Population Health or the health of the population has been a concern from the beginning as this would be the only way to control spiraling costs and improve outcomes. It is by no coincidence, that in early 2009 both ICD 10-Snomed and Meaningful Use were created.

In the past, the only thing the government had that would allow them to look at actionable data was the information provided by claims after they were adjudicated. Claims data provides limited patient demographics, digital picture of the diagnoses, procedure or treatment provided for the cure through the CPT codes and the cost associated with the treatment or service provided. The obvious was that information was retrospective and limited as it takes time for the government to receive the claims and adjudicate them. Due to many providers still submitting claims on paper which require the data to be digitally uploaded to the system (yes, we still have providers on paper) this has caused additional delays.

But let's say for a moment, that the information captured by the government was available through a porthole for physicians wanting to aggregate healthcare information on their patient prior to making a decision. How long would it take the physician to reconcile or look for the data that is pertinent in making a treatment decision while looking at two independent systems? Well, the answer is, that this would not be a feasible real-time solution without artificial intelligence and the information being consolidated in a meaningful medical structure for physician use.

ICD 10 and Snowmed provided a more defined digital look at the patients condition/diagnoses. We went from less than 10,000 codes to over 80,000 codes.  Meaningful use was created as a means to get everyone to use an electronic medical record/electronic health record and do so, in a way that the government could receive live data from the healthcare providers. This would be done by incentivizing small and large healthcare providers across the continuum of care with a three stage progress payment that would have to be attested to each one of its stages and years. The progress payment would go to assist the healthcare providers to make the investment into new technology that met their milestone set by meaningful use stages 1 through 3. Along the way, meaningful use would also direct healthcare providers to provide online real-time data to the patients through portals. This provided transparency and the ability for the patient to be involved in their healthcare and to provide another providers test results and encounter information to the physician which is being visited.

There has been a push to conglomerate the medical historical information across the continuum of care with the creation of Meaningful Use (MU). The problem is that though we are moving in that direction, the vendors of Electronic Medical Health records (EHR's & EMR's) and similarly those in the space of Practice Management (PA) or Population Health are reluctant to have other vendors access their codes. It is also the fear of healthcare professionals to share their data with others that slows this down. It has been proven, that to collect data across the continuum of care and have it available when making medical decisions for a patient have provided better results, better outcomes, less hospitalizations and save money. The only entity that could aggregate medical information retrospectively like diagnosis (ICD-10/ SnoMed), claims data from adjudicated claims (CPT-Codes), patient satisfaction results from CG & H- CAHPS, other Quality and outcomes from PQRS and now MACRA for Best Practice decisions is the Government. We will talk more about some of the nuances in my next blogs. 

By Mario Espino