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February 18, 2016

Electronic health records, population health management and public health

Photo credit: Anoto Group

In the midst of a formidable culture change in the American health care industry, information use, as opposed to information technology, lies at the center. Health care organizations must successfully navigate their transition to a value-based care model while remaining financially viable in a fee-for-service landscape, strive for high patient satisfaction survey scores, and – oh yeah! – continue to provide patient care. But where does public health fit into all of this? And, more importantly, what’s the benefit?

In a not-so-distant former life, I was an electronic health record (EHR) optimization specialist for a large hospital system. For context, this optimization team was part of a larger implementation team. Before going live on this new system, we spent 18 months validating, building and testing with each type of end-user, from clinicians to call-center staff to billing specialists. While well prepared, we were also realistic. Change is hard. We expected problems.

The optimization team’s efforts started on Day 1 of going live on the enterprise-wide EHR system. This work entailed spending a lot of time shoulder-to-shoulder with physicians and other providers. We observed them during office visits with their patients (with the patient’s permission, of course), showed them tips and tricks to make their charting more efficient, and took on bigger projects when those theoretical workflows hadn’t translated into practice.

“The long-term effects of arming the public health workforce with the best possible information will include reducing health care costs and allowing for more services to support overall population health.”

This strategy was all in an effort to help providers quickly rebound from the productivity decrease that follows rolling out a new system. Providers grew more confident over time and there were early high-performers who learned to use the EHR as a tool for prompting dialogue with patients, gave constructive feedback on ways to improve clinical decision support, and were all around super-users for the rest of their departments. These high-performers started to ask, “What else can the EHR do for me?” and “What else can it do for my patients?”

The next big optimization project was to kick-off a population health management (PHM) implementation that would start to answer some of those questions by giving providers a more holistic view of their entire patient population and comparing their own care delivery against their peers. PHM solutions integrate or exchange data with EHR systems and additional data sources to generate aggregate information on patients groups. With this aggregate information, PHM solutions then alert providers to care gaps which in turn improves clinical outcomes. These solutions and the population analytic capacity they provide can help increase a single clinic’s or hospital’s productivity, but they have the potential to do even more.

These data can be used to improve health outcomes for the broader community. Public health professionals can use these data to make timely and informed choices to better allocate resources, drive policies decisions, and prevent disease. The long-term effects of arming the public health workforce with the best possible information will include reducing health care costs and allowing for more services to support overall population health.

Goals of the Exploring Analytic Solutions project:

  • Explore capabilities of population health management (PHM) solutions.
  • Improve understanding of how PHM solutions meet clinical and public health needs.
  • Produce recommendations for improving data folow between clinical and public health entities.
  • Provide a guide for health care practices to collaborate with health agencies on improving population health.

PHII is contributing to this effort today through the Exploring Analytic Solutions project, which is funded by the CDC's National Center for Chronic Disease Prevention and Health Promotion. This project is currently assessing PHM solutions and will provide guidance to clinical practices and public health agencies who hope to use these systems in their own work. This project will help shed light on the capabilities of PHM solutions, improve understanding of how these solutions can meet clinical and public health needs, and result in recommendations for improving data flow between clinical and public health entities. We hope that this project guides health care practices as they consider adopting population health analysis tools and collaborating with public health agencies to improve the conditions in which their patients reside. Our findings will be available on phii.org this summer.