According to this Healthcare Finance News article, about $280 million in hospital readmissions penalties will be paid by 2,213 hospitals this year. This is a result of the Hospital Readmissions Reduction Program administered by the Centers for Medicare and Medicaid Services (CMS). It’s also a killer use case for data integration.
“The key to effective communication among providers is access to real-time data that supports patient care decisions. The challenge for most health systems is the ability to integrate disparate systems such as electronic health records and a system to collect patient information after discharge.”
This is a classic example of a business problem that can be solved through the use of data integration technology. Clearly, it won’t take long for the technology to pay for itself. Indeed, there is risk each day that this technology is not in place.
Most healthcare organizations don’t have access to many of the IT resources they need, including data integration. However, at least in this case, without data integration to support the integration of patient and health related data, they are facing fines that well exceed the cost of the technology. “Integration as well as aggregation and harmonization of data to make it available to multiple users are daunting tasks for overworked healthcare information technology (IT) staffs.”
The idea is to leverage data integration technology that will allow the monitoring and management of discharged patients. As stated in the article, …“if a patient neglects to refill a prescription, a message is sent to a nurse overseeing the program, who then calls the patient to discover the reason. This intervention reminds the patient of the importance of taking medication as directed and provides an opportunity to troubleshoot financial or logistical barriers that prevented the prescription refill. In this model, the nurse is able to track hundreds, if not thousands, of patients as opposed to the current model of a nurse only being able to keep up with a few discharged patients.”
What’s interesting about this use case for data integration is that the business case for using this technology is more than clear. If you don’t take action to resolve the issues around readmissions, then fines cause pain, and that pain drives the need for an automated approach.
The problem is in not leveraging data required to drive some of the core business processes, in this case, workflow, to alert humans of issues when data moves out of a predefined range. In this case, when patients fail to take or get their medication, follow up with physicians, or other events that may add risk to both the patient and the healthcare provider.
Another interesting point is that many healthcare organizations, typically healthcare providers, don’t have data integration strategies and technology in place. In many instances they are supporting data integration requirements using a hodgepodge of primitive technical approaches that don’t provide the ability to change those solutions around changing needs. Worse, they don’t provide the security and the governance subsystems required to remain compliant with the changing regulations.
The use case presented here is just one instance of a compliance issue that’s preventable using data integration technology. Given the changing regulations in the healthcare vertical, healthcare providers should be looking into this technology now, including spending some real dollars to get ahead of these issues.
I’ve spent a great deal of time within this blog discussing the healthcare vertical for a few key reasons:
- First, it’s the vertical that seems to be way behind the curve in creating data integration strategies, and has not invested in this technology as much as the other verticals.
- Second, new regulations will drive a drastic need for data integration technology, such as the problems covered above, as well as dozens of other regulations that will force providers to get good at integrating patient and health-related data.
- Finally, the time-to-benefit in leveraging data integration technology is extremely short, sometimes instantaneous.
Those in healthcare IT need to take the lead on this one. They need to create or update a data integration strategy, which means understanding all existing and future requirements, including existing or emerging regulations. Using this as the jumping off point, model the types of data integration use cases required, including security, governance, performance, and a clear understanding of the source and target systems.
I suspect that this situation will be “crisis driven” for many in healthcare IT. Meaning that they will look into the technology they needed a year or more ago, typically after they are fined. I don’t think that’s a great business and technology practice, and hopefully healthcare will become more proactive.