Payers and Providers Study: Turning Clincial Data into Actionable Information Key Mandate for Clinical Analytics

Annual HIMSS Analytics/Anvita Health study of payers and HCOs reveals meaningful use as a key driver in future clinical data gathering, data sharing and data analysis.

Orlando, Florida, February 20, 2011—Using clinical analytics to meet Stage One meaningful use criteria and lowering clinical costs emerged as the top drivers for providers and payers, respectively, for using and analyzing clinical data. This is according to a new HIMSS Analytics whitepaper released here today, based on a 2011 annual study of payers’ and providers’ use of clinical data.

The research is the second annual study conducted by HIMSS Analytics and sponsored by Anvita Health™, comprising a series of focus groups and one-on-one interviews with chief medical officers and chief medical information officers from the payer and provider communities.

Current Use of Analytics Still Basic, Future View Becoming More Sophisticated
As in the 2010 study, respondents reported that they currently use clinical data analytics to enhance patient care cost, safety and efficiency, but increasingly, the view of quality is being framed within the context of meaningful use. This is leading health care organizations to evaluate how they are capturing and analyzing data.

“The expected increase in volume and granularity of clinical data from the combination of accelerated electronic health record adoption and the shift to ICD-10 codes is giving payers and providers pause to think about how they can leverage this data for their businesses,” said Marc Holland, director of Market Research for HIMSS Analytics.

“While the list of questions organizations are trying address with their data is as broad as the sources of data itself, all respondents expressed a need to translate clinical data into actionable information,” he said.

Analyzing Individuals and Groups
The need for more actionable information centered around two general themes:

Individuals: Analysis of a single patient for a better understanding of his or her current medical profile, or a single physician to evaluate overall performance.
Populations: Analysis to study member or patient populations to identify trends that could lead to modified workflows, procedures or programs to enhance patient care, reduce hospital readmissions, and identify opportunities to reduce costs.

Preventing encounters with health care providers was another theme that emerged in the study. Payers and providers alike targeted data as a tool to help Identify and close gaps in care, and serve as the basis for establishing or honing existing wellness programs.

Data Sharing Seen as Key to More Robust Clinical Analytics
Study respondents reported sharing data with a variety of organizations with a number of anticipated benefits, such as establishing performance benchmarks. Most respondents also reported sharing information with health information exchanges, and those who were not sharing, either were currently exploring the idea, or were not located in states that offer this ability at this time.

Respondents said data sharing arrangements also offer health care organizations a more complete picture of a patient’s medical history, ultimately enabling more robust clinical analytics. Lab data, medical histories, physicals and prescription information were cited as clinical data sources that could be shared to help better target care.

No respondents reported payer-to-payer data sharing, citing HIPAA restrictions as a barrier.

Data Warehouses – Accessing Data a Challenge, Desire to Use Data in Real Time
Just as was reported in the 2010 study, respondents in the 2011 study reported that data warehouses are still not used universally, but payers were much more likely than providers to use data warehouses to store member data.

Accessing the stored data presented a significant challenge as most organizations do not permit clinicians to directly run queries to the data warehouse. And while retrospective reporting dominates the use of data, there remains a strong desire to use the data in real time to drive clinical decision support.

Top Barriers to Using Data Follow a Pattern
Respondents had varied answers when asked about the barriers to using data, but common themes emerged:

Getting data into the system: Important and relevant clinical data runs the gamut from handwritten clinician’s notes on paper to codes on medical claims, and manually entering data is resource-intensive.

Data mapping: Once data is in the system, it must be data-mapped for extraction to be made usable for analytics. Several respondents noted that this is a complex task, particularly when data is not captured in discrete data elements.

Incomplete data: Respondents expressed concern that some data elements required for analysis might be missing as a result of an incomplete record, resulting in an inaccurate analysis.

Multiple databases: Data required for a thorough analysis may be housed in multiple databases making the connection between databases a challenge.

Translating the data into actionable intelligence: Turning clinical data into relevant data that a clinician can act upon and integrating that information into the workflow is a challenge particularly for health care provider organizations.

To read the complete whitepaper on the 2011 HIMSS Analytics study called Clinical Analytics in the World of Meaningful Use visit www.himssanalytics.org.

About Anvita Health
Founded by physicians in 2000, Anvita Health provides innovative clinical analytics to its customer partners who, combined, cover more than 100 million lives. Anvita Health provides high-performance clinical analytics solutions for health plans, pharmacy benefit managers, disease management companies, personal health record and electronic health record companies, and health care providers. Anvita Health is headquartered in San Diego, California.

About HIMSS Analytics
HIMSS Analytics supports improved decision–making for healthcare organizations, and healthcare IT companies and consulting firms by delivering high quality data and analytical expertise. The company collects and analyzes healthcare organization data relating to IT processes and environments, products, IS department composition and costs, IS department management metrics, healthcare delivery trends and purchasing related decisions. HIMSS Analytics is a wholly owned, not–for–profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS). Visit www.himssanalytics.org for more information.