With the shift from fee-for-service to pay-for-performance, physicians are focused on improving quality of care and using population health management to achieve that goal.
Although more physicians than ever are using EHRs and have the ability to transfer and share information, healthcare is now "a data rich, information poor environment," says Tom Van Gilder, MD, JD, MPH, chief of medical services at Certify Data Systems.
By using EHRs, physicians are collecting more patient data. However, all of the data needs to be transformed into "information and information that can be acted on," says Dr. Van Gilder.
Data from many sources needs to be brought together for successful population health management, including EHR, pharmacy, and lab information. Once the information is gathered and any errors are corrected, Dr. Van Gilder says, it needs to be "presented within the cognitive workflow of a physician." "This has to occur so the data can be acted on."
If real-time data is what physicians need for population health management, what are the limitations to providing the information?
1. EHRs have limited capabilities. Some EHR systems are beginning to present real-time data to physicians. For instance, some systems have a pop up feature that informs the physician if a test, such as a diabetes test, needs to be done. However, many systems do not have these capabilities.
To solve this problem, there are some non-EHR businesses that are analyzing and presenting information back to physicians, but according to Dr. Van Gilder, some of the information can be dated, such as information from medical claims, which can be delayed weeks or even months.
Physicians having access to patient information at the point of care is vital for effective population health management. However, Dr. Van Gilder says "it is important to keep the physician-patient relationship in mind." "Sometimes we get caught up in bringing data together, and we forget the physician-patient interaction and the importance of it." There are times when an EHR or other technology can serve as a disruption, and although useful, "it is important to make sure any tools or technology enhances the physician-patient relationship," he says.
2. Fragmentation in healthcare. The care delivered by a primary care physician to a patient is only a small portion of total care, "especially for those with chronic conditions," says Dr. Van Gilder. To be successful with population health management, information needs to be interoperable by being brought from one system to another. Unfortunately, many systems do not have the mechanisms in place to do this, which prevents the sharing of patient information.
Dr. Van Gilder says "the change in healthcare delivery to accountable care organizations reduces fragmentation because patients are in a single system." Although patients are sometimes seen by a number of physicians, if they are part of an ACO their information will be easier to exchange.
3. Physicians need to look beyond the patient directly in front of them. Historically, "emphasis has been placed by physicians on taking time with patients in the moment," says Dr. Van Gilder. Although that way of providing care is effective in some cases, especially in caring for patients with acute issues, "it doesn't do as well when looking at patients' conditions over time or a whole population's health," he says. When physicians are only concerned with the patient in front of them, it does not lend itself to addressing population-wide needs.
More articles on population health:
Analytics in the era of value-based care
National Quality Forum seeks groups to test population management action guide
Should hospitals merge to improve care, lower costs?