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The solution to connecting streams of data in differing formats is a workflow system that can normalize data and track it to a plan member.
The American Recovery and Reinvestment Act creates funding and incentives for healthcare professionals who adopt electronic health records (EHRs) and abide by the concept of "meaningful use".
Federal legislation promoting EHRs is based on the principles that they secure patient information, cut down on healthcare costs, and improve patient care.
Starting in 2015, penalties are likely to be levied on entities dealing with patient healthcare data that have not upgraded to EHR technologies. Most of the penalties will be levied in the form of reduced Medicare and Medicaid reimbursements.
The increased adoption of EHRs by physicians, healthcare organizations and their related business associates is now a certainty, but a major challenge is the ability to capture feeds in many different data formats and merge the data into business intelligence analytic tools.
For instance, a health plan member can have services provided by physicians, labs, pharmacy, hospitals, mental health providers and others. Even if care is being delivered by an accountable care organization, the data will be fragmented. In order for the data to be useful, it needs to combine the data feeds into a patient-centric EHR.
The solution is a workflow system that can normalize the data and track all incoming data to a plan member. Every day, new analytic tools emerge that can take patient-centric EHR data and apply algorithms to look for errors and omissions in care, contra-drug interactions, prescription drug compliance, age-triggered tests or examinations, and more. The only real solution for connecting all of this data to a patient is to have a robust workflow management system that acts as the traffic cop and delivers the data to the right source at the right time.
Patient-centric data needs to reside on a workflow framework that allows the health plan to work collaboratively with the provider to improve quality of care and safety for the member, and allow information to be exchanged back to the provider. There are a number of data elements that have to be present to accomplish this, and they are available today.
To begin with, when a health plan receives data, a workflow tool needs to first identify that the data belongs to an actual plan member. One way to eliminate misdirected data is to have a robust eligibility system that interacts with the workflow framework.
There also needs to be a provider validation tool that interacts through the workflow framework and identifies the most current provider information. The workflow management tool must also have the ability to log the intake and delivery of data, and track that the discovered outcome was acted on.
There are many care management tools that are being used in the health plan industry today. Workflow management systems that can track claim, eligibility and provider data allow managers to react to changes in care almost in real time.
A health plan that uses the right workflow management tool, populating and then using the data in an EHR, will result in penalty avoidance and the delivery of more informed member care.
Bruce Lefco is president of Invidasys, a health information management company.