Closing Gaps in Care Through the Exchange of Health Data

Efficiencies that could be gained in healthcare information exchange present emerging opportunities to close discrepancies between evidence-based recommendations or best practices and the care that is actually delivered.

A new report from the Workgroup for Electronic Data Interchange (WEDI) presents first steps toward addressing gaps in healthcare and the barriers to identifying, preventing, and closing those gaps through education about data exchange via health information technologies (IT).

Efficiencies that could be gained in healthcare information exchange present emerging opportunities to close discrepancies between evidence-based recommendations or best practices and the care that is actually delivered, the report concluded.

The report, “Closing Gaps in Care through Payer-Provider Data Exchange,” noted that many providers are unable to seamlessly access or share patient health information electronically with other organizations. As a result, they are unable to efficiently identify patients in need of healthcare services or deliver services according to evidence-based guidelines in a timely manner.

“Not closing these gaps in care significantly affects the quality and cost of care by contributing to adverse patient outcomes and inappropriate care,” the report stated.

As value-based care, consumerization, and population health management strategies continue to change the healthcare environment, programs that can be implemented to address gaps in care will be critical to improving quality and reducing costs.

“Healthcare stakeholders must continue to work together to develop a health IT infrastructure that can seamlessly exchange data, automate the identification of gaps in care, and streamline the coordination of services,” the report noted.

WEDI’s research, conducted through the organization’s Sullivan Institute, suggested that greater education and communication are needed to raise awareness among stakeholders about this issue.

Gaps in care are often caused by the particular needs of a subpopulation of patients, the environment in which they seek services, and the capabilities of an organization to address their needs, the report states. The report summarized the key issues leading to gaps in care, “most of which are related to an organization’s ability and commitment to access, communicate or act upon information.” These include access to care, patient engagement, and care coordination.

The report presented additional key findings:

  1. The importance of gaps in care grows as value-based care efforts mature and more people gain access to health insurance coverage.
  2. Programs that address gaps in care have had a positive impact and appear to produce a good return on investment.
  3. Consensus about quality measures and methodologies for information exchange among health insurers, providers, and patients are needed.
  4. Provenance, quality, completeness, timeliness, transparency, and accuracy of data are key technical barriers that must be addressed, as well as interoperability.