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The Power of Combining Clinical & Claims Data

Posted on November 16, 2017 I Written By

The following is a guest blog by Monica Stout from MedicaSoft

Whether the goal is to improve outcomes or increase efficiency, the healthcare industry finds itself searching for more and better data to support its efforts. Clinical data provides substantial details on patient encounters, but it is often difficult to assemble and integrate data from more than one healthcare provider. Claims data is better at following a patient across multiple care providers, but lacks information on patient health status and outcomes. Individually, both sets of data tell helpful stories, from chronicling the cost of care to reflecting how medicine is practiced. Together, clinical and claims data provide a fuller picture of a patient’s interactions with health care systems, the costs involved, and the results achieved. This larger picture provides the information that healthcare providers and insurers can use to guide their actions.

Assembling this data and making it available in a useful framework remains challenging. Data is not always available from providers and payers. When data is available, it is often not standardized (a particular issue with clinical data), making analysis difficult. So, how do organizations avoid investing time and money in efforts that fail to produce meaningful results? How do you make the data useful and improve patient satisfaction, care quality, and drive down system costs?

  1. Better data sharing agreements. Both providers and payers need more stringent data sharing agreements in place as well as insistence that they receive good data from plans.
  2. Address data quality issues head-on. Use real experts armed with specific tools to address any data quality issues within an organization.
  3. Use technology to help. Clinical data platforms can aggregate and integrate data into clinically relevant patient records, and claims data platforms extract relevant information from the complexity of the underlying claims data. Further, new advanced platforms help integrate clinical and claims data to support meaningful analytics.

Bringing together clinical data and claims data in a form that supports a variety of tools and analytics is key to the efforts of both healthcare providers and payers to improve outcomes, quality, and cost. This integrated data approach will yield better results than can be achieved with clinical or claims data alone. Stakeholders can and should leverage both policy and technology to develop solutions that produce meaningful results.

Are you combining clinical and claims data in your organization? What value have you gotten out of doing so? Why aren’t you doing it if you’re not?

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or LinkedIn.

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. MedicaSoft is a proud sponsor of Healthcare Scene. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

Why Do We Settle in Healthcare?

Posted on August 22, 2017 I Written By

The following is a guest blog post by Monica Stout, Marketing Director at MedicaSoft. This is the introductory blog in a three-part sponsored blog post series focused on new Health IT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

Imagine your typical Friday night. You’ve worked hard all week and now you’re ready to watch Netflix. You’ve picked the perfect movie. You’re ready to watch. You hit a button and your movie is right there, available and on demand. But what if it didn’t work? You’d be annoyed. You’d hop on social media to complain or see if Netflix is down. Someone somewhere would hear you.

On Black Friday or Cyber Monday, you might visit Walmart.com to search for some holiday deals. These are the busiest shopping days of the year. What if the website didn’t work? Or, what if you had to enter your shipping and billing data every single time you viewed an item? You’d be outraged. You might hop on social media to complain or see if others are experiencing the same problem. Someone somewhere would hear you.

Now imagine it’s the middle of winter and you’ve caught the latest bug du jour. You call your doctor for an appointment. When you arrive, you’re handed a clipboard and asked to fill out the same repetitive paper form with your health information that you fill out every time you visit. You’re certain they have this information already, but you’re required to fill it out yet again. You might wait 30, 40, or 60 minutes past your appointment time before you’re called back to a room.

Once you’ve made it to an exam room, a nurse comes in to take your vitals. The nurse will ask questions about what medications you are on. Nine times out of ten, the medications the nurse repeats back to you are outdated or entirely incorrect. You wonder where that data came from and are sure you’ve told this particular office the same thing the last four times you’ve gone there, so why is it wrong? Again, you wait in the exam room for the doctor. Your doctor comes in and spends more time looking at a laptop screen and clicking than making eye contact with you. Do you hop on social media and complain? Probably not. Does anybody hear you? No, because you’ve accepted that this is just how it is. In fact, you were grateful to receive a same-day appointment instead of waiting at home in misery.

The technology exists today to make things work and work fast. Other industries have intuitive UIs that people use every single day – we use them so much we don’t think about them. So, why do we settle for what doesn’t work in healthcare? Why do we accept a system that isn’t operating in ways that are beneficial or efficient to us as patients or to our doctors or nurses? Shouldn’t health information technology and the systems that support our health, well-being, and in certain situations, life or death, work more efficiently than our television subscription services or retail websites? Technology can do better in healthcare.

The technology on the back-end of Wal-Mart’s servers was robust enough to handle Black Friday and deploy with over 200 million users online THREE YEARS AGO. Amazing, right? But it’s that way because people won’t accept something that doesn’t work. If Wal-Mart’s website wasn’t available come Cyber Monday, consumers would vote with their dollars and move on to another retailer’s website that did work. That retailer would get all the business. Yet in healthcare, we keep revisiting a system that’s broken – where our health records are disjointed, incomplete, exist in duplicate (or many, many more), and just don’t work well together across practices, hospitals, or health systems. We don’t have a one centralized record with our health information serving as our source of truth. Sharing data across our providers is broken.

I realize that healthcare is more complicated than simply voting with our dollars and moving on, but why is that? The Wharton School Economics Professor Eric K. Clemons wrote a great piece on why healthcare is complicated. The technology is there to help advance healthcare to be what humans need it to be, so when will we stop accepting less? When will we demand more?

There is technology that’s easy to use and access, makes your information available, and centralizes your health information into one record. In our subsequent guest blogs, our experts will talk in more detail about these best of breed technologies and how they can be applied to healthcare to capture, exchange, and share data.

About Monica Stout
Monica is a HIT teleworker in Grand Rapids, Michigan by way of Washington, D.C., who has consulted at several government agencies, including the National Aeronautics Space Administration (NASA) and the U.S. Department of Veterans Affairs (VA). She’s currently the Marketing Director at MedicaSoft. Monica can be found on Twitter @MI_turnaround or LinkedIn.

About MedicaSoft
MedicaSoft  designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.