The United States spends a lot on healthcare. In fact, in administrative costs alone, we spend more than four times the average per capita than other wealthy countries and three times more than Germany, the country with the second-highest costs. One would hope that the USA would get better healthcare outcomes with all that additional spending. Unfortunately, that’s not the case. Again, among developed nations, we’re in the bottom half for infant mortality, life expectancy, safety during childbirth, and many other measures.
In a nutshell, there’s a ton of opportunity to streamline and simplify healthcare administration processes. And some of the lowest hanging fruit for streamlining and simplification lies in health data and healthcare reporting. Modern healthcare systems have a lot of data, but instead of being stored in one common repository, it’s stored in a myriad of disconnected silos, often spread across multiple buildings that may not even be on the same campus.
Accurate reporting is essential to the success of a practice or hospital. Without it, neither the administration nor healthcare providers have any objective information with which to manage success and, in some cases, operate at all. These reports include:
Patient billing: These reports identify what care needs to be billed to whom, the split for payment between different payers (insurance, government, and/or the patient), and whether payments are up to date.
Nursing reports: Nurses are currently scarce and often overworked. So it’s never been more important for nurses to have current, accurate information on the care each patient needs to receive. In this way, not only will nurses remain abreast of any changes to their patients’ treatment, but it will also ensure continuity of care when the shift changes and a new nurse takes over.
Cost and quality reports to the Center for Medicare Services (CMS): Any healthcare organization participating in the quality payment program — which adjusts the rate of Medicare payments for services commensurate with the quality of care at the best cost — must send annual reports to CMS. These reports of retrospective data will inform payment models for the following year.
Daily operational reports: These reports measure key performance indicators — throughput in the emergency department, patient satisfaction, quality of care, productivity, etc. — on a daily basis so leadership and managers can identify areas of concern and take action to ensure they’re meeting their goals. They also benchmark progress over time to identify trends and best practices
Of course, this just scratches the surface of the reports that a healthcare organization creates. The point is that healthcare organizations need the ability to access large amounts of data in a comprehensive fashion and, in some cases, such as nursing reports, they need to be able to do so in near real-time.
Challenges to data management and reporting
That’s a tall order for most healthcare organizations today. For starters, most healthcare organizations have purchased gigantic electronic health records (EHR) packages for thousands of dollars, and many of them had to go without any customization to meet the unique needs of their institutions. And, frankly, even those that can afford customization often discover that the software still doesn’t deliver all the capabilities they require, which means they have to buy separate point solutions to address these functions and they may or may not integrate well with the main EHR platform.
But EHR doesn’t cover all the data that healthcare organizations need to access. The lab requisitioning system often sits outside the EHR, as does the pharmacy dispensing system. And time sheets? That data is never in the EHR but is instead in the human resources systems.
These disparate software solutions are often not connected, which makes reporting a highly manual process. And, as with any manual process, it’s slow, expensive, and prone to human error — and in a medical environment, it goes without saying that human error can potentially have extremely serious consequences. Medical errors are one of the top causes of death in the United States.
And then there’s the problem of interoperability. Different EHR systems do not play together well, which means transferring and consolidating data on patient records from different providers can’t be easily done. As hard as it may be for the public to believe, in many cases, faxing or hand-delivering hard copy records are the only means of transferring information between practices.
Consequences of the healthcare data mess
How does this play out? One example is how difficult it can be to predict how many nurses, physicians, and lab techs a hospital will need to cover summer vacations. The data on patient volumes and the complexity of the cases from a historical point of view will be in the EHR, while timesheet and personnel information will be in the HR systems. Administrators will need data from both systems to adequately forecast both the need for and availability of personnel to ensure sufficient coverage to provide a high quality of care.
Another problem is compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires that healthcare organizations provide patients with their entire healthcare history upon request. Reliance on manual processes and a lack of interoperability between systems makes compliance slow and expensive.
And then there are the issues it creates with patients. When hospitals issue patients a continuity of care document (CCD), it’s typically done electronically via the patient healthcare portal. But many patients will print it out and take it to another provider, where it can fall prey to transcription errors. And even if they upload the document to the new provider’s systems, it may not be searchable, which limits data access.
Patients are also forced to answer the same intake questions about medications and health conditions with every new provider they see, even within the same healthcare system. It’s irritating to the patient because it means they have to carry their records with them every time they see a new provider, and it wastes precious time that could be better spent providing care.
Addressing data and reporting challenges
To address these issues, ensure stakeholders can get timely, comprehensive, accurate data, and create healthcare data systems that are interoperable, we need to start by simplifying health data. Namely, it needs to be disambiguated, so the data’s meaning is clear and normalized so that it can be easily ported from one system to another. And it needs to be accessible.
There are multiple strategies for accomplishing these goals, and your organization may want to employ more than one, depending on your situation:
Deploy systems that orchestrate data by bringing all the separate data sources into one singular source of truth. Example: Pega
Deploy systems that sit on top of other systems, enable organizations to effectively manage all the data they have and also pull in third-party data to enrich in-house information: Example: Snowflake
Custom development to create improved user interfaces, custom integrations, and automated data aggregation and normalization.
Once you’ve simplified your data, you can then begin streamlining reporting. With data that’s normalized and disambiguated, data entry can be largely automated, which is faster and far more accurate than manual processes. Software can pull data directly from the proper data sources to automate the creation of reports.
Even better, you can now apply predictive analytics to the data to gain insights that point to likely outcomes, which allows you to take measures to course-correct before a minor issue becomes a crisis. And real-time data and analysis can be fed into alerts that could, for example, notify a nurse of a patient whose vitals indicate that they need immediate attention. Best of all, providers and administrators can now rely on a single source of reliable information regarding patient data.
So, there’s clearly a quality of care benefit to simplifying data and automating reporting. But there's also an enormous business benefit from investing in your health data. As an organization, you’ll spend less time on mundane admin tasks such as data entry, which enables you to redirect those human resources to more valuable tasks. You can make accurate decisions more quickly with current, comprehensive data and insights at your fingertips. And, you can increase patient engagement through data-driven decisions that tell you exactly what’s working and what’s not.
Simplifying healthcare data and streamlining reporting is a daunting, but necessary project. Our experts can provide guidance on best practices and the solutions that will work best with your specific situation. Contact us today!
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