医信观察 · MED IT
中文译文数据治理与互联互通

解决医疗行业97%的数据浪费管理问题

Solving Healthcare’s 97% Data Waste Management Problem

HIT Consultant··约 5 分钟阅读
译文2,070 字

Watershed Health 首席执行官 Effie Carlson回收会让人觉得自己正在保护地球;然而,放入回收箱的物品中,最终仍有多达70%会被送往填埋场。所有出于善意的分类最终都变成了浪费。

医疗行业建立了同样的系统,也犯下了同样的错误。该行业已向 Trusted Exchange Framework and Common Agreement (TEFCA)、互操作性强制要求以及区域交换网络等“回收箱”投入数十亿美元,而这些系统建立在这样一种假设之上:如果我们能够将数据分类并传送到正确的地方,最困难的部分就完成了。

事实远非如此。医疗行业是全球数据量最大且增长最快的贡献者之一,其中多达97%的数据都未被使用。数据被汇编、交换、格式化,最终仍被送往填埋场。这个行业存在数据浪费问题。

只是在分类,而非理解

联邦互操作性工作已经取得了明显进展,至少记录确实实现了传输。TEFCA 已从每年大约1000万次患者记录交换增长到超过10亿次。但传输数据与理解数据是两个不同的问题,而互操作性工作背后的一个隐含假设是:如果所有内容看起来相同,就可以使用。

一项2022年的研究考察了使用五种不同医疗记录系统的68家癌症诊所。使用同一系统的诊所大多数时候能够理解彼此的数据,但使用不同系统的诊所能够理解彼此数据的情况仅勉强达到五分之一。而且,这项研究只考察了那些已有明确编码规则的数据,例如检验结果和药物。很多时候,信息是手工输入医生笔记中的,没有任何内容可供计算机系统识别。记录虽然存在,但下一个接收它的系统可能完全无法理解其含义。

从设计上处于闲置状态

大多数临床数据被录入记录时,没有人考虑过以后会如何使用这些数据。它没有损坏,也没有错误;在传送到下一个目的地时,它是完整的,从技术上也可以使用,但其背后没有任何下游用途。数据箱只会装得更多。

这是一个数据“付诸行动”问题。互操作性虽然能让数据更快地移动,却无法解决数据到达之后该如何处理的问题,也无法解决这样一个事实:借助适当的技术,数据实际上可以发挥作用。

据估计,80%的临床数据存在于非结构化笔记和扫描文档中,难以搜索或采取行动;而在照护转接过程中,这是一个关键问题。一项研究发现,在12小时内从一家医院转往另一家医院的患者中,32%出现了重复检查,其中五分之一的重复检查没有临床依据。同样的模式也出现在用药错误、不必要的就诊和交接不佳中。数据在关键时刻无法使用,也没有向任何人提示问题。

如果数据能够走到这一步,更快的传输也无法改变它随后处于闲置状态这一事实。

立足现实进行建设

医疗行业一直在推进工作,仿佛更好的标准最终会让传真和纸质文件过时。但这并不符合现实,而且对很大一部分医疗服务提供者而言,永远也不会成为现实。农村医疗服务提供者和小型医院比城市同行更加依赖传真和邮寄,因为它们缺乏维持电子交换所需的 IT 人员和宽带接入。参与 TEFCA 是自愿的,而自愿系统往往只能覆盖那些拥有资源的机构。

许多急性期后照护机构同样严重依赖过时的方式。在护理院和家庭健康机构中,80%的机构已经采用 EHR,但很少利用 EHR 与照护合作伙伴交换数据。传真和纸质文件填补了这一空缺,并不是因为医疗服务提供者偏好这些方式,而是因为在考虑到预算、资源和人员受限的情况下,这些方式能够与所有人建立连接。

因此,每天都有许多照护决策是在缺少完整患者经历的情况下作出的。传真并不是损坏的数据,而是等待某个人或某种事物对其采取行动的数据。目标必须是建立不仅能简化数据流程,还能通过实时提醒和患者洞察促成行动的系统。这就是将非标准化、非结构化数据送往填埋场,与将其堆肥转化为有用事物之间的区别。

行动是共同的分母

答案不是强迫每个系统实现数据“同质化”,而是建设能够跨格式找到共同分母的基础设施,然后让每一位医疗服务提供者都能使用这些数据——无论规模大小,从启用 Epic 的医院到以纸质文件为基础的农村诊所。

