Data aggregation should occur from all disparate EHRs being used within a given health network, done through a series of interfaces and data loads. Systems should be able to manage multiple formats, including HL7 transactions and C-CDA documents, in addition to supporting all major means of data transport, such as XDS.b, Direct and FHIR.
Interoperability at a population level requires automation, flexibility and scale. The ability to aggregate is a critical first step, but only the beginning of assembling and reporting data at the necessary levels to impact care plans and satisfy advanced and alternative payment models built on risk.
The focus for data quality is two-fold. First, healthcare networks must understand their business goals in order to focus on the relevant data. Intelligent systems can use those goals to identify the relevant data and measure the data quality using key performance indicators and visualizations including interface integrity, provider attribution, patient duplicates, mapping accuracy and data completeness.
Incoming data sets are monitored for consistency and accuracy, and alerts should be present to identify errors before they show up in reports and analytics.
An essential part of data quality is to ensure completeness prior to submitting quality measures. For a quality measure score to be accurate, complete data from all sources must be aggregated and normalized into the measure components to generate a score.
CMS uses HCCs (Hierarchical Condition Categories) to tag patients with medical conditions, usually long-term conditions that impact the patient’s need for care. These codes are driven by the claims submitted to CMS. We prototyped a model to detect cases where a patient is missing an HCC code. For example, where a patient has HbA1C results, or insulin orders, but no diabetes HCC code, the model suggests that this code may be missing, a decision that would alter the patient’s care plan, but also reimbursement levels. Inversely, if the patient has an HCC for heart failure but no evidence in the data – no claims, no medications, no mention in notes – the model would suggest to review the case and see if there is a coding mistake or incomplete documentation.
While standard terminologies have been available for many years, and are part of the meaningful use requirements, for example, the reality is that in most health network data sets from EHRs, approximately half the data uses standard codes, but the other half uses proprietary codes.
This calls for developing a semi-automated mapping process: for all inbound data with non-standard codes (lab results, procedures, medications, problems, etc.) the system can propose a mapping from any source terminology to any target terminology including a LOINC code, CPT, SNOMED or RxNorm code. Once proprietary codes are mapped to known coding systems and/or value sets, the data will fit into the appropriate hierarchies and can be used in reports and queries.
We developed the mapping algorithm by applying state-of-the-art machine learning and natural language processing techniques. The mappings were validated and benchmarked against the Unified Medical Language System (UMLS). Our mapping compendium now contains more than 4.5 million mappings – compared with the UMLS’ 800,000 mapped terms. This enables us to interpret the codes for large sets of proprietary data without a manual mapping effort.
External data sources are also useful to a health network’s database. For example, data sets with social determinants of health, geographical data and external benchmark data. Merging in external sources includes connecting a health network’s financial and clinical database, and weaving it in at the patient level. Importing external data sources allows networks to compare patient populations based on nearness to health facilities, socio-economic factors and other external parameters – the so-called “community vital signs.”[i] This is a lot to consider at the provider and health network level, but as value-based care evolves into population-based payment models, abilities around data aggregation, quality and science are becoming essential.
