The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

 

Using Data to Improve Healthcare

By Truven Staff
Mike Taylor imageAs other have pointed out repeatedly, our healthcare system is badly broken. In fact, we don’t have a healthcare system in this country – it’s a series of independent businesses, often competing with each other in the goal of making more profit. The three constituencies in the healthcare business are the customers (patients), the providers (doctors and hospitals), and the payers (health plans, employers and the government). These three groups all have perfectly misaligned incentives. Patients want care at minimal cost, providers make more money by providing more care (whether it is needed or not), and payers want to minimize payments. The payment mechanism drives more care at higher cost, and the result is the U.S. pays 18% of its GDP for healthcare – more than twice as much as any other country on the planet.

How does smarter use of data help this picture? In my opinion, more intelligent use of data is an important part of the answer. Data is a powerful tool to help physicians make better decisions. In the hospital setting, physicians should have access to ALL of a patient’s medical record, not just information gathered during a single hospital stay. In most Emergency Departments, doctors often don’t have unfettered access to outpatient medical records that may provide important clues to making correct diagnoses. Tests are needlessly repeated, incorrect medications are given and diagnostic errors are made all too often.  Electronic medical records (EMRs) should be helping this problem, but unfortunately most EMRs are simply digitized versions of the old paper record. We need EMRs to be longitudinal electronic health records, aggregating all of a person’s health information into a single record to be used by all providers of care. A unified health record then needs analytic tools to be able to use the comprehensive record to improve care, provide guidelines for evidence-based medical care, prevent incorrect medication use, stop dosing errors, and have prompts in the analytic tool to stop repeat tests and x-rays- in sum, improve the care.

A unified, single, health record for a patient would be a great tool to help improve care, but in the U.S., we have more fundamental problems than a lack of accessible data. In today’s residency training programs, physicians should be taught how to use the data and EMRs to make better decisions. An evaluation of a patient should always start with the physician sitting with the patient, taking a probing history by knowing what questions to ask, and how to elicit symptoms. This information is supplemented by knowing how to properly examine a patient and understand how to put all the information together to formulate a diagnosis. We cannot rely on an EMR or CT scans to do this job – it must start with a thorough history and a proper physical. One of the most impactful lessons I was taught in residency was that if I finished taking a patient’s medical history and yet still didn’t have a series of probable diagnoses to consider, I needed to take more history. Unfortunately, in today’s hospitals, finding a diagnosis is all too often done by ordering more testing, and in a fee-for-service payment environment, more testing means more revenue. More procedures mean more revenue. Hospitals and physicians should be paid for providing a higher level of quality, not by volume. 

I am a strong advocate of using medical data and providing better analytic tools to help physicians and patients, but tools are just tools. Physicians and other caregivers need these tools to improve care, but providers of care also need to listen to patients, think critically in making diagnostic assessments, care passionately about improving care, and use sound judgment at all times. They cannot be effective in a fee-for-service world. Providers do need to improve the care they provide, but the U.S. needs a sound healthcare strategy to solve our issues. Technology is part of that solution.

Michael L. Taylor, MD, FACP
Chief Medical Officer

Using Big Data in the Best Interest of the Patient

By Truven Staff
Kathleen Foley imageThe recent USA Today article, ‘Analysis of huge data sets will reshape health care’ highlighted many of the ways in which ‘big data’ are being used to improve healthcare in the United States. The linkage of data across hospitals, insurance claims, electronic medical record systems, and genomics databases are helping to identify more efficient treatments and high-cost patients, and determine best practices for treating patients with particular conditions.

Despite these benefits and many others, the creation of ‘big data’ assets is fraught with difficulties that may be limiting the true potential of existing data. In addition to privacy concerns and constraints which limit what types of data can be linked and by whom, there are issues around ownership and access to big data. Who should pay for the creation of these large data assets, and once created, who should have access? The answers are not straightforward and require the development of trust and a shared vision across many stakeholders.

Truven Health is actively involved in the development of data infrastructures to both create big data and facilitate analyses while guiding appropriate interpretation. One of the first areas of focus is the creation of cancer data assets. To facilitate research that will truly answer important questions for patients, providers, and payers, we are exploring all avenues for linking various data from claims data to EMRs to cancer registries. Only by combining data sources can we finally begin to address questions that will get the right treatment to the right patient at the right time. It isn’t just about generating big data, it’s also about knowing how to use it to generate knowledge that is a game changer.

