The New Paradigm in Healthcare Data Quality

There is no higher importance in managing customer information than when making decisions on health care. While most markets are busy striving for a ‘single customer view’ to improve customer service KPIs or marketing campaign results, healthcare organizations must focus on establishing  a ‘single patient view’, making sure a full patient history is attached to a single, correct contact.  Unlike in traditional CRM solutions, healthcare data is inherently disparate
and is managed by a wide variety of patient systems that, in addition to collecting and managing contact data, also tracks thousands of patient data points including electronic health records, insurance coverage, provider names,  prescriptions and more. Needless to say, establishing the relationships between patients and their healthcare providers, insurers, brokers, pharmacies and the like or even grouping families and couples together, is a significant challenge. Among them are issues with maiden/married last names, migration of individuals between family units and insurance plans, keying errors at point of entry or even deliberate attempts by consumers to defraud the healthcare system.

In many cases, the single patient view can be handled through unique identifiers , such as those for group health plans or for individuals within their provider network. This was an accepted practice at a recent Kaiser Permanente location I visited, where a gentleman went to the counter and reeled off his nine digit patient number before saying “hello”. But while patient ID numbers are standard identifiers, they will differ between suppliers and patients can’t be relied on to use it as their first method of identification. This is where accuracy and access to other collected data points (I.e. SSN, DOB and current address) becomes critical.

While healthcare organizations have done a decent job so far of attempting to establish and utilize this ‘single patient view’, the healthcare data quality paradigm is shifting once again. For example, The Patient Protection and Affordable Care Act (PPACA) means that healthcare organizations will now have to deal with more data, from more sources and face tougher regulations on how to manage and maintain that data.  The ObamaCare Health Insurance Exchange Pool means that more Americans can potentially benefit from health insurance coverage, increasing the number with coverage by around 30 million. Through these new initiatives, consumers will also have greater choice for both coverage and services  – all further distributing the data that desperately needs to be linked.

With such inherent change – how do you effectively service patients at the point-of-care? And, do you want your trained medics and patient management team to be responsible for the data quality audit before such care can even begin?

So what are the new dynamics that healthcare companies need to plan for?

  • Addition of new patients into a system without prior medical coverage or records
  • Frequent movement of consumers between healthcare plans under the choice offered by the affordable care scheme
  • Increased mobility of individuals through healthcare systems as they consume different vendors and services

This increased transactional activity means healthcare data managers must go beyond the existing efforts of linking internal data and start to look at how to share data across systems (both internal and external) and invest in technology that will facilitate this critical information exchange. Granted, this will be a significant challenge given the fact that many organizations have several proprietary systems, contract requirements and privacy concerns but oddly enough, this begins with best practices in managing contact data effectively.

Over the last year, I’ve worked with an increasing number of customers on the issue of managing the introduction of new data into healthcare databases.  Just like healthcare, data quality is both preventative and curative. Curative measures include triage on existing poor quality data, and investigating the latent symptoms of unidentified relationships in the data. The preventative measures are to introduce a regimen of using DQ tools to accurately capture new information at
point of entry efficiently, and to help identify existing customers quickly and accurately.

For healthcare customers, we’ve managed to do just this by implementing helpIT systems’ technology, matchIT SQL to deal with the backend data matching, validation and merging and findIT S2 to empower users to quickly and accurately identify existing patients or validate new patient details with the minimum of keystrokes. This complementary approach gives a huge return on investment allowing clinical end-users to focus on the task at hand, rather than repeatedly dealing with data issues.

Whenever there is movement in data or new sources of information, data quality issues will arise. But when it comes to healthcare data quality, I’m sure healthcare DBA’s and other administrators are fully aware of the stakes at hand. Improving and streamlining data capture plus tapping into the various technology connectors that will give physicians and service providers access to all patient data will have a profound effect on patient care, healthcare costs, physician workloads and access to relevant treatment. Ultimately, this is the desired outcome.

I’m delighted to be engaged further on this subject so if you have more insight to share, please comment on this or drop me a line.

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