Your patient health care data is most likely scattered throughout the medical universe, in everything from notes scribbled by various doctors to test results resting in far-flung computer systems. So when medical professionals need to pull that information together to get a complete picture of your health, the process is a bit like throwing a lasso around a tsunami.
That's why integrated medical data has now become a major goal of health care reform. Integrating patient records, such as physicians' notes, diagnoses, medical device records, surgical procedure outcomes, and treatment histories, can be used in powerful ways, ideally leading to better patient care, lower health care costs and, ultimately, healthier patients.
“Trust on the part of both the consumer and doctor is hugely important in determining who is going to be the likely winner here”
There is certainly a market demand for solutions, but which type of organization will take the lead on a patient-data integration system that enjoys widespread success: hospitals, insurance providers, medical equipment suppliers, consumer tech companies, or some other entity?
Right now the answer to that question remains uncertain, but what is clear is that the organization will have to be one that both consumers need and doctors trust, says John A. Quelch, the Charles Edward Wilson Professor of Business Administration at Harvard Business School and Professor in Health Policy and Management at the Harvard T.H. Chan School of Public Health.
Quelch says integrating patient data is crucial to propelling the health care system to become more consumer-centric. Yet with many people concerned about privacy and skeptical about personal data being shared, he believes any organization looking to take the lead in this area will not only need the resources required to pull off such a complicated task, but will have to establish great credibility with the consumer.
"Trust on the part of both the consumer and doctor is hugely important in determining who is going to be the likely winner here," he says. "Some organizations may have the capability to integrate patient data, but may not have enough credibility with the consumer. And some may not have the motivation to realign their businesses in ways that would allow them to deliver this extra-added value service."
Electronic Health Records Promoted
In 2014, health care spending in the United States exceeded $3 trillion and was expected to reach $4.5 trillion by 2020. To reduce health care costs and improve care, some organizations have made it a priority to invest in information analytics, attempting to get their arms around the wide array of patient data. Government incentives are helping the push. In 2011, the US Centers for Medicare and Medicaid Services established incentives for doctors' offices and hospitals to switch from paper to digital, providing up to $2 million to hospitals serving Medicare patients that adopted electronic medical records (EMRs).
Quelch and HBS research associate Margaret L. Rodriguez released a case study in April about one organization that has ramped up its patient analytics: The Carolinas Healthcare System, based in Charlotte, which in 2014 owned and managed hospitals and acute care facilities in three states.
In 2011, Carolinas launched Dickson Advanced Analytics, which incorporated complex clinical, financial, demographic, and claims data to develop analytical tools that would speak to three strategic priorities: predict the health care needs of patients, continually enhance patient outcomes, and drive transformative solutions to import community access to health care.
For example, using patient data including emergency department visits and sodium levels, the analytics group helped clinical teams identify admitted patients who were at high risk for readmission to the hospital. Patients at risk of being readmitted within 30 days of discharge have hospital staff members who work with them on managing medications and connecting them with dieticians and others who can provide follow-up care.
"If you can predict the rate of readmission on the front end, you can put extra resources against that patient to minimize the risk of readmission," Quelch says.
“The consumer's time is being eaten up unnecessarily doing bureaucratic work”
In addition, the Carolinas analytics group has organized around 2,000 data points on each of its 2.2 million patients, including clinical data, medication use, education, socioeconomic factors, and consumer spending information to segment patients into groups, such as "high risk of cancer," so these segments can receive customized preventive messages and care specific to their needs.
The data have not only provided important information to improve patient care, they have also been used to support hospital investment decisions, such as which surgical devices to purchase, since patient data includes information on the quality of outcomes.
"Carolinas Healthcare employs 120 staff working on data analytics, a big strategic investment but a major potential point of differentiation in the quest to both cut costs and improve patient outcomes" Quelch says.
Other companies have made their own strides in health care analytics. For example, Quelch and Rodriguez wrote a case in May about Philips, which started in 1891 as a light bulb manufacturer in the Netherlands and, more recently, has become a major manufacturer of medical devices and software sold primarily to hospitals.
In June 2014, Philips announced its HealthSuite Digital Platform, a cloud-based infrastructure that supports the secure collection of information related to health and lifestyle, allowing hospitals and care providers to integrate and analyze data. Most health care providers do not have a complete data set that includes all of a patient's information; Healthsuite is an open platform that provides a secure and private home for data, allowing care providers and consumers to use the information to make decisions about patient care.
