Can't Afford an EMR? Try Mining Your Own Data
Vol. 1, Issue 2 - April 17, 2008
Even basic health information systems can yield a gold mine of information for improving prevention and care of diabetes and other chronic conditions.
“You have more clinical data than you think,” said Richard Miller, DO, chief medical officer at Avera Health Plans, Sioux Falls, S.D.
The payer and its affiliated integrated delivery network, Avera Health, had electronic storehouses of patient demographics, service and diagnostic codes and medication history, as well as sites of service. With no more than off-the-shelf grouping and analysis programs, data miners at Avera Health produced clinically meaningful information from existing claims and billing data.
Results were detailed enough for the organization to assign scores to diabetics based on both care opportunities — testing, office visits, and preventive care — and on severity, as measured by co-morbidities, medications, visits to the emergency department, and hospital admissions.
Similarly, Affinity Health System, an integrated delivery network and health maintenance organization in Menasha, Wis., chose to improve care management by mining data from its existing IT infrastructure rather than shelling out millions for a new electronic medical record.
Affinity’s leaders determined that technology already in place could provide clinicians with at least 80 percent of the information they needed to follow national care guidelines. Hospital information systems had records on blood pressure. For diabetics, blood-sugar test results were in existing laboratory systems, while claims and charge-capture databases could pinpoint the last time a patient was in for an eye exam.
On the clinical side, Affinity had electronic prescribing records that could be mined for information on medication adherence.
Return on investment
The results at both organizations speak for themselves.
In a pilot study at Avera Health, return on investment was 5 to 1 over the first 24 months, so far above organizational expectations that management re-tested initial results several months later and came up with an even greater ratio of 5.5 to 1.
For the health plan, monthly costs to treat diabetes patients dipped to $800 per patient from $1,100, and the care was highly effective. The average weight loss for diabetics enrolled in disease management was 15 percent, according to Miller.
At Affinity, officials decided they wanted to empower patients to be proactive in their own care as part of an overall quality-improvement initiative across the entire three-hospital system and its affiliated 200-physician medical group.
Patient communication is a vital component. Regardless of who the insurance carrier is, each patient in the diabetes disease management program gets an annual “birthday letter,” reminding him or her to get eye and foot exams. Letters containing test results also include “action steps” if that patient’s care falls short of national guidelines.
Effective planning is common
The common success factor at both organizations has been effective planning.
Organizations must define the need for clinical information, in terms of what needs to be changed, who the intended audience is, and what will prompt those people to act, Miller said. Avera focused on diabetes self-care and targeted health coaches, who received reports of risk factors and opportunities to improve health status.
Secondly, it is essential to find appropriate clinical questions to ask. “If you don’t get the question right, it’s most certain that you won’t get the answer right,” Miller said. For Avera, the question was: “Which diabetic patients are the sickest and are missing the preventive services they need?”
The targeting worked, as nearly two-thirds of patients identified enrolled in the program.
Affinity Health envisioned what its medical director for health informatics, Paul Veregge, MD, calls “push-pull” disease management, with reimbursement incentives for physicians to encourage healthy behavior and the promise of lower health care costs for patients who adhered to the program.
— Correspondent Neil Versel