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Paul Veronneau is a principal with PricewaterhouseCoopers' Health Industry Advisory Practice and leads the firm's U.S. payer practice
Secondary use of electronic data from claims and clinical sources will drive savings
IT MAKES COMPLETE SENSE TO MOVE patient records from paper to a digital filing system where information can be stored, shared and accessed. On the surface, Electronic Medical Records (EMRs) appear to be one of the most obvious ways of maximizing efficiency and delivering managed care's goal of high-quality care.
The greater payoff for the health system will be found in the secondary use of the data and how it is shared among payers, providers, pharmaceutical and life sciences companies and others throughout the system.
TRUE VALUE OF EMRS
Despite an intuitive appreciation, many providers are still struggling with the EMR value proposition. PricewaterhouseCoopers estimates that the average three-physician practice can expect to invest between $173,750 and $296,000 over two years to purchase and maintain an EMR system. The costs run into the tens of millions of dollars for large hospital systems.
Estimates say the conversion to digital records will save $12 billion over 10 years. But many providers see the dividends accruing to private and public payers. Clearly, this conundrum underscores the fact that realignment of financial incentives is some of the hardest work that still needs to be done.
Furthermore, the collection of patient health data is expected to explode over the next five years as the HITECH Act expands EMR adoption. But it is the secondary use of data that will bring the biggest payoff.
The "secondary use" of data is defined as clinical, financial, administrative and self-reported data, which is collected from electronic medical records, personal health records, insurance claims, clinical-trial information, billing information and other sources. The information is then de-identified, aggregated, analyzed and presented in a concise, actionable format for the purpose of improving health outcomes, reducing medical errors, predicting health trends and demonstrating the comparative value of drugs and treatments, among other benefits.
Imagine a time when a physician can prevent a chronic condition from becoming a catastrophic event because he has access to an analysis showing the efficacy of different treatment options across large populations. Imagine the use of predictive modeling to intervene before a claim is ever filed. Imagine a time when payers can easily track questionable filing patterns and identify fraudulent claims quickly.
In the future, the vast amount of data residing in the health system can be put to use to identify evidence-based best practices; monitor patient compliance; identify candidates for clinical trials or personalized medicine; better monitor after-market drug or device safety; and detect fraud. Equally important, secondary data can be used to manage finances and demonstrate value and quality in an era of pay for performance.