Making Sense Of Unstructured Data In An EMR

At Health IT Outcomes, we’ve made it our mission to provide the healthcare industry with expert guidance on technology system selection, integration, project management, and change management. To help achieve this goal, we speak with industry leaders on everything from EHRs to HIEs to HIM, and then share these conversations with you. We recently travelled to Chicago to attend HIMSS15 where we had the privilege to speak with Dr. Clive Fields, president, Village Family Practice and Co-Founder, VillageMD and Paul Martino, Chief Strategy Officer and Co-Founder, VillageMD about the patient population management challenges they faced before implementing their Talix solution, as well as how the implementation affected other systems at Village Family Practice. Additionally, they offer pre- and post-implementation scenarios to help readers better understand the benefits in real, tangible terms.

Health IT Voices: What kind of challenges were you facing before partnering with Talix?

Fields: Coding challenges have been a huge problem for a number of years, and almost all of the solutions that we have used over the last number of years have involved making sure this year’s codes capture last year’s chronic diagnoses. There’s never really been an attempt to improve the accuracy’s coding as much as there’s been an attempt to make sure that what happened last year also happened this year for those diseases that we would expect to continue year over year.

It’s always been a problem for us, because coding was always retrospective. We never really get a chance to use coding for what it should be used for, which is to help us with care coordination, risk stratification, and try to get out in front of patients to identify those who need help before they actually get in trouble.

Health IT Voices: Talk about the EHR that you have in place and what struggles or positives you are having with it.

Martino: The EHR we use at Village Family Practice is NextGen and it’s an application that works pretty well. However, what most people don’t realize is the majority of the data in an EHR that’s valuable is unstructured data. So, while the use of structured data has been around for a long time, the real value is in the clinical information that’s contained in the EMR that’s not structured.

The structured data looks like claims and codes — ICD-9, CPT codes — but, what’s missing is the actual, free-form text that’s used by the physicians to really understand the whole of a patient. The partnership that we have with Talix tends to help us capture the value of that information that it provides to optimize the actual EMR.

Health IT Voices: We have spoken about the complexity of taking all of that data and making it usable in a real, practical way in the day-to-day life of a physician. How do you manage that transition and get it down to something the doctors can use on a regular basis?

Fields: The Talix solution really delivers to the physician at the point of contact — either past diagnosis or likely diagnosis — for a physician to consider. That’s information that’s gathered not just from prior codes, but it can be from care coordination notes, transitional care notes, and unstructured fields that a telephone message may have been taken in.

The physician would traditionally know that a patient might have been previously diagnosed with Chronic Obstructive Pulmonary Disease (COPD), have a 496 ICD-9 code, but that’s not really the whole story. We want to know, “Has that patient called for refills on their inhalers?”, “Have they been seen in the office twice in the last couple of weeks for bronchitis or URI or other clues to make us think that they may be on the verge of an exacerbation of their COPD?” That information is delivered to the physician at the point of contact, where he can actually say, “Yes, I know this patient has COPD. This patient also has these other things going on that I need to think about.”

In the old days, when we worked on paper, everything kind of flowed, you flipped through a chart. Fortunately, or unfortunately, in the electronic medical record, there is information all over the place that a doctor can’t really see all at the same time. What the Talix solution has done is it’s taken a lot of that disparate information, put it in a place that a physician can make the best decision at the time he’s seeing that patient.

Health IT Voices: How much financial burden does it add to the medical practice to bring on board these various technologies to provide security and make the transition to an EHR more easily accommodated by the practicing physician?

Martino: I’d love to say it’s easy, inexpensive, we did it overnight, and everybody is happy with it. Unfortunately, it doesn’t work that way. It’s laborious. It’s expensive to get through that transition. It takes time and resources to do it, and then I’d invite Dr. Fields to talk about the user experience.

Fields: I would concur with Paul. I wish it did happen overnight and it was cheap, he’s right. It takes a long time and it’s expensive, but, ultimately, this is an investment in value-based care. Until we can actually change the cost and quality outcomes of the population we take care of, we as PermaCare doctors are stuck on hamster wheels just seeing patient after patient after patient.

Yes, there is an up-front investment, which is where VillageMD has been helpful at Village Family Practice. Ultimately the patient should experience better care and the deliverer of that care, the physician, should feel better about what he’s doing: able to identify those patients beforehand, there’d be more of his time, able to measure the outcomes of the work that he does, and actually be paid for the performance that he generates.

So, there’s an investment up front. I wish there was a way around that. Unfortunately, we have not found it.

Health IT Voices: Describe the complexity and timetable of an implementation.

Fields: What the Talix technology does is allow me to just look at a patient, highlight that patient, and scroll through either prior diagnosis or likely diagnoses. It requires absolutely no technical expertise on my part. Part of the challenge in primary care is always improving work flows. This can be done — the tool can be used by a care coordination nurse at the time of a telephonic outreach. It could be used by a nurse at the time that a patient is roomed or it could be used by a physician during the patient contact. So, it’s information that’s available across the entire, team-based care.

Workflow is an issue people are going to have to work through, but in terms of technology, there is really no technology requirement for the tool to be successful.

Health IT Voices: Big Data provides some predictive analytics that allow you to look at workflow, scheduling, and things like that. How do you vary your schedule to accommodate someone that analytics has told you may need more or less of your time?

Fields: We currently are using the Talix tool on 8,500 Medicare patients. We identified the Medicare patients as those most likely to benefit from improved care coordination, transition care management, and improved documentation, and also the population that is the higher utilizers of healthcare.

What we do is have all 8,500 of those patients run on a regular basis, so the tool is available at the point of contact. In terms of implementation, it’s really nothing more than looking at a computer screen. In the perfect world, are these tools actually included in your EMR so you don’t have multiple screens to toggle between? The answer is yes. Are we there yet? The answer is no, and I suspect the 37,000 people here at HIMSS today all have different screens to toggle to for their solutions.

Hopefully, that will all be integrated at some point. Today, it’s not there yet, but we are excited to work with Talix. We think they actually have a tool that’s of value to us, and one we can improve on with our clinical expertise and their technological know how.