Building Blocks to Better Data
By Matt Phillion
The one thing healthcare isn’t short on is data. The industry has data coming in from all directions, but that’s not always a perfect scenario—data that is duplicated, low quality, or siloed can present barriers to better analysis. For healthcare systems to improve the way they want, data needs to be organized and unified.
“Everyone sits on so much data,” says Gregg Church, president of 4medica. “Data is great, but if it’s not well organized into meaningful buckets, it’s not as useful for providers.”
So much of healthcare works in silos, Church notes. A physician may have access to a hospital’s centralized EMR, but what if the patient has seen physicians outside that hospital as well? “How do you know the data has been normalized and is accurate?” says Church. “We’ve always had plenty of data but never figured out how to use it and be more proactive and predictive of a patient’s behavior. Why aren’t we doing something more proactive with it?”
The industry faces a challenge in robustly identifying patients across systems and silos, he says. With no national-level patient identification system, duplication causes problems all along the data journey. “As you’re looking at data coming from multiple systems, if you don’t have a good matching process in place, you’re exposing yourself and your patient,” says Church.
4medica sees customers who face a 10%–30% duplication rate for patient data. “Healthcare is digitizing and modernizing, but the duplication problem is real—if you haven’t identified the patient first and fixed that core problem, how do you complete a longitudinal record of the patient? You can’t,” says Church.
The first thing to do, Church says, is think of health information exchanges as a gateway, bringing together data from different silos. “We have no control over the registration process,” he says. “That data is already in the system the way it is. We do a data quality assessment and drill down at the source level at registration issues—if there’s no Social Security number, no telephone number, transposed information.”
Church likens what happens next to when a child begins to build with a large Lego® set: They dump out all the blocks on the floor and start sorting. “We compartmentalize and identify attributes, and as we organize it we start to make sense of it,” he says. “If you can get that record into a single, golden record as you’re working with the clinical data set, you can start telling a story about that patient’s condition.”
Consumers want to be more engaged in their care, he says, and this aggregated data model offers a chance to keep them involved.
Challenges to implementation
In theory, a hospital’s existing apps may be able to match data, but normalizing and merging that data requires a lot of resources and personnel. “Because data comes in so fast, it’s harder to keep up,” says Church.
Professionals in health information management and IT have told 4medica they’re only able to keep up with the known problem, rather than get to the core issue. “Is it a training issue? A registration issue? They’re fighting just to stay ahead,” says Church. “The risk is if you’ve got multiple data sets coming in, you start creating overlays, and in the worst-case scenario there’s the risk of mixing the medical record information of two patients.”
That’s what hospitals are trying to prevent with better cleanup and organization of data, Church says: putting patients at further risk.
Labs run into their own challenges, Church notes, especially with COVID-19. “The lab industry has never really looked at data quality as a core business process,” he says. “They’ll tell you they know they create duplicate records because they have so many different patients from different sources. They have a lot of people manually entering paper requisitions into the laboratory information system. We have one lab that had 10 records for a single patient—they can’t make a quick, informed decision. They won’t take a chance, and so they end up creating a duplicate record.”
When a hospital gets a patient’s lab results back, inaccurate or missing information may mean the patient never sees the results at all. “We can get the data organized so that we can validate and understand what attributes are missing,” says Church. “When you see a million records and you don’t have key information, there lies a bigger problem. You have to go back to the main source. Our technology is able to quickly work with data, normalize it, and match it with less than a 1% duplication rate.”
The information going back into the clinical systems enables better quality management and coordination of care. “When you bring all those data silos together, the story you can tell from a care perspective becomes very actionable and reliable,” says Church.
A more unified process
Information overload continues to be a barrier to better data use. “The biggest challenge we hear is there’s so much data that comes in—the systems aren’t unified or organized well, and each organization handles it in their own way,” says Church. “It’s almost too much data, and it can be difficult to really organize it and drill into what’s most important to understand about the patient.”
Organizations relying on multiple record systems add complexity, as physicians and other providers jump from system to system to track patient data. “It’s overwhelming,” says Church. “Digital transformation is real, but if you haven’t cleaned up your own core systems, matching it carefully, I can’t imagine what it’s like having to pull data from outside your four walls.”
A unified, single patient identifier would help resolve this problem, but in the meantime, organizations rely on vendors to help circumvent patient safety concerns.
“Our mission is to stick to one patient, one record. We try not to disrupt clinical systems, but want to simplify it,” says Church. “Doctors spend 15 minutes max with a patient, so they need to have a well-organized story. If you don’t provide a good starting point, it not only throws off the clinician, it throws off the whole process.”
Data and patient involvement
“We sit on a huge amount of data that comes in from the clinical and demographic side,” says Church. “We don’t want physicians staring at a screen asking, ‘Was this the most recent lab result, or is it from three months ago?’ ”
Patients, as noted earlier, want more involvement in their care, and having access to their records is part of that. “They want to be more involved in their own journey, and they actually can be,” says Church. With access to their records, they can engage with physicians about their most recent test results or specialist visits.
“If you’re working with a hospital and want the patient to be more engaged, there are tools out there that allow this so they can access lab results, clinical notes, and become part of the process,” he says. “Consumers want more information. They’re getting more engaged in their care.”
Modern providers and patients are more comfortable with the digital technology these tools rely on—paper records are a thing of the past for many. “If you don’t provide [digital records], they become frustrated,” says Church. “The industry is moving faster and transformation is real, but there’s so much segmentation, and this is what slows us down.”
The current fundamental issue is ensuring data is reliable and travels with the patient. “Data isn’t our problem. There’s buckets of it. But until we learn to acquire, organize, and normalize it, and make sure we’re matching it with 100% accuracy so we can drop it into these repositories and make sense of it, that’s where healthcare will be better,” says Church.
At the end of the day, you have to tell a better story in the care journey, he says.
“We have to advocate for the industry as a whole to think more holistically and work toward a common goal,” says Church. “We’ll always have silos, and that’s healthy, but let’s go about organizing the data in a more standardized way. If we do that, everyone benefits, not just today but in the generations ahead. Healthcare becomes more affordable, and we do a better job living healthier. Data quality needs to be front and center in that.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.