Three Barriers to Effectively Using Information Stored in EHRs

The healthcare industry won't realize the full value of its investment in electronic health records until it finds secondary uses for all of the data being captured, such as predicting public health trends and improving patient care, according to a report by PricewaterhouseCoopers Health Industries Group.

Seventy-six percent of the more than 700 healthcare executives surveyed in June 2009 said that the information gathered in EHRs will be their organization's biggest asset in the next five years. But very few healthcare organizations are building systems and care delivery processes to effectively use the billions of gigabytes of data being collected.

"I'm surprised that more thought hasn't been given to the broader idea of using the clinical and administrative data to do continued improvement and process improvement in the industry," says Dan Garrett, head of the health IT practice at PricewaterhouseCoopers. "People are so busy doing the basic digitization of the whole industry that they haven't had time to think through what they will do with all of this data, and so it has not been taken into consideration in the deployment of some of these larger systems."

Healthcare executives should be thinking beyond implementing EHRs to how they want to use this data after the technology is in place. "If you know that you are going to try and aggregate the data and make statistical sense out of it, you are going to do it in a very different way than if you are designing a transactional CPOE," explains Garrett.

Unfortunately, there is no industry road map to follow. Instead healthcare providers are faced with three primary obstacles to the secondary use of data.

1. Data quality. Is there enough volume, depth, and breadth of data to produce statistically relevant information? For example, data that is aggregated from transactional-based systems like bill collection may not include clinically relevant information. In healthcare, after a bill is collected, "it is like that data is pushed off a cliff," says Garrett. He adds that in other industries—financial and hospitality—that doesn't happen. If people knew that data would be used by another physician, medical center, or research organization, systems would be designed differently and information would be captured differently, he says.

2. Workflow. Deciding when to physically interject that information into the clinical or administrative process is challenging, because it should be done at a point where it is relevant, the user can absorb it, and the user can take the appropriate action. "You are looking for impact, so you have to do it at the right point of the administrative and care delivery process," Garrett says.

3. Legal and policy concerns. Organizations are still struggling to determine when they can use this data and what are the liabilities associated with aggregated de-identified data. What if the data can be re-identified and traced back to patients? When can patients opt in and out?

There are some organizations that are already working through these obstacles, and the report "Transforming Healthcare through Secondary Use of Health Data," highlights the experiences of these five industry leaders:

• Aetna, which gathers data from multiple sources to create comprehensive, personalized views of each of its members.
• The American Heart Association/American Stroke Association, which has developed evidence-based guidelines for the treatment of cardiovascular disease and stroke based on hospital data.
• Geisinger Health System, which created a company called MedMining that de-identifies and licenses its data for healthcare research.
• Partners HealthCare, which uses data from its EHR to identify trends in drug usage based on post-market drug surveillance.
• WellPoint, which piloted an integrated health record for its members that demonstrates how claims data can be used to support the delivery of care.

Key findings from the report include:

• 65% of health organizations expect their secondary data use to increase significantly within the next two years.
• 90% of executives said the industry needs better guidelines about how health information can be used and shared.
• 76% of executives said that national stewardship over, or responsibility for, the use of the health data should be regulated.
• 59% of organizations using secondary data have seen quality improvement.
• 42% of organizations using secondary data have achieved cost savings.

To truly achieve meaningful use, healthcare organizations will need to be able to move aggregated and non-aggregated data across the industry. In other industries those two elements are directly related, says Garrett, adding that if someone enters bad data, there are checks and balances in place to uncover the error. "As soon as healthcare delivery professionals personally experience what happens if they don't capture the right data, they will become that much more attentive to getting it right," he says.

Of course, providers will need to see the benefit to them on the backend before they'll devote the extra time and effort to capturing that clinically-rich data. That is why pilot studies will be a key element to moving the use of secondary data forward, says Garrett.

"If you see personal benefit, it takes on relevance and moves this off of the ‘that is great idea' quadrant."