Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

EHR, Claims Systems Data Integration: Physician as Scientist

By Jacqueline DiChiara

- Data, data everywhere. From smartphones to smartwatches to even smarter people, data's future within the healthcare industry was a massive trend sparking tangible widespread interest within last week’s annual HIMSS15 conference in Chicago. Of particular interest was the idea of data in association with both Electronic Health Records (EHRs) and Medicare claims systems.

Electronic Health Records

Carlos Olivares, CEO of Yakima Valley Farm Workers Clinic, spoke with Xtelligent Media during HIMSS to offer greater insight about how healthcare organizations can collectively integrate such collected data via EHR and Medicare claims systems data analysis for meaningful analysis and how to effectively improve and advance population health management.

Olivares says there are certain focal points to consider from a healthcare organization’s perspective to enhance and improve readiness.

“We knew that there was some transformation or work that we needed to do,” states Olivares. “We knew that as we move through the changes in healthcare, if as a system if we didn’t make some radical shifts in direction that we would be left behind.”

Olivares says considering the needed tools and strategies to be implemented will help the healthcare industry best cope with what the future may bring.

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“We felt that we were lacking in a lot of areas that in the past were important but were not critical for the survivability of the system,” says Olivares. “We did well. We prospered without those tools and that kind of work.

Olivares explains one of the most important realizations an organization can comprehend is if actions are not implemented expediently, it will fall behind the competition.

“We begin to look and try to understand what elements of technology do we need?” Olivares states. Regarding his collective experience at the HIMSS conference, Olivares says his desire to understand what the competition is doing within the healthcare industry is imperative to understand new immediate focuses and where innovative energy needs to be directed so industries can work together towards a collective goal. 

“Everyone has the right solution. Everybody’s ready to help you. Everybody is in a place that they feel are going to advance your needs,” he says.

Olivares emphasizes the vital importance of not just talking about resolutions but about actually creating actionable plans.

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“We started by looking at transforming our entire system,” explains Olivares. The patient flow, the structure, the way in which we manage patients had to change significantly in order to make it effective.”

Olivares explains his partnership with Arcadia Healthcare Solutions resulted in him more clearly recognizing how to most effectively execute high quality of value-based care.

“We began to do patient transformation by creating a system that would mirror the patient medical home,” Olivares explains. “However, because we have a variety of other activities in our organization and services that we provided, a patient-centered medical home was not all we needed to do.”

Olivares says enacting a collaborative plethora of acquiring care, such as a combination of dental or behavioral health, strengthens patient-centered health by establishing a fruitful infrastructure to transform care delivery.

“We could have never implemented the kind of transformation we’ve seen,” Olivares states. “From there of course we evolved into now beginning to understand the analytical type of work we needed, the data that we needed.”

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This type of infrastructure, Olivares says, offers a thorough and effective implementation tool for comprehensively understanding EHR and claims data through effective population care management.

“We had a whole bunch of data systems that were floating all over our system and it was almost impossible to try to coordinate,” Olivares confirms, suggesting the creation of a data warehouse created the exact type of analysis needed to build an effective platform.

“I can tell you today things about my patients and my system and my doctors that it would have taken about a year to try to figure out and even then it would have been a very difficult lift without structure.”

Olivares says an analysis of such data has provided him with several unforeseen financial revelations.

“We were leaving a lot of money on the table,” states Olivares. “There were a tremendous amount of resources that we were able to harness because of the data that we understood.”

Olivares says having such data readily available means physicians can consider information from a more hypothetical, number-based approach.

“With this data, docs are really scientists. They understand data. They’re very familiar with it. So they easily relate to data.”

Olivares adds many systems around the nation struggle to understand the social determinants associated with the possibility of risk. He confirms the healthcare industry’s next venture should be focused on better understanding how to create and strengthen these impairments.

Regarding the administration of quality, value-based care, Olivares says a healthcare staff will simply be non-responsive to dashboards, which are static and not easy to relate to.

Instead, Olivares emphasizes the need to utilize truly actionable data from the moment point-of-service begins.

Olivares says registers are built so every time a patient shows up to a clinic, it is known what that patient needs and the required team segments to help implement care, not only within an independent system, but across systems.

“Not every diabetic has to be touched by a doctor,” Olivares maintains, adding that oftentimes there is an unfortunate level of ignorance on behalf of physicians involving what resources such individuals require, such as social workers or nutritionists.

Such information is needed more than ever since technology has blunt limitations from a qualitative care perspective.

“This information not only has allowed us to give the patient the right care at the right time for the right reason, but it also is beginning to help us understand population management which is something dashboards don’t do.”

Olivares says he is pleased with momentary progress being made along this front.

“We’re beginning to see some true progress in the care of our patients,” Olivares states. “Interview me a year from now and I’ll be able to tell you even more.”

Olivares is unsure if healthcare IT will help smooth out future wrinkles within the value based movement.

“What I know is that we have built a foundation that we are beginning to put layers on,” maintains Olivares. “The ability to use the portals and the recording infrastructure is a huge second layer.”

Efforts continue to be implemented with a focus on improving population health.

“We’re still working on a third layer,” says Olivares. “In order to really move population health and create the outcomes that we want, we need to understand the social determinants that are causing some of the problems our patients are having as they seek and look for healthcare.”

Although Olivares says the healthcare industry is on the right path and heading in the right direction to enact effective change, he confirms curiosity regarding what the Centers for Medicare & Medicaid (CMS) will define as outcomes of care in the future. Olivares claims he is uncertain built data will match the expectations of CMS.

Olivares suggests the healthcare industry consider analyzing other industry structures for guidance, such as considering patient engagement through the lens of a consumer engagement model.

Olivares maintains although healthcare connectivity is the first step to understanding care, this alone does not provide resolutions about effectively delivering integrated care to resultantly improve care outcomes.

Olivares maintains the healthcare industry is moving in the right direction and is actively building upon needed fundamental steps.

“As long as we’re profitable and as long as we’re delivering care in a good, comprehensive way, I think we’ll do well,” states Olivares.

Regarding the concept of hiring additional informaticists and investing in more staff now that parsing data has become more valuable, Olivares says it is imperative to consider a combination of critical, technical, and analytical staff.

“Validation about the information that’s coming to us is probably the biggest challenge we have,” Olivares explains. “We don’t know what we don’t know. Most importantly, people who have not worked with data don’t know what the right question is.”

To combat such needs, Olivares says education is a significant part of acquiring patient data from actual patients, as building upon this foundation will help an educational process flourish.

“It’s a competitive field,” Olivares states. “You’ve been providing care for forty years and all of a sudden, your world is changing and it’s turning everything upside down. It isn’t a gradual change.”

Olivares addresses the fact that because technology within the healthcare industry is advancing at lightning speed, it is imperative that this technology is absorbed quicker than it progresses.

“Technology has changed so fast that we can’t keep up,” Olivares says. “We need people who can understand it.”

If the healthcare industry considers how to best implement data analytics to improve patients’ health, the financial performance of organizations will only thrive and flourish.


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