Health systems, pharmaceutical companies and health insurance plans have several innovative options for using electronic health records (EHRs) to improve patient outcomes, according to a roundtable discussion at the World Congress EHR and E-Prescribing Summit. But several significant obstacles, including interoperability and effective data mining, need to be overcome for this strategy to start improving clinical outcomes, according to the panelists.
Incorporating clinical trial data into the EHR may be a good place to start, according to Christina Weir Ripley, the director of business innovation and digital health at Boehringer Ingelheim. By doing so, “we’re identifying the right patient for the right treatment at the right time,” Ms. Weir Ripley said. “The benefit to the system is on many fronts, but ideally you have patients getting better treatment, probably experiencing fewer adverse events, getting better and then hopefully, they stay adherent to the medication.”
Running data queries based on criteria from clinical trial protocols in the EHR and then matching patients to those protocols may also benefit research. “By helping to identify patients based on inclusion and exclusion criteria that is captured in EHRs, we can help advance the research space as well,” said Lisa Flaiz, the group product director of digital marketing at Janssen Pharmaceutical Companies of Johnson and Johnson, in Philadelphia.
Hampered by Disorganization
The various sets of health care information—claims data, EHR data and clinical trial data—are not integrated. “None of those data sets are organized in ways that make it easy to proactively identify potential diseases and interventions,” said Tom Olenzak, the managing director of strategic innovation, portfolio corporate development and innovation at Independence Blue Cross, in Philadelphia.
But now efforts are underway to address that shortcoming. Independence Blue Cross, for example, is working on combining its longitudinal claims data, which include information on diagnoses and patient encounters across all providers, “with deep clinical data, both structured and nonstructured, that exist within EHRs,” Mr. Olenzak said. For instance, the data are used to develop care gap reports that alert a physician when a patient has missed a preventive exam, such as mammography or colonoscopy.
Independence Blue Cross also is working with New York University’s Langone Medical Center on a predictive diabetes model. This model uses EHR data, external data and an algorithm “to identify not only patients with undiagnosed diabetes but also patients who are likely to be diagnosed with the condition within the next 18 to 24 months, so we can work with a patient’s physician to make appropriate care available,” Mr. Olenzak said.
Ms. Flaiz added a caveat. “By no means am I suggesting that [patients] should be sending that data to their physician every night for integration into their personal medical records, but there probably are some valuable and viable approaches to using the data that patients have captured, particularly if they’re a patient that has a chronic disease,” she said. “That would help doctors spot trends over time.”
Roadblocks to Success
The lack of interoperability is perhaps the biggest obstacle to fully harnessing the potential power of EHRs to improve health outcomes. Indeed, EHR data are often incompatible with health plan claims data, and the different EHR platforms frequently are unable to communicate with one another, according to Mr. Olenzak. “Even within a single hospital, different instances of a single EHR don’t play well together,” he said.
The hope is that a technology giant, such as IBM, will build a structure that will link the various users to the cloud and “make all that unstructured data structured and then somehow magically pipe it back down into the systems,” Ms. Flaiz said. “We’ve got a long road ahead of us from an interoperability perspective, which doesn’t mean that we can’t leverage the data … but to get scale in the space, there’s a lot of different ways we’re going to have to approach it.”
One way is partnering with multiple EHR platforms. Other options include partnering with a health system that has an established and willing IT infrastructure, or by collaborating with middleware providers “that sort of sit on top of the EHRs and be agnostic and allow plug-and-play systems,” she said.
Reasons for Optimism
The sheer brainpower being applied to this area is one reason for optimism. Companies such as Google, with its considerable resources and fearlessness in trying new ideas, have established a stake in health care. The other players in health care—pharmaceutical manufacturers, health care providers and insurers—must foster a better understanding of the complexities of health care.
“Health care is not Uber,” Mr. Olenzak said. “That’s a very simple, very repeatable transaction. This is far more complex and far more regulated. There is a wealth of entrepreneurs wanting to disrupt health care. We can help them understand the system that they’re trying to disrupt and really help that disruption.”