Is converging clinical, administrative data a good idea?

There has been much discussion about the convergence and interoperability of administrative and clinical data and transactions but is it truly worthwhile? That was the big question during a panel discussion at the Centers for Medicare & Medicaid Services’ eHealth Summit on Aug. 2.

A bigger concern, at least at this point, should be what data are being moved around, said Thomas Meyers, vice president, product policy department, America's Health Insurance Plans. “From a convergence standpoint, the data only need to be blended at a point in time when the relevant data need to be pulled together and used appropriately.” He said that different common datasets for the two are sufficient.

“They are two separate animals,” agreed Jim Daley, chairman of the Workgroup for Electronic Data Interchange. Blending the two adds the risk that treatment decisions could be based on administrative information such as price when they should be made based on clinical measures and reasons, he said.

However, a critical alliance is needed in some places, said Gwendolyn Lohse, deputy director, Council for Affordable Quality Healthcare. “Data definitions need to be the same so we know whether we’re talking chargemaster or price.” She also cited the need for standards, common goals and how to achieve those goals. “If our goals are different, we have a challenge.”

Lisa Gallagher, vice president, technology solutions, Healthcare Information and Management Systems Society, pointed out that we might not know exactly what we will need in the future. “There are a lot of drivers, such as clinical and business intelligence, implications of health information exchange, payment models, payment portals, population health—there’s a long list. I agree that we’re going to have different sets of data that will need to be pulled together and there are infrastructure challenges there.”

She also questioned whether the right data are being collected at the point of care. “We know what we need to do for the treatment of a patient but maybe additional data need to be collected to meet other goals. It’s going to evolve over time. This is a learn-as-we-go experiment.”

Everyone needs better provider data, said Lohse, but which data elements are most critical? “What are we calling an acceptable level of accuracy in provider data? What are the definitions of different data elements? We need a dialog about goals for clinical data and for administrative data. We certainly don’t need to reinvent the wheel and collect more data from the providers who are already overburdened.”

There’s a push-pull for data, said Meyers. Once everyone can adopt common sets of standards, “we can then start to build information systems where you can get into complex decision-making tools, leveraging the data you need when you need it. You don’t need to pool all this information--you really need to be able to push and pull information from the sources when and where you need it. Federated models work great as long as you adopt some common footprints.”

Meanwhile, consumers want to see their health status, claims, what they pay and more. “The consumer is an important point to look at where the data are converging and how they can be presented in a form they can understand,” Meyers added.

Small providers are the most trusted entity the patient has, Gallagher said. “How does it affect their workflow if they have to talk administrative details with patients during treatment? That’s not their traditional model. A lot of factors will come into play and will drive our data needs as we go forward with our drive to involve the consumer.”

This all adds up to “an enormous cultural shift,” said Robert Alger, vice president, health plan business technology solutions and services, Kaiser Foundation Health Plan. This will lead to the need for organizations “to arm caregivers with information they’ve never had before.” He also addressed the October 1 launch of health insurance exchanges. “Are we ready to explain American healthcare to a group of people who now need to make very complex personal decisions? My thought is we’re very early on in this journey.”

Lohse agreed that the industry is early in the process but key indicators show stakeholders are making adjustments. For example, she said the Council for Affordable Quality Healthcare started a provider database with no listings and now includes 1.2 million providers. “Rather than 700,000 entities asking the same question, now there is one source to ask the same question. It’s a shared utility and I don’t think you would have seen that 10 years ago.”