Mastering Data Management

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MDM and Data Governance can help a medical team collaborate

Lately, the concept of Collaborative Care is gaining a lot of attention and innovation. Collaborative Care means that providers, clinicians, counselors, payers, pharmacies, regulators, care-givers, state/federal agencies, employers and plans will work together for the benefit of patients.

This is a patient-centric model, not a provider-centric or a payer-centric model. No, all these entities will work together for better preventative care, being paid on performance of the prevention and treatment, not on the treatment(s).

This is a significant change, but not a radical change. If pressed, each participant will declare that they’re in this to help prevent disease and treat people.

So what’s different? Well, it’s not dissimilar to what we’ve seen in other industries – everyone is propelled by their own “profit” motives. Yes, even non-profit organizations need to operate efficiently and effectively, and achieve better outcomes. So they are all motivated to super-optimize for themselves and their own private ecosystems.

Now, we’re asking all of them to work together for a common goal, even when it means sub-optimizing from their own perspective. Not only will these disparate organizations have to work better together – “better” meaning in a more timely manner, using electronic data (not paper forms, folders and faxes), but they will have to work to achieve new standards of prevention and quality outcomes.

This means overcoming the fragmentation that exists within and across legal entities, and ensuring that the information needed is available when and where needed, with a level of quality and authority needed to complete the task at hand.

Regardless of whether this is fraud detection and prevention, treating a chronic condition exacerbated by multiple drug interactions, or trying to improve the living conditions of at-risk Medicaid or Medicare patients, MDM and data governance can make the job easier.

So, how do MDM and data governance apply to this kind of smarter planet application? Well, it should be obvious, but let me lay it out here.

MDM to the Rescue

MDM can help in areas where we need to uniquely identify a patient, a caregiver, the providers who have treated them in the past, their insurance plan(s), their employment status, their health history and other related questions. The situation may call for understanding their past prescriptions, looking for drug interactions and if patients have followed prescribed treatment regimens. You may even look for fraud and abuse if there are restricted drugs/narcotics involved.

In some cases where minors are involved you may need to understand their living situation (a child living in a rat-infested apartment will have a higher propensity for certain illnesses, conditions & diseases), their guardians, any involvement with social services, household members who have had troubles with drugs, law enforcement, etc.

You would need to know which providers have seen, diagnosed, advised, treated and/or cared for the patient. You may need, in some cases, to investigate their medical history. You might need to know which providers work within which Integrated Delivery Networks, or within which practices, or in association with which hospitals.

You may also need to check the providers’ own licensing and certifications within the jurisdictions in which they have practiced medicine. You might also want to know their “success rates” and “satisfaction ratings” given by patients (this is not done that much – yet).

It’s easy to see that MDM is critical in understanding who the patients are and the people they are associated with. It’s critical to understand the providers who have treated them. It’s critical to understand who their insurance carriers are.  The use cases go on and on and on, but hopefully these spark your thinking.

One thing I expect people to struggle with is in “crossing the privacy line,” which leads us to the role of Data Governance.

Data Governance to the Rescue

As you read through the types of data above, you might have had red flags going off left and right – well, I certainly did! What do you mean someone is going to ask about my driver’s license! Who gives someone the right to ask about what prescriptions I’ve filled? Isn’t this an invasion of privacy? How DARE you!

Well, these are all issues of policy, and when I say “policy” it immediately makes me think of Data Governance!

I’ll tackle this more in my next blog post. Should be juicy!

But in the meantime, a couple things to think about:

Is it okay to look into someone's living situation when a minor is involved?

Or to look into "sealed" parts of a patient's history when knowing their medical past could impact their necessary treatment?