Deciphering healthcare buzzwords

'Electronic medical record, member portal, case management, and other vendors do not produce PHM systems'
By Don Yish
10:42 AM

The healthcare industry is infamous for its overuse and misuse of buzzwords and acronyms. Many of them arise from the ever-changing regulatory shifts designed to improve quality care and reign in increasing costs. The one constant in healthcare is change, and the industry is scrambling right now to adapt to historic change in the early wake of the Affordable Care Act and the ever-increasing migration from traditional fee-for-service models to value-based care. Byproducts of this new healthcare landscape are new buzzwords that are once again being misused, or at the very least are misunderstood.

One of the more commonly misused or misunderstood buzzwords today is "population health management," or "PHM." The shift from volume-based to value-based care is putting the onus on healthcare organizations, now more than ever, to improve the quality of care, improve the health of populations, and reduce the per capita cost of healthcare – the Institute for Healthcare Improvement's "Triple Aim."

To capitalize on this new directive, many healthcare IT vendors have rebranded legacy products as population health management solutions rather than investing in the required innovation. As a result, healthcare organizations' misunderstanding of the term PHM has been formed, in part, by the marketing of these products. The HIMSS 2015 Conference in Chicago was inundated with vendors capitalizing on the new population health management term, but with as many different definitions as there were products being marketed.

Electronic medical record, member portal, case management, and other vendors do not produce PHM systems. They provide isolated, "slice of the pie" products. By its truest definition, a population health management solution must be a fully integrated system that provides three critical components. First, it must aggregate data from the full continuum of sources and create normalized views for the entire care team.

Second, it must deliver the tools necessary for the care team to leverage that information, update and collect additional information, communicate and collaborate amongst themselves and with members and their families – all in the effort to positively affect the quality and cost of care. Lastly, a true PHM system must enable healthcare organizations to mine actionable data through broad-based analytics, business intelligence and risk stratification. While some vendors may provide some of these siloed components, true population health management systems provide one ecosystem in which all of these components reside to ensure seamless data flow and efficient business and clinical processes.

Another commonly misused buzzword is "interoperability." Today, patient data resides in a multitude of EMR systems, claims and eligibility databases, case management systems, laboratory information systems, radiology information systems, pharmacy benefit management systems, etc. Although the industry has established some data exchange standards like Health Level Seven (HL7) and Clinical Document Architecture (CDA), few healthcare organizations and vendors fully support them.

As a result, portions of data are extracted from these systems in a very time consuming and costly process that results in an unstable connection and a view of the patient that is far less than whole. That is not interoperability. True interoperability is defined by the ability to exchange a complete dataset, one way or bi-directionally, securely, with proper validation, business rules, and error handling, on a timely basis between two systems.
Without an imposed data interchange standard on all healthcare IT products that all vendors fully adopt in a consistent manner, interoperability will remain a misunderstood and misused term in the healthcare industry. There are a few innovative software vendors that are leading the way toward true interoperability. They have been successful in building connections to disparate data sources in a timely and cost effective way and integrating that data into broad-based platforms, so that a full 360 degree view of the member can be realized and leveraged. Many of those select vendors are the most advanced proprietors of true population health management solutions.

A critical driver of success with the Triple Aim is another overused and misused buzzword – "interdisciplinary care team coordination." Realistically, this can be characterized as something we are striving for as an industry, not something we've yet fully achieved. Without access to a full 360 degree view of the member, tools to collaborate and communicate, clinical and operational workflows that are automated as much as possible and advanced analytics and reporting on outcomes, the noble ambitions of the Triple Aim will be elusive.    

Although these three buzzwords are overused and misused throughout the healthcare industry, they do represent the foundation of improved quality of care, better health for the populations served and lower cost. As the healthcare industry continues to progress toward those goals, the challenge will be for organizations to pinpoint those advanced solutions to true population health management, interoperability, and interdisciplinary care team collaboration rather than those that attempt to jump on the bandwagon with nothing more than new, glossy marketing material.