Population Management and ACOs/PHOs

As hospital organizations around are moving to organize their ACOs and PHOs, I reflected on population managment today.

EHRs, it seems, weren't built to provide population management. Have we not placed on emphasis on quality of care here in the US? Maybe that is why we rank poorly according to the WHO data (I still have epidemiologic reservations to this data). Regardless, it is fascinating that the product best suited to provide population managment, the EHR, is actually the element that is inhibiting ACOs from developing quality population managment.

There are hundreds of EHRs (hey, I even coded my own while I was on-call as an intern). Getting to communicate with eachother, however, is the challenge. HL7 interfaces are very nice, but setting this up takes an informatics expert on-staff as well as licensing agreements between both organizations. What a mess. Wouldn't it be wonderful if EHRs provided an option for custom reporting? My EHR has built-in reports, but the data is notoriously inaccurate. This happens because the data isn't normalized and the "primary" keys contain duplicates. So, I built an application that will normalize the data and then provide reports for our practice. For instance, here is an example of one of my custom reports:

All active patients (not inactive or deceased and has a vital sign in the last three years) with a diagnosis of diabetes who's last hemoglobin A1C was greater than 7 but haven't had one drawn within the last 90 days.

That type of report just isn't available from most EHRs, but THIS is what doctors care about. EHRs in America need to improve so that we can actually use them in a "meaningful" way. If not, then the EHR is just a way to save on paper. There are vendors that sell products that will communicate with the EHRs and provide these population reports/quality reports. This leads to more red tape and confusion...not what we need. I have over 20 applications that I use for patient care, I don't want to remember one more password.

Here is to hoping that the EHRs get it together. If not, I may just start selling my EHR :)