Healthcare Needs an Enterprise Approach to Data for the Digital ’20s

This year sets off the decade of data, making it critical for organizations to get their data houses in order by embracing an enterprise strategy based on a solid data platform. But before we look into what the future will bring, let’s revisit the major themes from the past decade:

It all began in 2009

In 2009, the passage of the American Recovery and Reinvestment Act incented the adoption of electronic health record (EHR) systems, leading to major, multi-year initiatives to select and implement new, consolidated EHR platforms. The end result has been a marketplace consolidation, with only a handful of major players left.

A few years back, the CIO of an early adopter of a new EHR platform stated that the EHR implementation is not the destination, just the ticket to enter the show. By and large, most healthcare organizations have made their choices and completed their implementation cycles at this point. As the energy and resources dedicated to that process fade into the rearview mirror, organizations will begin pivoting to the “show”– in other words, figuring out how to use data from across the enterprise to impact decisions.

The industry has seen other major changes over the last ten years, as population health and care management gained momentum and value-based care (VBC) models took root.

Population health and care management has grown increasingly important as a way for organizations to tackle costs by segmenting their populations into groups and managing their care more proactively. What we have learned so far from these initiatives is that the more data we have throughout the patient journey – including social determinant factors – the more successful all programs can be with a more granular approach.

On the other hand, VBC models were off to a slow start. A recently updated study from Numerof & Associates highlighted some of the ongoing challenges and a few changes that took place in the last few years. In the 2016 survey, 61 percent of respondents predicted they would be at least “very prepared” to take on risk in 2018. In the current survey, however, barely 25 percent felt they had achieved that mark. Financial, organizational culture and data challenges abound as barriers for the successful shift to VBC models.

In summary, the last decade has shown a titanic shift towards a few consolidated HER vendors as the industry turns its eye to managing care for various sub-populations and prepare for the shift from fee-for-service payments to VBC arrangements.

What’s in store for the future?

As we close up the last decade, we’re already seeing a number of items that are going to continue to gain momentum in the years to come:

• Providers using claims data and payers using clinical data to give more context to the patient journey.
• Patients taking control of their data through interoperability and a growing amount of user-generated data through wearables and apps that organizations will want to tap into.
• New care models, such as care shifting to non-traditional players like CVS, Walmart, and perhaps Amazon. For example, Walmart is consolidating treatment across the country for certain surgeries to a specific provider to reduce costs. As a result, providers are going to need data to show they can deliver low-cost, high-quality care.
• An explosion of interest in the advanced use of data through predictive, machine learning and artificial intelligence technologies. Although there is a bit of hype, early use cases show promise and momentum will grow in the next decade. All three technologies are dependent on cleansed, curated data, which remains a challenge for most organizations.
• The digitization of healthcare, which encompasses the aforementioned advanced uses of data, as well as tailored patient experiences supported by digital technologies and personalized medicine.

When you factor in healthcare’s current challenges with the initiatives that are likely to accelerate in the 2020 and beyond, it’s clear that healthcare organizations have a lot on their collective plates.  The common theme here, through this collection of industry shifts, new technologies, and initiatives, is that success relies upon the use of data.

Enterprise data platforms for healthcare

Healthcare data provides an outsized challenge with its complexity in sources, disparity and volume.  Executives within the industry have widely hoped that a move to large consolidated EHR platforms would alleviate data silos, but in reality the scope of the problem is wider and too complex for EHR vendors to take on, despite their ability as transactional point of care systems. Organizations that want to thrive and succeed in the coming “Digital 20s” need to invest in an enterprise approach to managing their data assets in a consolidated, curated manner.

Healthcare organizations need to consider how they will organize and leverage data, not just for an individual need like population health, but to meet the needs of the entire enterprise, now and moving forward. An enterprise healthcare platform must be able to:

• Onboard data rapidly and without the need for complex extract, transform and load (ETL) processes requiring the support of talented and expensive ETL developers;
• Master multiple data domains including patient, provider, provider practice, workforce, facility and member;
• Organize data around a centralized model with agreed upon data and metric definitions. This includes a process and capabilities that support the data stewardship needed to keep data clean and accurate;
• Harmonize data with the millions of codes and value sets;
• Manage the hundreds of complex metrics that organizations must execute against; and
• Prepare cleansed and curated data for analytical and other downstream uses such as predictive, AI and ML algorithms to drive new insights across the organization.

Healthcare organizations willing to make the needed organizational investment in data will reap great rewards in the Digital 20s. Organizations that haven’t made the plunge will find themselves falling behind other organizations leveraging new models of care delivery, and the target of merger and acquisition activity as the digital winners increase their scale.