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Q&A: Fragmented Patient Data Impedes Analytics in Healthcare

Technology is making great strides in healthcare, but a fragmented system that makes it difficult to share patient data is blocking advances, argues a healthcare attorney.

• By Linda L. Briggs
• January 5, 2017

"Using analytics," asks attorney Harry Nelson, "how can we catch up with countries that are spending much less than we are but seem to have much better health outcomes and healthier populations?"

In Part 1 of our conversation, Nelson discussed how healthcare companies could be using technology more effectively and reasons they aren't doing so. In this part, we discuss overall healthcare systems and more in-depth uses for analytics.

Nelson is a cofounder and managing partner at Nelson Hardiman LLP, a Los Angeles-based law firm specializing in medical technology law, HIPAA compliance, Medicare laws, and medical practice law. He has launched three companies that advise healthcare clients on efficiency, including how to store and secure data to ensure compliance with HIPAA and other privacy laws.

Upside: When we look at other countries that we sometimes compare our healthcare system to -- Great Britain or Canada, for example -- are they using technology in more effective ways than we are?

Harry Nelson: In terms of the administration of healthcare, they are managed a lot more effectively. I'm not taking a political position here; I'm not advocating for a single-payer system inherently. Where we thrive in the U.S. is this: yes, we have all this incredible technological equipment, we have all these diagnostic devices -- many MRIs and lots of radiological equipment. We have all this equipment because we are a privatized, decentralized system.

However, in the area of actual patient management, because there is specialized responsibility and expense in those other countries' systems, there is much better management and coordination of patient data.

Our system is completely fragmented. As part of the HITEC (Health Information Technology for Economic and Clinical Health) Act of 2009, which President Obama signed as one of his first acts after his inauguration, there's been a real effort to change that. The whole point of that law was to say, OK, we have electronic records now, but they're not actually being used in meaningful ways -- let's change that. There's been some progress, but in some ways it has stalled.

There is still such a problem of data in silos in particular systems. The secretary of Health and Human Services recently convinced the industry to make a promise regarding interoperability -- and this has been a big quest over the past seven years -- to move toward a system where data can flow freely to and from any professional health system. Data, essentially, can then follow the patient.

If you look at Canada or England, there's no issue with interoperability. The last barrier in the U.S. has been that problem of fragmentation and siloing of data. It's only a problem because our system is so decentralized and because electronic health records companies make their money by being gatekeepers of the various silos.

What is the solution to achieving true interoperability?

The real solution, if the government wants to change things, is negative consequences. We need carrots, which the government is using now, but we also need sticks. There have to be some sanctions and some real consequences. It's not so much about the healthcare providers themselves as it is about healthcare IT having to face some real sanctions for impeding the transfer and interoperability of healthcare data.

I don't mean to be completely negative. There has been some progress, but the government needs to be prepared to put negative pressure on organizations that are obstructing interoperability of data.

You focus on the midmarket segment of healthcare providers. Are there areas in which that segment is using technology really well?

One example is healthcare staffing. There is a lot more attention being paid to talent management in some clinics -- setting staffing ratios and making sure that staff is managed well. I see organizations that are doing much better with talent management, with figuring out who the outstanding performers are, and with customer service.

I'd say there's been a revolution there in the last decade in the use of electronic communication -- it's being used much more effectively and organizations are much more responsive to problems. Those are areas where I see a lot of progress being made with technology.

Can you describe specific examples of how healthcare companies you work with are using analytics effectively?

There are a number of companies in healthcare that are using analytics positively, in a disruptive way. We work with a handful of companies that have studied patient data and identified from utilization patterns that a patient had a particular problem such as substance abuse. Looking at data such as the number of visits to emergency rooms, you can identify people with apparent alcohol or drug dependency problems. That's a really useful screening tool.

You might have half a million patients, but you can find the 50,000 who have a specific issue by using analytics. A number of companies have taken that a step further and looked for successful and different approaches for targeting that population for treatment.

This includes the idea of using analytics as a cost-effective way of helping these people manage their problems. The challenge is that only a certain portion of your patient database is receptive to a certain approach. There are a number of different approaches, from case managers who make direct contact with those who need help to software solutions that give patients the incentive to go through a program to reduce their consumption.

Can you offer another example?

Another example, in hospital settings in particular, is using analytics to focus on particular cost–driving populations. For example, we were working with a health system when we recognized, through analysis, the high cost of certain healthcare utilizers.

Take people who suffer a traumatic event such as a car accident. They need a massive amount of care as a result of that trauma. Using analytics helped identify a population who didn't fully understand how to engage with the system for follow-up after a traumatic injury. They were continuing to use the emergency room as their primary care provider, when there were many more proactive, cost-effective, wellness-oriented resources available to them.

We looked at how analytics allows you to take a slice of your patient database and say: Who are our really expensive patients? Why are they expensive? How do you deal with that? Part of the solution might be looking away from analytics to some one-on-one solutions that involve putting people on the problem. We might alternatively build resources that are more user-friendly to try and address the problem by creating more acceptable options.

Here's another example of how analytics is being used. We have a number of clients who are looking at services in which the patient and doctor are connected remotely -- asynchronous telehealth. This is one of the frontiers of medicine today. With analytics, we're trying to use an asynchronous model to allow people to get prescriptions -- to non-controlled, safe medications where there is an established protocol for use.

Analytics can identify the characteristics that can safely allow a doctor to prescribe medicine, even if this patient and doctor never actually meet each other. What data does the doctor need in order to identify whether this patient really needs this medication and is not at risk of a contraindication?

That's an exciting use of analytics because ultimately it is giving patients -- perhaps rural patients -- more immediate access to a doctor. Basically, it expands the power of doctors to prescribe by using an analytics framework to develop an evidence-based standard, then to allow this doctor and patient to have an encounter without actually meeting. Many people aren't quite ready for it, but that's part of the future of analytics regarding the doctor-patient encounter itself.

What are some advances you see ahead in health technology?

We're living in a time when there's a lot of receptivity to trying and testing and investing in new technologies. There's some cool stuff happening around predictive analytics. We also see a lot of exciting work around the "aging in place" idea. There's a whole world ahead -- a "silver tsunami" of baby boomers coming in the next 20 to 25 years. We're seeing incredible technological advances that support aging in place, where people will be able to live at home with support from caregivers and coordination from technology tools.