Clinical informatics: data in action
If there is one emerging pattern within the clinical informatics field, it is the quest to make data "actionable" for users. With all the technology infrastructure development over the past decade to facilitate electronic health record installation in healthcare facilities, providers are finding that the data generated often can't be used in a timely and constructive manner.
The obstacle to achieving this level of manageability, summed up succinctly by Dan Riskin, MD, is this: "It's hard." Riskin, co-founder and CEO of Menlo Park, Calif.-based Health Fidelity, may be a bit glib about the challenge of harnessing the magic of clinical data, but he says the juncture where healthcare finds itself requires more deep contemplation about how to proceed from here.
In explaining the high degree of complexity involved in transforming clinical data from being an inert body into a vehicle for quality care, Riskin dissects the challenge this way: "The problem fits into two buckets – risk and quality. Risk is a market need today for value-based healthcare in risk-based payment models and requires a fundamental understanding of what it means. There is also a lot of talk about quality and the same technology is needed for both. The base content is full clinical data – claims data plus narrative data. This is complete clinical data, providing the full picture."
Providing that high definition picture is where the heavy lifting occurs, Riskin said, because of the multi-dimensional aspect of data accuracy, timeliness, patient profiles and relationship of all data elements.
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"One problem is that the government is paying people to report, but it doesn’t have to be accurate," he said. "They are paying for information, but not quality information. So the need still exists to get accurate data."
Another challenge, he said, is that there hasn’t been a strong enough demand for taking the critical next steps.
"What the market wants now is what the government made them want – ICD-10, pushing up revenue cycle codes and reporting – even if it is inaccurate,” he said. “I’m not laying this at the feet of the vendors. The reality is that there is minimal demand at this point."
Tom Van Gilder, MD, chief of medical services for San Jose, Calif.-based Certify Data Systems, contends there is no weak link preventing the next level of functionality for clinical informatics; instead he considers it a part of the evolutionary life cycle.
"The focus over the past decade has been on installing systems and connecting physicians with EHRs, and now we have reached the stage where it has to be connected across the spectrum and data presented in a way that it is useful," he said.
Certify Data Systems has been working on an HIE platform called HealthLogix – a "network" approach that offers multiple system configurations, including cloud-based options, to connect hospitals and their affiliated providers. The platform delivers "true semantic interoperability" between disparate EHR systems, Van Gilder says, enabling hospitals, health systems, providers and laboratories to exchange essential health information in real-time without changing workflow.
"It presents the data to the physician and connects to an analytics engine for analysis of all the data," he said. "It is not duplicative and provides clear analysis for things like medication interaction, opportunities to improve care and providing a complete set of services to patients. By providing linkage and analysis, we are trying to solve issues by putting it together in an actionable way."
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Finding 'use' meaningful
Despite its challenges, clinical informatics has come a long way in the past decade, says Steve Ross, MD, medical informatics specialist with Denver-based Health Language. Since the founding of the Office of the National Coordinator and launch of the EHR initiative, he says the provider community has become routinely comfortable with using information technology.
"Providers now largely take it for granted that they’ll be using informatics applications in clinical care, even if EHR adoption isn’t universal," Ross said. "I’d say that most clinicians are at least familiar with ‘meaningful use’ and feel that it has appropriate goals and rational metrics."
For those who have adopted informatics tools, optimizing use of those tools in clinical workflows is an ongoing effort and "clinicians are eager to see these efforts pay off in more informed care, better coordinated care, and enhanced patient engagement," he said. "We’ve all seen early wins in the timeliness and comprehensiveness of the information available at patient encounters."
Going forward, the healthcare industry needs to demonstrate that investments in data acquisition, interoperability and functionality provide more relevant and impactful decision support in caring for individual patients, Ross says.
"We also need to ensure that electronic quality measures instigate effective actions to improve care processes," he said. "Finally, we need to expand tools that assist clinical teams in population health management, providing registries, dashboards and tools to track outreach. Now that economic incentives have stimulated widespread adoption of clinical informatics tools among healthcare providers, demonstrably better care will be the best insurance for continued progress."
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Birth defect reduction
One clinical area that could benefit from advanced functionality is obstetrics, because timing is so critical in labor and delivery, says Emily Hamilton, MDCM, senior vice president of obstetrics and clinical informatics for Cranbury, NJ-based PeriGen. Having a complete picture of the patient's status in real time, she says, can mean the difference between a healthy baby and potentially tragic complications.
Specifically, the right information at the right time can reduce the incidence of rare, but devastating brain-related injuries. The key, Hamilton says, is the availability of digital electronic fetal monitoring tracings. Yet the obstetrics field remains stubbornly rooted in manual processes, she says, and needs to embrace the new technologies that are available.
"This specialty has been slow in adopting technology to discover new things,” she said. “Half the population is women and 80 percent will have babies – twice, on average. So it’s a realm of medicine that impacts a large amount of our population, which makes it a public health issue."
Fetal heart rate is the core vital sign for determining the baby’s health status and risk for neurological complications. Historically, the heart rate has been the only method for determining pattern recognition, but it only presents a shallow picture of what is really happening, she says.
"It’s like looking at a map without any tools to measure anything," Hamilton said. "Many people tried to develop pattern recognition from that signal and perhaps see things we can’t see. That is difficult, but that is what we have done. If something substantial is found, it gives the physician time to rectify it."
Though they are low incidences, brain-related injuries are of "high consequence," Hamilton said. Among the biggest concerns are encephalopathy, seizures and coma, which can cause severe motor impairments, such as cerebral palsy and blindness.
"So much of this is preventable and we need to do everything we can to avoid these tragedies," she said.