Providers Lag Behind Payers, Pharma on Data Exchange

Healthcare providers lag behind the efforts of payers and pharmaceutical/life science companies to exchange data with others, according to a PwC US Health Research Institute report.

"Many providers are focused on using their own data first," says Daniel Garrett, principal and leader of PwC's healthcare practice in Philadelphia. "In the pharma world, there's already an established economy around providing and consuming data, and in the payer world, they've been using data outside of their own systems to understand risk for a long time."

In its latest study, PwC surveyed more than 600 provider, health insurer and pharmaceutical/life science professionals.

The quality of EHR data was a concern to 87 percent of the pharmaceutical/life science organizations surveyed. Garrett says they point to lack of standards in how EHR data is collected, stored and aggregated. "As people understand that the data will be used downstream to make decisions on, they'll improve the time that they spend entering the data" and add to its quality and depth, Garrett predicts.

Only 20 percent of health insurers are "very confident" in their ability to offer providers access to evidence-based protocols. "It's a good reflection on the need for a tight collaboration between the payer teams and the provider teams," Garrett says. "It's only provider teams that are going to create those evidence-based protocols. Then payers can take all those protocols, aggregate them, and then push them back out to the provider community.

Despite the slow uptake of EHRs and lack of standards, many organizations, particularly pharmaceutical companies, are forging ahead. "I compare the recent explosion of clinical data to the human genome information available 20 years ago," says Andrew Gaughan, director of payer evidence informatics at AstraZeneca Pharmaceuticals, who is quoted in the report.

A Need for EHR Standards
"The quality of data was pretty bad then, but we still used it, albeit with a pinch of salt," Gaughan continues. "You can't just stop because there are no agreed upon industry standards of EHR data. It's better than having nothing at all to work with."

Garrett says most of those featured in the PwC study agreed. "It would certainly be easier if the standards existed," Garrett says. "Right now anybody that's going to get into this space is just going to have to work around that."

The survey found that for now, 69 percent of providers are exchanging no data, versus 53 percent of health insurers and 51 percent of pharma/life sciences companies.

Informatics staffs needed for new product development or business models are bogged down in other tasks, such as medical loss ratios, meaningful use, and converting to ICD-10, the report says. "Non-compliance is going to put you out of business faster than new initiatives will generate business," one health insurer executive told PwC.

Although 60 percent of respondents say they are effectively performing clinical data capture and sharing, only one-quarter of provider respondents believe they are effectively integrating and aggregating clinical data, measuring it, and delivering actionable information to the point of care, the report says. These components are likely components of later stages of meaningful use.

Barriers to Clinical Data Capture
Major organizational barriers identified by providers included prioritizing tasks (58%), aligning clinical and technology teams (50%), preventing information overload (44%), data being kept in silos throughout the organization (43%) and inadequate funding (43%).

The report recommends giving CIOs strategic decision-making authority, reassessing the CMIO's role, developing a framework for prioritizing projects, and demonstrating to governing boards how informatics aligns with quality improvement initiatives.

Access to clinical data in EHRs would help 45 percent of pharma/life science companies in drug development, and 43 percent in clinical trial protocol design and recruitment, the study found.

So far, only 13 percent of provider respondents believe they have been able to impact patient behavior through their informatics efforts. Nearly 60 percent of providers and nearly all health insurer respondents identified patient compliance and adherence was a goal of their clinical informatics program over the next two years.

Nearly 40 percent of provider respondents said they were collecting and incorporating data received directly from patients into the medical record.

Within two years, 48 percent of providers expect to increase technical informatics staffing, and 35 percent expect to increase related clinical staff, the report says.

"The process of actually presenting clinicians' data is an art that we're all learning how to do," Garrett says. "A lot of our clients have teams of people embedded in IT to run the infrastructure, produce the data, and get the reports. Then they have physicians and nurse executives embedded in the health care delivery process that receive that data and act on it."

The full PwC report is available for download.