EHR interoperability, regulations top patient record concerns
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Jonathan Niloff, M.D., is vice president and chief medical officer of McKesson Corporation's Connected Care and Analytics unit. In the second part of this Q&A, Niloff, a population health expert and former longtime Harvard Medical School associate professor, talks about how effective population health analytics requires interoperability so clinicians can share health data to best coordinate care.
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Jonathan Niloff: To be successful in population health requires data, both to assure the good coordination of care and to feed the analytics that are so important to understanding [what's] happening in a population, and being able to manage both quality and utilization, which, of course, is a proxy for costs.
Interoperability, if used as the sharing of clinical data among providers in different venues of care, is the key way that clinical information is shared among providers. It assures that all caregivers know what care a patient is receiving and that nothing is missed from a quality of care and patient safety perspective, and that tests aren't ordered redundantly that have already been done. That's accomplished through the sharing of test results among different providers.
In parallel with that, moving data around or acquiring [data] to feed your analytics solutions, which are so important to understanding utilization and opportunities to improve both care and utilization metrics, is another form of interoperability. The barrier to interoperability [is] the lack of standards to make it easy to share information back and forth. We have seen the emergence of some new standards that are under development such as FHIR [Fast Healthcare Interoperability Resources].
How can population health systems best work with EHRs? How do you fit in population health management and population health with the daily EHR workflow?
Niloff: I think the clinicians in the field, optimally, would prefer to work in one system, because that's most efficient for them. So optimally, the insights that are gained through the analytics that support population health would be integrated into the clinicians' workflow, in the electronic health record. So those interventions can be executed during a clinical visit.
A challenge that I've been hearing a lot about from clinicians with the proliferation of analytics, is information overload. That's whether [they're] getting multiple alerts -- some of which are more relevant than others -- popping up in their electronic health records, or interoperability producing multiple long, multipage CCDs [continuity of care documents] to review. These represent very potentially inefficient ways of either displaying the output of analytics or sharing information. And it's driving inefficiencies.
In some ways, having multiple text CCDs to go through isn't much better than the old days when we used to get 4-inch paper charts to go through. To really make workflow efficient, we need a way of prioritizing the information and the outputs of analytics and delivering that information to the most appropriate caregiver to execute on those interventions. And our interoperability has to be smarter. We have to be able to aggregate and normalize all of the clinical data that we're exchanging, and then be able to deliver that in the workflow, in a summarized fashion that makes it easy to digest and makes it consumable by the clinicians that are using the information in taking care of patients.
Jonathan Niloff, M.D.vice president and chief medical officer, McKesson Corporation's Connected Care and Analytics
So going forward, what role will the cloud play in population health and population health analytics?
Niloff: I think that cloud-based technology is the future in healthcare. It's efficient, it's cost-effective and it will facilitate interoperability and sharing of data. Given the volumes of healthcare data that we are going to see increasingly going forward, the cloud makes a tremendous amount of sense for that.
What are a few of the best and most proven patient engagement strategies for population health?
Niloff: Patient engagement is a very rapidly growing area. And the options go all the way from what I call "wellness activities" to devices that monitor and promote wellness: from things like Fitbits, to apps where you can look up information online, to apps or portals where alerts can be delivered to patients. Also, appointments can be scheduled online, or there's communications with patients online.
That all then leads into telehealth; that essentially [means] remote visits, which seem to be growing in popularity as well. I think there is a role for home monitoring to provide the opportunity for earlier intervention to avoid an emergency room visit or hospitalization. There's a very large spectrum of patient engagement technologies that are emerging.
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