The Crossroad of Population Health and Information Technology
By Pracha Eamranond, MD MPH, Senior VP of Medical Affairs & Population Health, Lawrence General Hospital
Population health continues to play an enormous and evolving role in the forefront of health IT. Organizations across the country are working at various levels to integrate technology in managing the health of the various populations they serve. We are at a crossroads where success will depend on an organization’s ability to leverage tech-enabled services to better care for the overall health of the population. More access to data is also changing the healthcare landscape as networks transition from volume-to value-based care. Data sources include insurance claims (e.g., per member per month costs), network utilization (e.g., inter-hospital transfers), quality metrics (e.g., HEDIS), community data (e.g., housing and food access), EHR (e.g., clinic diagnosis codes), among others. As organizations try to collate, digest, and output these diverse groups of data, they will need to navigate the milieu of partners who own and manage these data sources (e.g., providers, administrative staff, senior management, vendors, and payers).
As part of two very different healthcare systems with different IT capabilities, I am facing challenges that are more similar than they are different. On one hand, I am working at Brigham and Women’s Hospital as part of Partners Healthcare which is one of the most integrated healthcare systems in the country with Epic as its platform. On the other hand, I am also working at Lawrence General Hospital which is part of Beth Israel Deaconess Care Organization and utilizes multiple inpatient and outpatient platforms including McKesson, GE Centricity, Athena, IBEX, ECW, Epic, among others. Regardless of the EHR platform, we need to understand how to best share information across and within organizations to change behaviors at every level. As an example, typical population health outcomes such as total medical expenditure (TME) and readmissions need to be tailored to the provider, practice, and network level. A nurse practitioner in clinic will need to understand her/his role in TME as well as how they play a direct role in preventable readmissions. At the same time, a skilled nursing facility needs to see their network performance in bringing down TME and readmissions as they transition toward providing more value-based care to patients, their families, and the networks to which they belong.
“Regardless of the EHR platform, we need to understand how to best share information across and within organizations to change behaviors at every level”
Leaders in health IT need to provide tools to balance such population health outcomes while keeping in mind that most finance departments continue to focus on the bottom line which generally relies on network patient volume and overutilization that is generated by our volume-based payment systems. Health IT tools include data warehousing, systems to integrate data, technology to engage patients/providers, and business intelligence platforms to output population health outcomes effectively. Not all network IT programs need to develop every available tool to manage population health as different networks have different needs and require different resources. Current reform in alternative payment strategies put forth by the government will force population health leaders in various networks to engage health IT in different ways. Health IT programs can ensure their own success and take a more proactive approach to design and implement strategies to better manage population health.
Looking beyond traditional health IT, hospitals and outpatient practices across the country are starting to utilize different types of technology to expand their population health management and patient engagement approach. In order to be successful in a value-based care model, communication between the patient and their clinical team needs to extend beyond the traditional healthcare setting. Our patient population is predominantly Latino. Several challenges exist when caring for these patients. Latinos are at an increased risk of developing diabetes, obesity and heart disease. Latino patients and their families can also be transient and do not consistently see the same providers or go to the same emergency rooms and hospitals. Lastly, communication difficulties can exist between patients and clinical team members. We need to focus on a strategy that breaks down communication barriers and allows patients and their family members to become more active in their health, regardless of where they are living or seeking care.
A 2013 report finds that Latinos are the highest utilizers of social media. This report also finds Latinos to be the highest internet users from a smartphone. Several studies support this notion by employing social media and text messaging to improve disease management and increase appointment attendance. Additional studies focused on disease specific measures demonstrate improved patient outcomes in weight loss, smoking cessation, and diabetes management, as well as increased medication adherence. Social media in conjunction with email or text messaging is shown to be more effective than using a single platform.
Expanding our patient outreach is especially important because many networks such as ours engage in multiple risk- and quality-centered contracts with different payers. We are beginning to implement an appointment reminder solution in our outpatient clinics. The goal of this tool is to use text messaging to increase appointment attendance, especially in our Latino population. A successful response to this tool could pave the way for a continued investment in technology for health improvement and disease prevention for all of our patients.
The emergence of value-based contracts coincides with the passing of the Health Information Technology for Economic and Clinical Health Act (HITECH) OF 2009 and subsequent meaningful use incentive programs. This has prompted the rapid widespread adoption of at least a basic EHR system in most hospitals nationwide. Utilizing an EHR as the foundation, organizations are implementing more advanced tools for population heath including disease registries, patient portals, evidence-based treatment algorithms and innovative patient engagement. The continued evolution and adoption of health IT will consistently allow for safer, better quality and more efficient care. We need technology that is easy for clinical staff to use, while also limiting disruption at the point of care. Patient oriented technology also needs to be inviting and intuitive, in order to engage patients of all ages. These factors will lead to empowered clinicians, decreased healthcare costs, and healthier and happier patients.