Clinical informatics may hold the key to better population health and a reduction of the healthcare costs in the United States if health organizations can use it to engage patients in managing their own health. A new PricewaterhouseCoopers (PwC) US Health Research Institute (HRI) report published recently suggests that health organizations view clinical informatics—the integration of IT into healthcare—as paramount to their financial success and ability to effectively and affordably manage patient care and wellness.
While improved patient care and safety is a top goal of their clinical informatics efforts, few health organizations have found ways of using health information to engage patients in managing their own health. A recent PwC HRI survey of more than 600 health management professionals across the country found the following:
• Only 15% of health insurers and 13% of hospitals, physicians groups, and other providers believe they have been able to successfully influence patient behavior through their informatics efforts.
• Nearly eight in 10 providers (79%) are looking to clinical informatics to help reduce medical errors, 61% hope to use it to improve population health, and 52% hope it will help them reduce costs by involving patients in preventative care routines.
• Eighty-five percent of health insurers are counting on clinical informatics to improve management of complex cases such as care for patients diagnosed with cancer, 80% are seeking a reduction in preventable emergency department visits and hospital readmission rates, and 56% hope that findings from their clinical informatics programs will lead to earlier diagnosis and prevention.
The HRI report, titled "Needles in a haystack, Seeking knowledge with clinical informatics," looks at the state of clinical informatics in the industry and the needs, goals, barriers, and opportunities that health organizations face in expanding their informatics capabilities. To inform its findings, PwC US surveyed health management professionals, including those from hospitals and physician groups, health insurers, pharmaceutical companies, and life sciences companies, and conducted in-depth interviews with 30 chief information officers, chief medical informatics officers, and clinical leaders at health organizations across the country.
PwC found that all of the organizations it studied are now focused on clinical informatics capabilities, a nascent, fast-growing field that combines technology, patient care, financial reporting, and collaborative information-sharing. While organizations have different needs, expectations for their informatics programs, the one common informatics goal PwC found they all share is a better understanding of medication compliance. Billions of dollars a year in wasteful healthcare spending can be attributed to excess hospitalizations, premature deaths, and other avoidable expenditures caused by patients who do not take medications as prescribed.
PwC's survey found the following:
• Nearly 60% of providers and 91% of insurers said that improving patient compliance and adherence to prescribed medication is a goal of their clinical informatics program over the next two years.
• Nearly three-quarters (71%) of pharmaceutical companies believe that access to information in EHR could help them better understand what factors lead to noncompliance as well as the factors affecting the safety and efficacy of patients' drug usage.
"Health organizations recognize the value of effective informatics and analytics, but they are struggling to institutionalize the insight, make it actionable, and use it for competitive advantage," says Daniel Garrett, HIT practice leader for PwC. "They need strategies for mining data, conducting and integrating evidence-based research, translating findings into practice, and influencing patients to participate in the process."
The State of Clinical Informatics in the Health Industry
PwC reports that clinical informatics is likely to become even more important in healthcare as the reimbursement landscape shifts from a fee-for-service or volume-based model to an outcomes-based model.
Comparative effectiveness research has made it incumbent upon providers, drug makers, and medical device manufacturers to understand and demonstrate how different treatments, tests, or procedures work compared with others.
PwC's research found the following:
• More than one-half (56%) of health organizations now have a formal clinical informatics program in place.
• Six in 10 (61%) hospitals and physician groups have a formal clinical informatics program, compared with 59% of health insurers and
33% of pharmaceutical/life sciences companies, which have been more likely to outsource their informatics functions.
• All health organizations—especially health insurers—have plans to increase informatics staffing over the next two years. Nearly one-half (48%) of providers plan to increase technical analysts and 35% will add clinical informaticists. Among insurers, 70% will increase technical staff and 30% will add clinical informaticists. Among pharmaceutical/life sciences companies, 39% intend to add technical staff and 38% will add clinical informaticists.
• Within the next two years, nearly two-thirds of providers will look to clinical informatics to help them improve care delivery by better understanding variances in performance, while 60% of health insurers will use clinical informatics to identify lower-cost, high-quality providers.
• Health organizations that already have formal informatics programs have made greater progress than those that do not on business strategies that position them to compete for patients and revenue in the new health market. They are more likely to be sharing data outside the organization and participating in new care delivery models; have advanced informatics functionality needed to meet requirements for meaningful use of EHRs, such as the ability to integrate and aggregate data, measure performance, and deliver information to the point of care; and be considering new collaborative strategies to expand informatics capabilities with other organizations and patients.
Health Industry Converges Around Clinical Informatics
The nature of the once adversarial relationship among payers, providers, and pharmaceutical/life sciences companies is becoming more collaborative in an outcomes-based reimbursement environment as health organizations discover they need each other and access to one another's information and capabilities.
Clinical informatics is spurring an increase in collaborative agreements, partnerships, and deal activity among health organizations, suppliers, private equity firms, and other market participants.
PwC's research found barriers that may slow collaboration and progress in the use of clinical informatics, including the following:
• Fewer than one-half of health companies are exchanging information externally today. Only 31% of providers, 47% of insurers, and 49% of pharmaceutical/life sciences companies participate in external data exchange.
• Despite the need for clinical information, the two biggest challenges health organizations face in expanding their clinical informatics efforts is data integration and lack of industry-wide data standards, leading to distrust in the data itself and its usage.
• Nine in 10 (90%) of pharmaceutical/life sciences respondents said that access to the clinical data stored in EHRs would help with drug research and development, and 85% said it would help clinical trial protocol design and recruitment, yet 87% also expressed concerns in the quality of EHR data. Pharmaceutical companies, which have historically purchased clinical information, have decreased purchasing activity from 45% in 2009 to 24% in 2011.
• More than one-half (54%) of providers said they would like to provide feedback into evidence-based protocols, yet only 20% of health insurers are "very confident" in their ability to offer providers access to evidence-based protocols.
• Seven in 10 providers and health insurers said that their top technical goal is integrating data from multiple sources, and only 17% of providers and 16% of health insurers are very confident that their health information exchange vendor will be able to meet their analytic and integration needs over the next two years.
A copy of PwC's clinical informatics report is available for download at www.pwc.com/us/hitinformatics.
Source: PricewaterhouseCoopers LLP