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Industry Collaboration Can Improve Healthcare Data Inaccuracies

An initial data set with established standards and a multi-stakeholder governance structure will be key to eliminating healthcare data inaccuracies, a CAQH group found.

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Source: Thinkstock

By Elizabeth Snell

- Broad collaboration between numerous healthcare stakeholders is crucial for developing an efficient and sustainable system that can cut down on healthcare data inaccuracies, according to a report from the Provider Data Action Alliance.

The group was convened by the Council for Affordable Quality Healthcare (CAQH), and wanted to find “an overall vision for what the provider data ecosystem should look like and a three-phase plan to implement the vision.”

The Alliance published An Industry Roadmap for Provider Data, which recommended that healthcare must declare its commitment in achieving an alignment across the board and that a not-for-profit, multi-stakeholder governance structure will be essential.

CAQH Executive Director Robin Thomashauer explained that inaccurate provider data has been a significant healthcare challenge for some time.

"Individual providers, provider organizations, patients and health plans are all affected by this issue, and it requires a collaborative effort to achieve real change,” Thomashauer said in a statement. “This Roadmap lays the foundation for the actions required to move forward.”

READ MORE: Solutions for Addressing Health Information Exchange Challenges

Montefiore Care Management Chief Administrative Officer of CMO Michael Dowling participated in the Alliance and praised the progress made with the report.

“We are delighted that this pressing issue is now closer to finally being addressed,” Dowling said. “Healthcare providers – both individuals and organizations – are eager to reduce the amount of time reporting their data, improve the accuracy of that information, and focus on patients instead of paperwork.”

The Alliance consisted of “a diverse cross section of more than 20 healthcare leaders, representing health plans, provider organizations, state and government representatives, regulators and HIEs,” while individuals from more than 100 healthcare organizations provided input on the final version of the report.

 “To succeed, this endeavor requires governance by a diverse set of stakeholders capable of defining and shaping the necessary solution details,” read a CAQH statement.

The roadmap suggested that stakeholders “align on scope by defining the initial dataset on which to focus, as well as the standard against which to measure data quality.”

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Additionally, regulators, accreditors and other stakeholders should be properly educated on the commitment to improving data inaccuracies. That way regulations and standards will continue to be aligned with the industry solution.

Finally, report authors recommended that measures are established “for value, cost and overall data accuracy so that the results of the industry-led effort can be assessed.”

The report also highlighted four key principles, which address underlying challenges to collecting and maintaining accurate provider data:

  • The time and attention of providers must not be wasted - A provider should have to report changes to their data as few times as possible. In turn, the system should be able to disseminate these changes to interested stakeholders.
  • The solution must be flexible and adaptable - The uses and definitions of provider data will continue to change as industry needs evolve.
  • The solution must be pragmatic and focused on near-term business realities - Immediate business, patient and regulatory needs must be addressed initially while setting the stage for continual, long-term improvements.
  • The solution should be industry-governed and standards-based - The system should take into consideration a wide range of industry viewpoints and operate through a transparent, standards-based and common technical infrastructure.

“More than $2 billion is spent annually by the healthcare industry to maintain provider data,” the report stated. “Despite these costs and the wide-ranging needs for accurate information about healthcare providers, inaccuracies continue to jeopardize business processes and patient care.”

Provider location data can create persistent problems nationwide because there is not one common understanding of how the data element should be used in different use cases, report authors posited. That data could be used for paying claims, receiving mail, or even be the “official place of business.”

READ MORE: Top 5 Challenges to Achieving Healthcare Interoperability

Along with there being varied data standards and requirements, the report explained that there are often few authoritative provider data sources in existence.

“Multiple sources may be designated as authoritative for the same data element, leading to potential conflicts, while other sources are advertised as authoritative but have significant accuracy issues,” the report said. “Conversely, in some cases where no authoritative source exists, data users may be forced to interpret available data in ways that are not broadly shared, creating compatibility issues when data is combined or compared across or within organizations.”

Data also changes frequently and multiple entities need to be notified of those changes. The demand for real-time provider data has increased but new procedures, tools, and business processes to support that pace have not been created.

Additionally, providers are not engaged in the dialogue for how to make necessary improvements.

“The industry has not made a coordinated effort to engage providers in these discussions or to educate providers about their role in data quality and maintenance,” report authors wrote. “As more of the administrative burden for data falls on providers themselves, their time spent delivering patient care is diminished.”

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