Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. HealthInfoNet Population Analytics

10/29/2013

HIN is moving toward population health management including support for the Northern New England ACO Collaborative (multi-state and multi-provider) and their need for analytics at a broader community/population level. HIN is focusing on data analytics to drive changes in care. For examples, HIN is analyzing data in such areas as:

  • Services utilization -- e.g., ADT events allow HIN to track hospital/ED utilization and rehospitalization rates).

  • Patterns of care -- advanced analytic techniques are used to find patterns and predict behavior.

  • Comparisons -- compare doctors, their outcomes and ordering patterns to determine.

  • Risk monitoring -- track patient risk scores and the impact of new clinical data on the score which could support emerging programs in patient risk score profiles.

The potential for leveraging the data of standardized assessments used by LTPAC providers to support population analytics was discussed during the site visit. For example, the OASIS and MDS have provided LTPAC organizations a wealth of data for analytics programs. LTPAC organizations large and small have been harvesting the data to assess quality, performance and risk. As HIN continues to move into big data analytics for population health inclusion of the OASIS and MDS data and the patient assessment summary could provide a rich source of information.

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