Electronic Health Records

Adoption & Implementation News

What tools are needed for managing population health?

By Kyle Murphy, PhD

Providers participating in models of accountable care have agreed to share risk to manage the health of a patient population. This kind of population health management requires that accountable care organizations (ACOs), patient centered medical homes (PCMHs), or similar collaborations have three types of tools in order to be successful, says IDC Health Insights Research Director Cynthia Burghard:

• analytics — being able to identify the risk levels of patients as well as measure the performance of clinicians treating them

• workflow — generating appropriate care plans, tasks, and similar activities to get patients on a path toward an improved outcome

• communication — enabling effective and timely interactions between providers and patients in a meaningful way

“Those three capabilities coming together really allows the accountable care organization, patient-centered medical home, or whatever the model is to manage a population of both at-risk patients as well as healthy patients,” observes Burghard.

And two of the three present more of a problem than the other — that is, workflow and communication. According to Burghard, providers generally don’t have well integrated tools in their hands and are required to interact with multiple health IT systems to complete the workflow associated with a certain treatment.




“Most of the vendors will present that data around gaps in care either on a piece of paper or by going to a separate system, and that frankly is one of the challenges for you, particularly at the point of care,” she explains. “Most of the systems are designed for the embedded care manager to manage the population rather than at the point of care.”

Communication also proves to be a problem and one that may prove the greatest of all. “It’s one of the biggest challenges of population health management,” says Burghard. “We’re still pretty much using letters, phone calls, patient portals. The more cutting-edge delivery systems are now realizing that they need to touch their patients where their patients are.”

A solution to inefficient communication already exists but it is at play in another industry. Burghard points to the Amazon ecosystem as example of a consumer-friendly communication platform based on convenience.

“That is one of the things that we have figured out. If you look at other industries,” she continues, “it’s figuring out how to imitate those models that the healthcare organizations are struggling with because there are issues with security and privacy. But going to where the patient is rather than having the patient come to me is more convenient, easier, and more likely to be compliant.”

For both workflow and communication, the problem is the same. The end-user (i.e., patients and providers) must be able to make decisions in a convenient and efficient way. For the provider, that is in the form of an integrated health IT system. For the patient, that’s in a format consistent with how she manages other aspects of her life.

It may be called population health management, but in the end it is still very much about the interaction between two individuals, provider and patient.





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