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The American Journal of Managed Care December 2016
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Getting From Here to There: Health IT Needs for Population Health
Joshua R. Vest, PhD, MPH; Christopher A. Harle, PhD; Titus Schleyer, DMD, PhD; Brian E. Dixon, MPA, PhD, FHIMSS; Shaun J. Grannis, MD, MS, FAAFP, FACMI; Paul K. Halverson, DrPH, FACHE; and Nir Menache
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Amity E. Quinn, PhD; Sharon Reif, PhD; Brooke Evans, MA, MSW; Timothy B. Creedon, MA; Maureen T. Stewart, PhD; Deborah W. Garnick, ScD; and Constance M. Horgan, ScD
Data-Driven Clinical and Cost Pathways for Chronic Care Delivery
Yiye Zhang, PhD, and Rema Padman, PhD
Accountable Care Organization Hospitals Differ in Health IT Capabilities
Daniel M. Walker, PhD, MPH; Arthur M. Mora, PhD, MHA; and Ann Scheck McAlearney, ScD, MS
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Hannah Rettler, MPH; R. Monina Klevens, DDS, MPH; Gillian Haney, MPH; Liisa Randall, PhD; Alfred DeMaria, MD; and Johanna Goderre, MPH
Telemedicine and the Sharing Economy: The "Uber" for Healthcare
Brian J. Miller, MD, MBA, MPH; Derek W. Moore, JD; and Chester W. Schmidt, Jr, MD
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Kitty S. Chan, PhD; Hadi Kharrazi, MD, PhD; Megha A. Parikh, MS; and Eric W. Ford, PhD, MPH
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US Hospital Engagement in Core Domains of Interoperability
A. Jay Holmgren, BA; Vaishali Patel, PhD; Dustin Charles, MPH; and Julia Adler-Milstein, PhD

Getting From Here to There: Health IT Needs for Population Health

Joshua R. Vest, PhD, MPH; Christopher A. Harle, PhD; Titus Schleyer, DMD, PhD; Brian E. Dixon, MPA, PhD, FHIMSS; Shaun J. Grannis, MD, MS, FAAFP, FACMI; Paul K. Halverson, DrPH, FACHE; and Nir Menache
Aligning health information technology with population health requires organizations to think differently about data needs, exchange partners, and how to leverage both for evidence-based action.
ABSTRACT

The United States’ decade-long transition from a paper- to technology-based information infrastructure has always been recognized as an initial step—a laying of the foundation—for future changes to the delivery of care. An increasingly important focal area for improvement is population health. Numerous policies and programs now require healthcare organizations to manage the risks, outcomes, utilization, and health of entire groups of individuals. Nonetheless, current health information technology (IT) systems are not ready to support population health improvements effectively and efficiently. Existing health IT systems were designed for organizations that are structurally, operationally, and culturally focused on individual care delivery, rather than improving health for a population. Opportunities exist to align health IT resources and population health management strategies to fill the gaps among technological capabilities, use and the emerging demands of population health. To realize this alignment, healthcare leaders must think differently about the types of data their organizations need, the types of partners with whom they share information, and how they can leverage new information and partnerships for evidence-based action.

 

Am J Manag Care. 2016;22(12):827-829
Take-Away Points

  • Existing health information technology systems were designed for individual care delivery rather than population health.
  • Healthcare organizations need to expand data collection efforts beyond “sick care” information to information on actual health behaviors and social determinants.
  • Health information exchange can better support social determinants of health by including new partners, like social service organizations and public health agencies.
  • New data sources and information-sharing partners may lead to more predictive models.
Incorporating Meaningful Use (MU) into the Medicare Access & CHIP Reauthorization Act (MACRA) of 2015’s Quality Payment Program signals that healthcare organizations are expected to use health information technology (IT) to improve care. One focus of these improvements is population health, which requires managing the risks, outcomes, utilization, and health of entire groups of individuals. For example, both of the Quality Payment Program’s pathways—the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM)—include population health in calculating payments. MIPS requires population health quality measures and population health–based clinical practice-improvement activities.1,2 APMs promote organizational accountability beyond the individual patient encounter and are expected to reduce utilization through improved health.
 
The changes wrought by MACRA are just one indication that population health increasingly matters. The CMS Hospital Readmission Reduction Program penalizes hospitals for excess readmission rates.3 Nonprofit hospitals and health systems now must assess and adopt strategies to address community health needs to retain their tax exempt status.4 Moreover, influential projects like the “Culture of Health” initiative of the Robert Wood Johnson Foundation and “Health in All Policies”—which is promoted by numerous public health entities— foster an environment that emphasizes population health over the provision of medical care alone.5,6
 
The decades-long transition from a paper- to a technology-based information infrastructure in the United States has always been recognized as an initial step, laying a foundation for fundamental care delivery changes. Nonetheless, current health IT systems are not ready to support population health improvements effectively and efficiently. Existing health IT systems were designed for organizations that are structurally, operationally, and culturally focused on individual care delivery rather than improving health for groups of people.7 For example, electronic health records (EHRs)—primarily designed as clinical documentation tools—often lack sophisticated risk stratification and targeted case-management functionalities.8 Even when possible, healthcare organizations are not widely deploying health IT systems in ways that support population health.9,10
 
Opportunities exist to align health IT resources and population health management strategies to fill the gaps among technological capabilities, use, and the emerging demands of population health. To realize this alignment, healthcare leaders must think differently about the types of data their organizations need, with whom they share data, and how they can leverage these data for evidence-based action.
 
Embracing Novel Health Data Sources
Supporting decision making for population health requires expanding the fundamental types of data collected, integrated, analyzed, and used. Today, healthcare organizations collect what can be labeled “sick care” information (eg, diagnoses, encounters, symptoms, medications, procedures, tests). These data only present a “keyhole view” of a patient’s overall health; population health also requires “nonhealth” data about a population. Yet, notably absent in most current health IT systems are comprehensive data on health, behaviors, and social determinants, which are more significant drivers of health than medical care service utilization.11 For example, socioeconomic status, housing stability, nutrition habits, language, and location are all associated with poor postdischarge outcomes.12 Healthcare organizations traditionally collect and/or use these data in day-to-day operations only to a limited degree, however.13 Thus, healthcare organizations must expand data collection and usage to better understand how health within populations is created and maintained.
 
The good news is that many of these data exist and are available for when healthcare organizations choose to embrace them. Society is in the midst of a health data revolution. Estimates suggest that 1 in 5 adults uses a wearable fitness device,14 and similar numbers are actively measuring their own health indicators electronically.15 Beyond exercise, sleep, and physical activity monitors, retail loyalty programs generate information on purchasing behaviors, which provide objective measures of nutrition, medications, and even tobacco usage. Opportunities to leverage these information sources for educational, motivational, and communication functionality in health consumer IT abound. Beyond data about individuals, an unprecedented amount of information is available on the environment, public safety, traffic, neighborhood context, and public health.16 The opportunity to move from measuring how sick to how healthy populations are is within easy reach.
 


 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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