On August 9, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for the Medicare Shared Savings Program called “Pathways to Success.” Under this new rule ACOs would have to verify that a portion of their eligible clinicians are using certified electronic health record technology (CEHRT) to record patient encounters and communicate with other providers.
The goal is to promote broader interoperability, but the practical implications of this are a bit more troubling. While using an EHR can help providers better manage care for patients the data that ACOs generate across care providers and EHRs is highly unstandardized. For example, a single ACO may need to coordinate data from 15 different health information systems. A 2016 report from CMS on Next Generation Accountable Care Organizations (NGACO) noted, “About half of the NGACOs are interacting with at least nine distinct electronic health record [EHR] systems. Data sharing and interoperability among all providers was limited and was a priority for improvement.”
A single source of unstandardized data is hard enough to corral. The minute multiple sources are involved, coordinating the extraction of that data so it can be normalized to a standard that is leverageable and reportable, can be a monumental undertaking. In a recent Verinovum analysis:
- 86% of HL7 data was not properly formatted for analytics and AI
- 56% of patient codes were not available for mammogram patients
- Only 10% of providers ordering labs were identified by an NPI number
- Only 50% of HbA1c lab results had standard codes needed for HEDIS®1
Tellingly, a 2017 report from KLAS Research found that 86 percent of healthcare organizations surveyed had not yet reached “Deep interoperability” when it comes to their data. “The opportunity for deep interoperability has increased, and that’s good news. The bad news is that it has not translated readily into an impact on care. And the most obvious reason for that is that people are frustrated that the data they are getting is not as useful as it could be. There is either too much, too little, or it’s unwieldy. So the challenge is now getting that information into a form that is useful,” Bob Cash, vice president of provider relations at KLAS told Healthcare Informatics.
As value-based care continues to be the elusive goal of the industry, hospitals, payers, and ACOs are paying careful attention to gathering information needed to report quality measures. Yet they have been less concerned with the data quality inefficiencies behind that information. Organizations have become complacent with their current data submission process, and too often, something is missing. For example, payers frequently lack information tied to the clinical encounter. This missing information, as simple as a clinical diagnosis code, could have significant financial implications for payer and provider reporting needs.
Even when ACOs are aware of poor data quality issues, they may be unsure how to address the dilemma, have insufficient resources, or have been told their EHR would actually help solve the problem. Acquiring usable, actionable data from so many different EHR systems means not just data management, but data enrichment—data extraction, standardization, normalization, and identity management.
Verinovum offers solutions to help ACOs untangle the web, whether the goal is achieving quality standards, reducing administrative burden, or improving patient care management.
1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
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