Electronic health records (EHRs) can improve population health outcomes by efficiently collecting and storing data that can be shared across multiple healthcare organizations and leveraged for quality improvement and prevention exercises. This data can be used to improve public health reporting and surveillance, better an organization’s ability to prevent disease, and expand communication between providers and public health officials. However, a study published by Price Waterhouse Cooper’s Health Research Institute (PwC’s HRI) suggests that EHRs do not yet have the necessary capabilities to support population health management and value-based care. While all executives interviewed agreed that EHRs are essential to digitizing care, only 25% of providers agreed that EHRs have helped position their organizations to meet the demands of population health.
EHRs are an essential component of population health management, but just having an EHR does not establish population health management. Many providers haven’t prioritized using EHRs to support practice-based research. To get started with a population health program, healthcare organizations (HCOs) need to have a way to collect and analyze data, along with patient claims and geographical data.
EHRs are efficient as an archive for clinical data, where providers can draw information about their overall patient population. They can also stratify risks and organize patients into subpopulations based on their conditions and needs, which enables HCOs to provide groups of patients with targeted support.
Though EHRs are useful for descriptive reviews of patient populations, they don’t have the ability to do more robust analyses, such as predictive modeling, which can help providers uncover a population’s future needs. More mature data models are needed to integrate other data to be able to perform patient stratification, which is critical to managing risk in population health programs. In Figure 1 (from PwC’s HRI Study) you can see that only 36% of providers are using their EHRs for population health management, and just 14% feel EHRs have met their expectations for it.
The consensus from HCOs seems to conclude that EHR technology and data analytics capabilities are not yet developed enough to accommodate processes necessary for risk management and population health. Most providers need additional tools and technologies to optimize their systems and fully utilize EHR data. An analytics component that could also help would be a health information exchange (HIE) which allows providers to share patient data and access their data regardless of where the patient received care. HIEs can not only help doctors make more informed treatment decisions, but are critical for public health analysis and research.
Population health success will also require that providers understand patients’ lifestyles and the social determinants affecting their health, including employment status, income, education and living conditions. When it comes to a person’s overall health picture, all the data in a provider’s EHR only accounts for one-third of what is needed, according to Jonathan Weiner, Director of the Center for Population Health IT at Johns Hopkins University [I]. This lifestyle data will likely need to come from other sources, such as community databases or customer relationship management systems, and will require providers to integrate them with clinical, claims, financial, marketing and other data in a data warehouse.
“Now that MACRA is a reality, healthcare teams can no longer afford to treat population health as an abstract concept. Therefore, learning to optimize EHRs, work with data, and adopt proactive population management strategies are actions that should be on every healthcare team’s to-do list if they want to be successful under evolving value-based payment models.” –Richard A. Royer, Health Data Management
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