicine. Sharing patient data across multiple independent care settings can help physicians avoid duplicative or unneces- sary procedures and close gaps in care, thereby lowering costs and improving outcomes. Although exchanging medical information is key to facilitating more seamless and cost-ef- fective care delivery, it also presents a host of complex security, privacy and operational challenges traditional data-sharing models struggle to adequately or efficiently solve. "e complexities of today's healthcare data go beyond the capacities of the traditional point- to-point data model," especially when dealing with data on a large scale, says Arien Malec, senior vice president of Change Healthcare. Connecting data by manually matching source to source, one interface at a time, is neither cost-effective nor efficient, and can result in expensive, unruly ownership models that are difficult to sustain. Managing this data complexity in out- comes-based medicine requires forethought and consideration, as well as two specific IT criteria — scalable data acquisition and adap- tive data policy. is article defines and ex- amines the issues of data acquisition and data policy in value-based payment, as well as ineffi- ciencies in traditional data models. It identifies three criteria health systems should consider when choosing a data platform for managing value-based payment models. Defining the data challenge: Data ac- quisition and reuse Individual hospitals generate and store vast amounts of patient data every day. While this information is valuable for monitoring perfor- mance internally, it isn't adequate for making healthcare decisions for an entire population. Rather, gaining actionable insights from data requires assembling and analyzing the most complete and accurate data possible, drawing from a diverse array of sources to build a com- posite medical record. For most organizations, this means connecting to sources outside of their own four walls. "First and foremost you need the ability to get the data from all these different siloed entities, and everybody knows right now data acquisi- tion in healthcare is messy — it's poorly coor- dinated and oen requires a bunch of ... inter- faces," Mr. Malec says. e greatest stumbling block for many hospi- tal systems is their inability to cost-effectively acquire and scale data — either because the data are isolated in disparate or incompatible formats or because their existing infrastructure and IT tools lack the sophistication to scale be- tween multiple sources. For example, traditional point-to-point shar- ing models between systems, such as appli- cation program interfaces (APIs), are useful in isolated situations but infeasible on a large scale, as they must be built and custom fit to each individual technology. Every time new data sources are required due to changing reg- ulations, treatment protocols or quality metric definitions, data must be remapped and inte- grated. Manually, this lengthy process can take several months to more than a year. Using this IT model, mappings must be redone again and again as data models shi. "Point-to-point data acquisition works for da- ta-sharing for one particular use case. But if an organization wants to share and access the same data for a different purpose, they have to acquire the data all over again," Mr. Malec says. is becomes especially problematic as health systems begin taking on risk for populations. Consider that a single EHR from an indepen- dent physician's office represents just one por- tion of a patient's medical history. Patients are likely to see dozens of primary care providers throughout their lifetime in addition to multiple providers for behavioral health, care specialists and nurse practitioners. It is highly unlikely a single care setting or EHR possesses a patient's entire medical history, let alone the complete medical histories for an entire community. is is especially true for patients with complex or chronic disease who regularly receive care in multiple settings to manage their health. And clinical data is just half the story. In a value-based care model, health systems are re- sponsible for more than just health outcomes. ey are also evaluated according to cost-ef- fectiveness, patient satisfaction and efficiency, which requires keeping track of financial and operational data across facilities. Finding ways to acquire and scale data is in- tegral to outcomes-based medicine moving forward, Mr. Malec says. Repeatable data ac- quisition methods can accelerate what used to be a laborious and costly process of point-to- point integration by enabling hospitals to apply standard data mapping models. A solution that leverages a variety of data acquisition methods can reach through departmental silos and sys- tem barriers, to connect hospitals to the data they need, and drive insights from the new connections they make. Data policy: Managing the who, where and when of data Managing which healthcare partners can access which patient information for what purpose — known as "data-use policy" — is invaluable when dealing with patient information, espe- cially as health systems engage increasingly complex partnerships. Data policy is a technical term for an IT frame- work that gives users a high degree of control over their data sources. Specifically, data poli- cy enables users to manipulate who can access what data for what purpose and when. Con- trolling data access is essential for healthcare organizations, as some data are appropriate for one organization to see at one time, but may be inappropriate for another partner organization to see at a different time. Consider EHR data shared between a hospital and a physician group participating in an ACO. It's helpful and appropriate to share patient in- formation for that specific population when making healthcare decisions, such as planning interventions or offering new services. Howev- er, it is inappropriate for a hospital physician to access all of the patient records in the physician group's EHR for the purpose of poaching pro- spective patients. "[e hospital and physician group] are work- ing together for one purpose, but there may be other situations in which they're competing, and it's not appropriate from a HIPAA or busi- ness relationship perspective for all of that data to be accessible to either organization all the time," Mr. Malec says. As organizations establish new data sharing agreements with more providers for value-based care, the data needed to support these relation- ships grows increasingly complex. A solution that doesn't incorporate data use policies re- quires health systems to acquire the same data multiple times and store it in multiple ways to ensure that only the right data is seen by the right person for the right purposes of use. CONTRIBUTED CONTENT

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