I was showing my children photographs of me at a younger age; some of them black and white, affixed to heavy stock page that had yellowed over time.
Snapshots of what was. Single depictions of specific events at specific times, none of them betraying or foretelling my future. The photo album chronicled parts of my life, those parts captured by the pictures. Some of the pictures are of my friends, mostly of my closest friends.
“What is that guy doing now?” My son asked about one of my track teammates. I had no idea. We had not kept in touch, and I lost track of him.
White space exists on the album’s pages between each photograph. At times, the white space serves as a placeholder covering a few days. At other times, the white space between the photos represented months or years.
To conclude nothing happened during the white space would be wrong. In fact, if I marked calendars showing when the photos were taken, less than one percent of the days would be marked. Simply looking at a collection of photos spread across the years would serve as a very poor predictor of whom and what I would become.
My charts, not to be confused with MyChart, are scattered among four Philadelphia hospitals, my primary care physician, and a smattering of specialists. Three of my hospital records are still paper-based, since I was seen prior to the implementation of their EMR. Not one of my charts gives anyone an accurate picture of my current health. Each chart contains different data, none of the charts contains all of my data, and none of the charts contains any data beyond the date of my last visit.
I mention this because I think the health records of many patients are scattered like mine, like seashells among beaches. If that is even remotely true, how then does a health system manage population health — or my health, or yours?
Do health systems participating in population health have what they need to effectively manage the health of the population, or even of a single individual in that population? Many systems are making big investments in Big Data as a way to help them drive the effectiveness of population health. Health systems also point to the value of the EMR and how all of the data stored in the patient portal will facilitate managing the health of the population and the health of individuals.
But do health systems really have Big Data, or do they simply have a lot of data? I think they have lots and lots of data, but I do not think they have the data they need to manage a population’s health, nor do they have the data to manage the health of most of the individuals within the population.
To be even remotely effective at population health management or running an ACO, a health system needs volumes of up-to-date data points on every individual, and they need that same volume of data on most of the individuals within their service area. What health systems actually have are volumes of data all tied to a single date or dates for specific case or treatment, and the most up-to-date health data they have one anyone only reflects that person’s most recent appointment, treatment, or procedure.
Snapshots. Old snapshots of health about a specific disease or treatment. The EMR has data describing how you were, it has no data describing how you are.
Suppose Sally had a negative mammogram last September. How is Sally’s health today? Nobody other than Sally knows. And there are two reasons nobody knows:
- Nobody has talked to Sally since September
- Sally has no way of communicating her current health or her ongoing health to anyone at the health system.
The health data in Sally’s patient chart is static. Sally’s health is not static. Her stored health data is no more informative than an old black and white photo pasted on the first page of her health photo album.
Population health management based on the data contained in the EMR is a non-sequitur. It is not logical to conclude that someone’s health, or that everyone’s health, can be managed effectively, or managed at all, without having the data needed to manage it. If the most current information a health system has about the current health of a patient is based on data from 9-month-old mammogram, can the health system make any claims about the state of that person’s health today?
The problem with charts is that they are simply charts. Snapshots of what was. The white space between snapshots continues to be the issue. A health system needs a means of storing the daily health data of each patient and consumer. It needs a way to fill the photo album, a way to eliminate the white space and collect all of a person’s health events.
The health data stored on the smart phones of many people is more up-to-date and current than what is contained in their collective EMR charts. People manually enter data every day about their diet and exercise. Other data is recorded by their smart devices or by something they wear. And the people who own those devices play doctor, drawing conclusions about the state of their health based on how they interpret their stored data.
We already know that people given the chance to record and track their health data will do so faithfully. We also know that many of the applications people use for managing their health may have been developed by two teenagers working out of their basement.
Health systems can elevate health and get data out of the cellar by designing apps that:
- Capture, track and manage my health data
- Have a great user interface and to deliver a great user experience
- Communicate my data among the various apps
- Populate my health record with the data
- Provide a way for the health system to evaluate my data and to notify someone if that data suggests I should be seen.
When my health system does this, it can begin to proactively manage my health. And it can manage the health of consumers, people who have never been their patients. If two teenagers in a basement can do this, can’t our leading health systems?