IT Investments

In our October 2014 Intelligence Report, healthcare leaders described a variety of investments in IT infrastructure capabilities that are directed toward population health management. Members of the HealthLeaders Media Council discuss such investments.

This article first appeared in the April 2015 issue of HealthLeaders magazine.

Laura Pryor, RN, MSN
Chief Quality Officer
Windrose Health Network, Inc.
Trafalgar, IN

We have put our own system together. We have a calendar of specific chronic conditions that we are monitoring and also some preventive health factors such as well-child visits, immunizations, colorectal examinations, and cervical cancer screenings. For diabetes we may be running a report out of our own medical records system as a registry. We can run a report for people who have a specific condition, and it lets us do more sorting where we can narrow it down to people who did not have a hemoglobin A1C in the last 90 days and we might want to do some intervention.

You have to have the ability to collect data that is current. You also have to have a dedicated stakeholder who is the main person responsible for running the reports and getting the word out to patients. We created a new position for the care coordinator.

Levi Scheppers
Chief Administrative Officer
Nebraska Medicine
Omaha, NE

We know that we have key data gaps to understand performance risk for population health. We are trying to assess specific competencies and data gaps that we don't have currently.

Using payer claims data: That was a clear gap when we formed the Nebraska Health Network with our Methodist Health partners. We don't have a sense for total costs across the continuum for any cohort of patients, let alone the patients that we take care of within our primary care offices or inpatient facilities. We knew we had to close that gap. We found a good partner that could do that, we could get experience with it, but as we started to close that gap, we knew there were other types of data gaps.

The University of Nebraska Medical Center has a college of public health, and they analyzed population health data. We are trying to understand how we can use that university-based competency in our clinical delivery competency because we know that if we want to produce value and mitigate performance risk, we are going to have to understand that data.

Looking with the end in mind, we have to bring this together in a comprehensive data analytics and warehouse package; but we are starting with trying to close the immediate gaps in the competencies we have to have, and over time we will bring them together.

Michael Kanter, MD
Regional Medical Director of Quality and Clinical Analysis
Southern California Permanente Medical Group
Los Angeles, CA

We approach it from the patient and population point of view first. We define what problem we are trying to solve, what population we are trying to help, and IT is typically one component of a multifaceted approach.

Our data comes in the form of information from our electronic medical records system. It's better data in that it is clinical data that is more granular than one gets from claims data. There is no lag in claims processing.

The fact that we are an integrated delivery system means we have all the medical records so we can use them instead of claims data. Other organizations will need to get to the point where they are using medical record information. It is feasible to do once you are set up to do so. The barrier is going to be getting compatible systems in place in every delivery system that can talk to each other.

We have over 80 patient registries in Southern California that are all connected electronically. So, inpatient, outpatient, lab, radiology, everything feeds into a large data warehouse that we can go into and abstract data from. The key is integrating all of that with the medical groups and the delivery systems so it's not just information standing alone somewhere and not being acted upon.

Ronald A. Paulus, MD
President and CEO
Mission Health, Asheville, NC

On infrastructure: One area is core electronic health records and connectivity infrastructure components. Cerner is our partner and our core platform vendor in that realm. We have several joint development products that we are working on together, most specifically an integration of a wellness platform (that is looking at lifestyle and behavior modification, weight maintenance, and exercise, and those kind of things) into the traditional patient portal for looking up lab results and communicating securely with your provider or scheduling appointments.

On patient interaction: Another investment area would be around more novel tools or devices. We have a partnership with a company called Livongo Health. They have a different form of the traditional diabetic meter. It's wireless. It uploads to the cloud. It has a GPS. It has interactive capability back and forth between the physicians and the patient. We are piloting that in a group of our patients here trying to enhance the patient engagement factor, which the literature and my own experience would suggest are critical elements of engaging in population health. We're looking at a variety of smartphone-based apps that allow different forms of interaction between providers and patients, whether it is a virtual visit or just a text-based communication or text-based behavioral health modification. We link that into our wellness platform, where we integrate with a couple of different biometric devices—the Fitbit and the Pebble are two examples—and we try to incorporate coaching and behavioral health reminders around those activities.