Home Health Care Medicare needs more than digitization – it needs unification

Medicare needs more than digitization – it needs unification


As a new generation ages into Medicare, more participants than ever are enrolling. The agency is at a pivotal moment and must find a way to innovate systems that integrate new Centers for Medicare and Medicaid Services (CMS) regulations that improve data platform interoperability, while answering the demand for updated technology for this new, more tech-savvy Medicare generation.

Healthcare providers are jumping into digitization as a way to empower seniors. However, just storing data on a digital platform is not enough – for the data to be valuable to patients and providers, it needs to be unified, de-duplicated and scaled to provide insights like patient engagement rates, at-risk patient indicators and more. Healthcare data platforms that are CMS-compliant and facilitate the management of patient and population health are the solution. A quality healthcare data platform (HDP) can ingest patient data from multiple systems and data silos and unify it into consolidated, 360-degree patient records that mean enhanced healthcare quality and safety for beneficiaries. This type of platform enables providers and patients to not only access key medical information in one place but empowers patients by giving them increased visibility into their records, while streamlining provider workflows and giving clinicians more time to focus on patient-centric care.

Current state of healthcare data

Traditionally, patient healthcare information has been almost universally siloed. Digital data stores remain separate and inaccessible, largely because of the challenges associated with data integration and data management at a massive scale.  Medical practices are constantly at risk of using out-of-date, incomplete patient records, or holding multiple records with differing information for individual patients, creating the potential for unsafe care. Additionally, a lack of care team coordination across providers remains a large challenge in the U.S. healthcare system. As Medicare beneficiaries often consult more than one clinician, it is important that each provider be aware of the care a senior receives from other providers, not just in their own practice. However, there has not been a common way to do this, as different medical practices use different electronic health records (EHRs), and the systems may not be able to speak to each other.

Today, new federal interoperability rules are driving a technology revolution. In addition, the population currently aging into Medicare is savvy about technology and more engaged in their own care. This means there is increased demand for technology-related policies that improve the healthcare experience for Medicare beneficiaries, as well as an opportunity to solve the data fragmentation issues plaguing the system.

However, for these rule implementations to be truly successful, we need a platform that can unify digital data from multiple data silos and combine it into a single, accurate and complete patient profile, providing access and a 360-degree view of medical status for both the provider and the patient. But providers will then need to ensure the patient is recognized across all systems and that their profile is consistently updated and protected. It is not enough just to have the data in one place; providers need to be confident that the data they use is accurate in order to make informed decisions.

How digitization impacts healthcare stakeholders

The outcomes possible through the unification of data for healthcare stakeholders can best be understood by looking at our current state and federal government data systems. Many government services have moved online, similar to the digitization of healthcare records, yet all of the information is siloed – there is no one place to see a 360-degree view of the information all government agencies have captured on an individual. While we can log on and view information on our individual tax filings or government benefits, we are unable to see it all in one convenient location; we need a different login for each portal – just like hospitals and outpatient clinics frequently require separate log-in credentials and draw from separate data silos. Imagine if there were one unified “U.S. Resident” portal – that would provide visibility into your overall relationship with the government and, conversely, provide the government with a better understanding of its population. This is the type of patient view a HDP provides.

This unification of patient data is even more important in healthcare, where the quality and safety of care depend on accurate, complete patient data. This is particularly true when patients see multiple providers, which increases risk for the patient if each clinician isn’t fully aware of which drug therapies the others have prescribed, for example. Two different doctors could prescribe drugs that interact poorly with each other without either being aware of any potential for an impending adverse drug reaction because they did not have access to a unified profile of the patient – instead, they had separate EHRs that cannot speak to each other. A unified patient profile not only empowers the patient, as they can see and understand all of their information in one place, but providers can be more confident in the quality and safety of their care plans and can more easily coordinate care across teams.

Patients are consumers, and alongside the new CMS rules, the generation aging into Medicare is driving the demand for access to health records and integrated care options. Not only will a data platform engage and empower patients, but it will ultimately reduce the burden on providers, providing them with more time to focus on what they do best.

How HDPs unlock the potential of healthcare data

An HDP can make data unification and interoperability a reality and allow data to benefit everyone involved in a patient’s care. HDPs allow the provider to view not just the patient’s history within their own medical practice, but the full patient view – providing a profile that contains relevant insights from all of the patient’s doctors and allowing for a more unified, safer, higher quality care plan. The needs of Medicare beneficiaries are changing, and a flexible, scalable data platform can provide the solution they need to stay safe and healthy.

HDPs can push beyond CMS standards and provide true interoperability. For example, an HDP is capable of supporting machine learning, overcoming the challenging hurdle of patient-matching and ensuring all patient data is up to date. Data is then compiled into a flexible, secure, and well-governed patient 360 view, enabling healthcare brands to see the needs of the people they take care of and deliver patient-centric care by identifying gaps in healthcare delivery that should be addressed. HDPs can also use AI to predict future patient needs, which is key to controlling healthcare costs and preventing disease.

Top-quality HDPs will support standards, like CMS standards and FHIR, to facilitate compliance and enable patients to feel confident that their data is secure. These standards allow for the extensibility of patient-related and clinical data and provider directory requirements. Further, quality HDPs support an extensible, open architecture that allows brands to easily and cost-effectively innovate new experiences and workflows on top of the patient data foundation. While protecting patient privacy, provider organizations can build apps that “call up” de-identified patient data to better support patient scheduling and follow-up, prescription management and more.

It is time for Medicare to move past legacy data storage and look to the incorporation of healthcare data platforms that provide beneficiaries with direct, unified access to their data and a way for providers to get a complete picture of their patients. By incorporating technology like artificial intelligence and increasing interoperability through HDPs, providers have access to complete, organized patient profiles that increase the safety and quality of care, and patients will experience better health outcomes as a result.

Photo: alexsl, Getty Images

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