Kathleen Foley
Senior Director, Strategic Consulting (Life Sciences)

Digital Health Records: Lower costs, better quality – eventually

By Truven Staff
Bill Bithoney imageBetween 2011 and 2012 the federal government spent over $9.2 billion for Meaningful Use (MU) incentives, which are part of a comprehensive plan to decrease the cost of healthcare as well is improve its effectiveness and quality. As of December 2012 just over half of US hospitals have attested to MU Stage I, and an additional $9 billion in incentive payments will go out as the remaining half reach this milestone.
 
Meaningful Use I, and later MU II, should be viewed as laying the groundwork for electronic health record interventions which may ultimately result in improved health care. For now, though, growing adoption of digital health records seems to be accompanied by higher provider charges: CMS has documented increases approaching 4%.  This may be due in large part to electronic health records’ ability to quickly document more precisely and completely all types of care provided, and to generate bills at the highest possible level of reimbursement.  CMS and other health insurers are actively investigating this issue.



Enhancing Analytical Capability

By Truven Staff
Robert Sutter imageWith the advent of electronic health records healthcare providers are in the midst of an unprecedented digital revolution - They are becoming awash with data. The question they face is: How to harness all of this data in a manner that facilitates enhancing organizational performance?

The first step to answering this question is to perform an organizational assessment to understand the current state of the organization's analytical capabilities relative to the five stages depicted in Table 1. With that accomplished, the organization can plot a course to advance to the successively higher stages of analytical competency - which will facilitate achieving higher levels of organizational performance.

Table 1


Stage
Analytical Objective
Analytical Process
Skills
Sponsorship
Culture
1:Analytically Impaired
None established
Non-existent
Absent
Absent
Adverse to fact based decision making
2: Localized Analytics
Sparse, not integrated or aligned
Narrow focus, fragmented
Isolated, minimal
Isolated, not uniform
Craves for more and better data
3. Analytical Aspirations
Organizational performance metrics established
Fragmented, not aligned
Analysts to produce dashboards
Early stage of awareness of the advantages of analytics
Senior management support for fact-based decision making
4: Analytical Company
Develop an integrated analytics program
Some integrated, aligned analytics
Analysts with moderate skills but not aligned
Generalized senior management support
Change management underway to transform into fact-based culture
5. Analytical Competitor
Well developed and focused
Fully integrated, aligned analytics
Advanced: predictive modeling, data mining
Genuinely committed
Fact-based decision making is the way business is conducted


In order to be successful at becoming an analytical competitor an organization must have a senior management team that is genuinely committed to fact-based decision making. In addition, a well defined strategy is required to provide direction on the goals to be accomplished, the analytic questions to be answered and how to allocate analytical resources.

Robert Sutter, RN MBA MHA
Consultant


Using Data: Turning Information into Action

By Truven Staff
Mike Taylor imageProfessionals within the health care system are ‘awash’ in data, but that does not necessarily translate into actionable information.  As chief medical officer at Truven Health Analytics, I see this disconnect at all levels. Doctors using electronic medical records (EMRs) still have difficulty understanding the complete risk profile of their patients. Seemingly easy questions like: which of my patients need help to quit smoking? , or which of my patients with diabetes are not at goal for blood pressure? EMRs are good data collection tools, but may not always be effective in turning data into actionable information.
Employers are facing similar difficulties in their role of paying for health care for their employees. Health reform is a reality, and 2014 will be a year of major change and disruption. Employers are struggling to understand how they should use their health cost data to make good decisions about offering exchanges in place of traditional insurance for their employees. They need to know how employees can make better decisions about the best medical coverage plan for their families.
EMRs and databases seem to offer the hope of data-driven solutions, but having the data is not enough.  EMRs are useful tools, and are helpful in tracking a patient’s medical care. However, EMRs are not the best solution to understand the population for which a physician is caring.  Cost reports will not be up to the task in helping an employer understand which insurance products to offer their employees. Hospitals and health systems need help in determining how to succeed with new payment models that completely change their business strategy.

Answering these important healthcare questions requires more than having the data; answers require a deep understanding of content and context of the data, and thoughtful and complete analysis of the data. At Truven Health Analytics, this is the role we play as we help our clients make important decisions. With new models of health care payment such as Accountable Care Organizations (ACOs), bundled payment and risk contracting, employers, hospitals and health systems have a greater need than ever to understand what the data are telling them.  “Big Data” is not just a new buzzword—it is a necessary source of new data needed throughout all parts of the health system.

Michael L Taylor, MD FACP
Chief Medical Officer

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