Philips executives are hoping the company's early entry in the market will provide a significant advantage, since hospitals tend to seek technology partners that can grow with them over a long period, rather than bearing the switching costs of starting over with a new platform and supplier.
Ideally, a sophisticated analytics system would allow consumers to have easier access to their own health records, providing the kind of "timely, accurate, and complete information that enables you to do a better job of taking charge of your own health care—preventative or therapeutic—to speed a healthy outcome," Quelch says.
Aside from enjoying lower health care costs and improved care, consumers stand to benefit by saving time handling appointments, referrals and the like. Quelch says he recently had to arrange an appointment with a specialist, was told by the specialist's office he needed a referral from the primary care physician, and was given a fax number. He then had to call his doctor's office to pass along the fax number so the document could be sent.
"This is not consumer empowerment. This is consumer enslavement," he says. "The consumer's time is being eaten up unnecessarily doing bureaucratic work. When there is cost pressure—and there's a lot of criticism about health care costs—the natural tendency is to shift work to the consumer."
About 18 percent of US gross domestic product is spent on health care costs, and a certain portion of those expenses are related to operational inefficiencies that could be alleviated with big data analytics and efficient IT systems that handle a good chunk of the work, Quelch says.
Yet consumer trust when it comes to data privacy is not always a given, and consumers want to have a say. Some people fear that information about a serious disease diagnosis or a visit with a mental health provider could be shared with their employers and used against them—and the consequences could involve missing out on a promotion or even losing a job.
"No one will be able to integrate all of my data for the benefit of doctors without consumers also being involved," Quelch says.
Handicapping The Players
So which organizations have the best shot at creating an integrated health care data system that enjoys widespread adoption and acceptance? Quelch outlined the possible players:
- Hospitals: Large organizations like Carolinas have created their own data systems. But the hospital world is fragmented, and unlike Carolinas, many hospitals don't have the resources, commitment, and management capacity to build and oversee a complex data analytics system.
- Insurance companies: Large insurance companies, such as UnitedHealth and Humana, are increasingly focused on analytics. Some use claims and consumer profile data to target high-risk patient segments with advice about exercise, nutrition, and other programs in an effort to minimize medical visits. The problem: insurers' claims data is not as current as hospitals' clinical data. In addition, insurers have a perception hurdle to overcome: "They are not well trusted by consumers," Quelch says. "Can a health insurer counter out of the mold and break the standard prejudice against trusting insurers to develop a closer relationship with the end consumer?"
- Device companies: Device companies like Philips have created health instruments used in hospitals and homes to monitor millions of patients. Philips generates over one-third of its global sales from health care. Other companies like GE and Samsung are also active in health care. These brands enjoy some consumer credibility, but they tend to be viewed as device companies, rather than as data companies. Partnerships could alleviate this concern. For example, Philips recently aligned itself with Salesforce.com, a leader in customer relationship management approaches that could be applied to patients.
- Consumer tech companies: Consumer tech companies including Apple and Google have entered the industry with health care dashboards that track and aggregate data from various health wearables, such as heart rate monitors and step counters. Apple is also partnering with several EMR companies to make medical records and lab results available to consumers on their iPhones.
These tech giants have expertise in analytics and managing huge amounts of information, have access to demographic and location data, and enjoy broad consumer adoption of their devices. But do they have enough access to and necessary understanding of claims and clinical data? Quelch asked. And do they have enough credibility with physicians in terms of their health care expertise?
- IBM: IBM has entered the health care data fray with IBM Watson Health, which is intended to bring together clinical, research, and social data from a range of health sources, creating a secure, cloud-based data-sharing hub that can help patient diagnosis and improve outcomes. IBM is trusted by many consumers, but because it has not specialized in health care, it may be perceived as lacking an intimate understanding of doctor-patient decision-making.
Quelch is planning to write additional cases, including one on an insurance company as well as one about IBM Watson Health, to explore advances by other players in the integrated patient data market.
Note to readers: John Quelch invites Working Knowledge readers to comment on which type of organization they think offers the most convincing combination of capability and credibility to pull off widespread health care data integration?