There is no question that the merger of “big data”, data analytics software, and electronic health records [EHRs], has the potential to revolutionize the way that population health is managed. The focus on healthcare in North America will undoubtedly shift from an event-based treatment approach to a preventive medicine comprehensive wellness focus.
At a panel discussion entitled “Innovations in Population Health Management,” industry leaders will ponder a variety of issues around the connections between population health management strategies and innovations and the leveraging of healthcare IT. That discussion will take place at the Health IT Summit in Seattle, to be held August 19-20 at the Seattle Waterfront Marriott. The summit is sponsored by the Institute for Health Technology Transformation, or iHT2. (Since December 2013, iHT2 has been in partnership with Healthcare Informatics through HCI’s parent company, the Vendome Group LLC.) For further information on the Summit, please click here.
In the past month, HCI spoke with three panel participants about their perspectives, as they prepare to participate in the summit. Jat Sandhu, Ph.D., an epidemiologist and regional director of Vancouver Coastal Health Authority’s Public Health Surveillance Unit in British Columbia, envisions the constituencies of population health as a pyramid. Forming the tip of the pyramid, he says, are patients with chronic diseases or health conditions who frequent healthcare providers. Just below that is a layer of individuals who are at higher risk of having an ongoing problem: borderline diabetics, the obese, patients with hypertension or skeletal bone loss. A portion of this group are patients; the remainder can be identified using population demographics and medical statistics. The base of the triangle and its largest part are presumably healthy individuals who do not interact with healthcare provides. But some have or are starting to develop behaviors and habits that could put them at risk.
“The challenge,” Sandhu says, “is how to address all of them to improve the overall health of a population and reduce healthcare costs using information technology? The devil’s in the data,” he emphasizes. The ability to assess any group is dependent upon having the right information available about the patient population, Sandhu observes. In fact, he says, population health management has not yet been able to develop upstream interventions of people who are at risk for developing healthcare complications. Healthcare IT isn’t there yet. But the development of electronic disease registers and increasing use of EHRs offers better opportunities to monitor, intervene, and interact with chronic patients.
Group Health Cooperative has been practicing some form accountable care since 1947, when it was founded by a group of visionary physicians in Seattle. Today, it provides medical coverage and care to more than 600,000 individuals in Washington State and Northern Idaho. Sarah Miller is the executive director of its Care IT Delivery Department, whose work increasingly is focusing on what the department calls “ingenious use of standard functionality”. GHC has taken full advantage of its EHR’s ability to create registries of patients.
“We have developed hundreds of registries,” Miller notes. “One of the first was to track medication usage of patients with multiple sclerosis (MS). Prescription drugs to treat MS are very expensive and they are not effective for a percentage of patients. This registry enables us to track the medication and use of these drugs,” she adds. “We can make sure that patients are taking them correctly and determine if they are effective in reducing symptoms. Alerts are automatically generated and we can intervene in a timely manner.”
Miller goes on to say that “Customized documentation tools identify care gaps and record how our clinical staff addresses them.” GHC’s EHR has hundreds of reporting and notification tools embedded in the clinical workflow. Miller adds that any caregiver can review a list of patients with appointments for the day to see what registries a patient is on and what care gaps there may be. The gaps won’t be overlooked and can be efficiently addressed during the patient visit.
Vancouver’s public health surveillance unit has developed a disease register for HIV patients who are among the one million plus patients living in the region. The goals of the region’s “seek and treat” program to stem the incidence of HIV incorporates proactive offering of diagnostic testing to target population segments, early treatment, and monitoring of care. Sandhu says that the registry represents analytic use of number of existing data sets to identify patients who aren’t linked to care, who aren’t adhering to a treatment regimen, and/or who are not virally suppressed. “This example shows the parallel between disease surveillance and population health where we are applying analytics to identify alerts and cluster adverse health events at a population level by person, place and time. We are just starting to consider how we apply the population health management approach to some disease areas.”
Sean Rogers, M.D., is medical director of primary care and a practicing internal medicine physician at the Polyclinic, a large independent physician owned multispecialty practice with a large integrated clinical network in the greater Seattle area. For the past 17 years, Polyclinic has been at full risk for Medicare Advantage lives, and has worked hard to implement programs to focus its patients on staying healthy.
“Population health is about providing a better quality of care, patients having a better care experience, and while doing a better job, lowering the cost of care,” Rogers says. “I spend a lot of time thinking about demonstrable quality and metrics and how analytics can be used to slice and dice data. Registries can identify our patients each day who’ve missed a doctor’s appointment or lab tests, allowing us to intervene and organize a communications campaign, whether by telephone, email, or letter. The ability of today’s technology to be updated in real time without human interaction is amazing. What is now a challenge is to convince patients to respond to our notifications and offers for health,” Rogers adds.
Sandhu notes that there is also a challenge for care providers. They need to shift their perspective from the routine practice of dealing with patients to provide a clinical “fix” of a healthcare condition to start thinking about documenting in a systematic way all of the interactions with their patients. Their input is needed for the underpinnings of any population health initiative.
Will the plethora of mobile apps help? While the panelists believe that mobile health apps can play a huge role in the future population health landscape, they are not yet ready for prime time utilization. The vast majority of proliferating healthcare apps are standalone. The key problem is getting secure information from the patient back into the system, whether a disease registry or the patient’s electronic record, in a way that is accurate, visible, actionable, and without compromising security firewalls of an organization..
“The hype-to-real-world benefit ratio of mobile apps is pretty large,” Rogers says wryly. “But that is the world of technology. I expect mobile apps to help change the focus in American healthcare from an acute episodic emphasis to lifetime preventive care. This should help reduce the cost of healthcare. But counteracting this is the ‘ravenous beast’ aspect of technology. It consumes enormous resources, both in terms of capital outlays and operating costs, and the growing number of staff with a high level of expertise needed to maintain healthcare IT technology.”
There’s no question that health IT will have a huge impact on population health management. The questions at this point in time remain how, how rapidly, and at what cost.
These and other topics will make for a lively discussion in Seattle, as these three panelists and others discuss key topics around this important subject. To learn more, please check out the Health IT Summit in Seattle, August 19-20,, sponsored by the Institute for Health TechnologyTransformation.
