By Phil Giarth, Director of Product
Published by: MGMA
Recent developments in data analytics bring with them critical barriers, despite the promise of propelling the industry into the 21st century. Most healthcare organizations have yet to effectively integrate data analytics into their regular operations. In fact, one study showed that 56% of hospitals don’t have a strategy for data governance or analytics.
Healthcare data varies among health plans and even within the same organizations. Payers may have multiple variations of the same datasets used for various reasons. In fact, it’s not uncommon for a payer to have five versions of the same claims file, three versions of the same risk adjustment file and more than eight versions of the same Star quality information. Typically, payers have the same raw data/table with different joins, fields and summations used for various applications within the organization. This leads to confusion, redundancy and inefficiencies.
An application programming interface (API) allows applications to communicate with one another in a similar language to solve these communication overlaps through a standardized format, cadence and method to push and pull information. They also save massive amounts of information, while sharing and helping strengthen security measures as the calls/pushes activate only the information needed versus massive file dumps.
Provider integration of APIs
APIs make it possible for healthcare organizations to avoid massive data pulls, easing the burden on stakeholder organizations sharing the information. They also enable more real-time information, which saves the user from having to account for recent changes and ensures access to the most actionable information.
In looking at hospital admission, discharge and transfer (ADT) data sets, most health information exchanges (HIEs) create APIs that allow real-time feeds, and yet most health plans perform the minimum level of exchange on a daily basis. This is comparable to an air traffic controller who receives updates on takeoffs, landings and in-flight aircrafts once a day. Extending this analogy to the hospital setting, many hospitals are managing a patient’s condition — not the whole patient — and failing to account for comorbidities, medications and other factors that influence outcomes.
APIs send real-time notifications and populate dashboards regarding procedures, actions and services that are delivered. This allows physician practices and organizations to intervene and enable the highest quality of care possible.
The most sophisticated organizations have incorporated APIs for discharge planning, medication reconciliation post discharge, readmission prevention, real-time prior authorizations and accruals for future payments, which can improve gain share and quality payments for value-based care models.
How APIs benefit patients
For patient portals, APIs enable them to receive information and transparency about the services that have been delivered so they can better plan their future deductibles, copayments and benefit needs.
As a growing number of medical groups seek seamless and secure access, exchange and use of electronic health information (EHI), there will be increased innovation and competition. By giving patients and their healthcare providers secure access to health information and new tools, patients will gain much-needed access to a wider array of options in care and treatment.
APIs help individuals to securely and easily access structured EHI using smartphone applications. To achieve this, healthcare organizations must adopt ways to provide data transparency between other healthcare organizations through a central and secure exchange of EHI. For hospital systems, this includes clinical notes and ADT files. For payers, this includes anything from claims to clinical data, including labs, pharmacy, immunizations and vitals.
Of importance to providers focused on value-based care, having access to real-time and actionable information at the point of care is a significant improvement over information from claims filed 60 to 90 days after the care was provided.
The limitation of current EHRs
Direct integration to and from EHRs would allow patient data to be seamlessly available at the provider’s finger tips. The challenge is that EHRs are only as good as the information fed into them. The moment a patient goes outside of a circle of care, the user loses sight of the services being rendered. The typical EHR has yet to master how to economize on full population health analytics.
With a post discharge, for example, questions must be answered: Have all the federal rating gaps been completed? Are there any acute conditions post discharge that need to be updated? Do medications need to be reconciled?
To maximize the value-based care opportunity, these questions must be integrated into systems that are also interoperable, with all parties freely sharing patient data in a two-way street. The absence of interoperability creates a burden for all stakeholders including hospital systems and other healthcare facilities and undermines payer efforts to achieve high quality care and more appropriate utilization.
It also impacts reimbursement and profits — money and resources that are better used to improve diagnostic and treatment capabilities or attract new patients. When more information is shared historically, it allows payers to manage the whole patient experience. This is where an innovative EHR browser extension can make all the difference.
The purpose of a browser extension
The ideal browser extension serves as a population health solution built upon an EHR foundation and completes the circle of care by aggregating information through continuity of care documents, claims, labs, health information exchanges, vendors, ancillary providers and hospitalists groups to not only answer the question of “who is in my office now?” but also “who should be in my office?”
This is accomplished through alerts, with defaults based upon the system’s history or on the specific user — based on the information they want to access. It’s about creating a user journey that notifies the provider of an admission through real-time APIs, sending care alerts to the case manager, flagging the risk-bearing entity to a potential future cost and relevant information to patients and caretakers via a mobile app.
While many organizations struggle to redo their EHR architecture to meet real-time needs, an innovative solution, such as a browser extension, can already meet the requirements to push and pull information to any properly assigned user through role-based access control (RBAC), which is customized per user.
This saves time for the provider/medical group trying to break down which patient came from where and how much information they can access.
Look for a web-based tool that is available at the point of care and has connectivity capabilities that can allow EHRs to reach their full potential. The platform should enable payers and providers to gain insight on the impact of Medicare Advantage, Medicaid and commercial value-based care initiatives and should be available as a Chrome browser extension that can operate on any web-based EHR.
Checklist of EHR browser extension capabilities
The right browser extension enables providers to access all data from a single source, improve workflow and provide exemplary patient care.
Key factors to look for include:
- Sits on top of any web-based EHR
- Uses patient matching when on top of an EHR to pull the correct patient and his or her relevant data
- Sends alerts to providers within their existing workflow
- Eases workflow and provider administrative burden by eliminating the need to toggle between different platforms.
Ultimately, the best browser extension should be designed to optimize the way information is shared, enhance how programs are implemented and improve care delivery. It eases workflow and provider administrative burdens by eliminating the need to constantly switch between different platforms, further streamlining the pathway to improved patient outcomes.