将传入数据转化为主动工作流程,而不是收件箱和存储箱的组织,能够弥合照护缺口并加快后续跟进,同时无需一线工作人员承担更多工作。

大多数健康数据仍未被使用,而我们面临的机遇并不是更快地对数据进行分类和传输,而是利用已经存在的数据,让其付诸行动,并将其堆肥转化为真正能够到达患者的照护。

关于 Effie Carlson

Effie Carlson 是 Watershed Health 的首席执行官。她在医疗服务提供者和支付方领域拥有超过17年的医疗行业领导、政策、战略和业务发展经验,其经历涵盖管理式医疗、医疗技术、政府关系和基于价值的照护。Carlson 创办了 EJC Consulting Group,并曾在 Modivcare、PayrHealth、Team Select 和 CareCentrix 担任高管领导职务。Carlson 目前积极担任医疗行业组织的顾问和董事会成员,包括 Texas e-Health Alliance、SendaRide 以及 Non-Emergency Medical Transportation Accreditation Commission® (NEMTAC®)。

原文4,693 字符

Effie Carlson, CEO of Watershed Health

Recycling makes people feel like they are protecting the planet; yet, up to 70 percent of what gets placed in recycling bins still ends up in a landfill. All the well-intentioned sorting results in waste.

Healthcare has built the same system and made the same mistake. The industry has poured billions of dollars into bins like the Trusted Exchange Framework and Common Agreement (TEFCA), interoperability mandates, and regional exchange networks that were built on the assumption that if we could get the data sorted and moved to the right place, the hard part would be complete.

Nothing could be further from reality. Healthcare is one of the largest and fastest‑growing contributors to global data volume, and as much as 97 percent of it goes unused. Compiled, exchanged, formatted, and landfilled anyway. The industry has a data waste problem.

Sorting, Not Understanding

Federal interoperability efforts have made demonstrable progress in that records actually move. TEFCA has grown from roughly 10 million patient record exchanges to more than 1 billion in a year. But moving data and understanding data are different problems, and the quiet assumption behind interoperability efforts is that if everything looks the same, it will be usable.

A 2022 study looked at 68 cancer clinics using five different medical record systems. Clinics using the same system understood each other’s data most of the time, but clinics using different systems understood each other’s data barely one in five times. And that study only looked at data that already has clear coding rules, like lab results and medications. Often, information is typed into a doctor’s notes by hand with nothing for a computer system to recognize. The record is there but might mean nothing to the next system to receive it.

Idle by Design

Most clinical data gets entered into a record without anyone thinking about how it will be used later. It is not corrupted or wrong, and it arrives clean and technically usable to its next stop, but with no downstream purpose behind it. The bins fill up more.

This is a data “actioning” problem. While interoperability moves data faster, it does not solve what to do with data once it arrives. Or the fact that data can actually be put to work with the right technologies.

An estimated 80 percent of clinical data sits

in unstructured notes and scanned documents that are hard to search or act on, and that is a critical problem in transitions of care.

One study found

duplicate testing in 32 percent of patients transferred between hospitals within 12 hours, and a fifth of those repeat tests had no clinical reason. The same pattern shows up in medication errors, unnecessary visits, and poor handoffs. The data was unusable—and alerted no one to issues—when it mattered.

Faster transport does not help the fact that data then sits idle, if it makes it that far.

Build for Realities

The industry has proceeded as if better standards will eventually make fax and paper obsolete. This is not a reality, and for a large share of providers, never will be. Rural providers and small hospitals lean more heavily on fax and mail than their urban counterparts because they lack the IT staff and broadband access to sustain electronic exchange in the first place. TEFCA participation is voluntary, and voluntary systems tend to reach those with resources.

Many post-acute settings rely on outdated modalities just as heavily. Among nursing homes and home health agencies, 80 percent of them have adopted EHRs but rarely use them to exchange data with care partners. Fax and paper fill the gap, not because providers prefer them, but because those are what connect to everyone when you consider constrained budgets, resources, and staff.

In turn, every day, care decisions get made without the full patient story. A fax is not broken data. It is data waiting for someone, or something, to act on it. The goal must be to build systems that not only streamline data but also actions it with real-time alerts and patient insights. That is the difference between landfilling non-standard, unstructured data and composting it into something useful.

Action is the Common Denominator

Not forcing every system into data “sameness,” but, instead, building infrastructure that finds the common denominator across formats is the answer. And then putting it to work for every provider, big and small, from Epic-enabled hospitals to paper-based rural clinics.

Organizations that turn incoming data into active workflows, instead of an inbox and storage bin, close care gaps and speed follow-up without asking front-line staff to do more work.

Most health data still goes unused, and the opportunity in front of us is not sorting and transporting it faster. It is making use of what is already there, actioning it, and composting it into care that actually reaches patients.

About Effie Carlson Effie Carlson is the CEO of Watershed Health. She brings more than 17 years of experience in healthcare leadership, policy, strategy, and business development across the provider and payer sectors, and her experience spans managed care, healthcare technology, government relations, and value-based care. Carlson founded EJC Consulting Group and has served in executive leadership positions at Modivcare, PayrHealth, Team Select, and CareCentrix. Carlson is an active advisor and board member for healthcare organizations, including the Texas e-Health Alliance, SendaRide, and the Non-Emergency Medical Transportation Accreditation Commission® (NEMTAC®).

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