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Health Data Exchange, Standardization Lacking in Chronic Care

By Kyle Murphy, PhD

- The American Medical Group Association (AMGA) has made several recommendations to Congress to ensure that policies intended to support chronic care in fact do so, ranging from incentives for investing in and adopting care management tools to requirements for health data exchange and timely access to standardized data.

Chronic care providers rely on health data exchange, standardization for population health

Last week, the organization submitted comments to the Senate Finance Committee Chronic Care Workgroup, many of which stressed the importance of health IT and information sharing to effective care management processes.

“Effective care management processes begin with an ability to identify and risk stratify patients with multiple chronic conditions. Clinical data is derived from medical group EMR systems and combined, when possible, with administrative claims data,” states the letter to Congress.

Although health IT has the potential to improve care management for the chronically ill, its effectiveness is limited by a number of factors, the group claims:

While easy to describe, the information technology (IT) and staff needed to create the infrastructure necessary to identify and care for chronically ill patients is enormous. Functions, data definitions, and clinical activities must be standardized and integrated into the IT and provider workflow across the system. EMR fields must be developed to capture data, data from many systems must be integrated, dashboards must be built to demonstrate care gaps and performance, and consistent education and support teams must be in place. Importantly, medical group leadership must champion the change management effort.

The AMGA highlights difficulties in accessing quality data from the Centers for Medicare & Medicaid Services (CMS), such as those faced by accountable care organizations (ACOs) which must convert CMS data into “a consistent format.”

CMS, however, isn’t the only payer with data access and format problems. Chronic care providers face a major challenge in trying to aggregate both clinical and claims data:

Claims data is needed for providers to understand the care that happens outside of the medical group office. Claims data is also needed to better predict risk and identify chronically ill and high cost patients. In other words, medical groups need both clinical and claims data to manage a patients’ care and their costs. However, access to claims data is uneven. Some commercial payors will share its claims data with providers while many will not. CMS shares its Medicare claims data with ACOs but there are limits to the effectiveness of this data share effort.

To this end, AMGA is calling for the development of a centralized data warehouse where providers can request relevant data on an as-needed basis. Additionally, the group emphasizes the need for quality data standards.

“Different payors require providers to submit different quality measures in different formats, at different times, with different inclusion/exclusion criteria etc.” states the letter. “This fragmented quality measurement system takes up resources on the provider end and diverts attention from building the infrastructure necessary to effectively manage population health.”

The AMGA provides no details about how the data should be standardized other than recommending CMS to convene a group of stakeholders to address the issue of data standardization. As for health data exchange, the group calls for it to be “timely, actionable and accessible.”

Read the full letter here.

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