Health care analytics is the

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health pr ...

analysis activities that can be undertaken as a result of data collected from four areas within healthcare; claims and cost data,

pharmaceutical A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...

and research and development (R&D) data, clinical data (collected from

electronic medical records An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared throu ...

(EHRs)), and patient behavior and sentiment data (patient behaviors and preferences, (retail purchases e.g. data captured in running stores). Health care

analytics Analytics is the systematic computational analysis of data or statistics. It is used for the discovery, interpretation, and communication of meaningful patterns in data. It also entails applying data patterns toward effective decision-making. It ...

is a growing industry in the United States, expected to grow to more than $31 billion by 2022. The industry focuses on the areas of clinical analysis, financial analysis,

supply chain In commerce, a supply chain is a network of facilities that procure raw materials, transform them into intermediate goods and then final products to customers through a distribution system. It refers to the network of organizations, people, activ ...

analysis, as well as marketing, fraud and HR analysis. Health care analytics allows for the examination of patterns in various healthcare

data In the pursuit of knowledge, data (; ) is a collection of discrete values that convey information, describing quantity, quality, fact, statistics, other basic units of meaning, or simply sequences of symbols that may be further interpret ...

in order to determine how clinical care can be improved while limiting excessive spending. this can help improve the overall patient care offered in healthcare facilities.

Federal government role in health IT

Multiple federal entities are heavily involved in health IT. Within the executive branch, the administration itself,

Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...

(CMS), and

Office of the National Coordinator for Health Information Technology The Office of the National Coordinator for Health Information Technology (ONC) is a staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services. ONC leads national health IT efforts, charged as the prin ...

(ONC) each have strategic plans and are involved in determining regulation. Within the legislative branch, multiple committees within the House of Representatives and Senate hold hearings and have opinions on using data and technology to reduce costs and improve outcomes in healthcare. The ONC issued the Federal Health IT Strategic Plan 2015-2020. The plan outlines the steps federal agencies will take to achieve widespread use of health information technology (health IT) and electronic health information to enhance the health IT infrastructure, to advance person-centered and self-managed health, to transform health care delivery and community health, and to foster research, scientific knowledge and innovation. The plan is intended “to provide clarity in federal policies, programs, and actions and includes strategies to align program requirements, harmonize and simplify regulations, and aims to help health IT users to advance the learning health system to achieve better health.” The Strategic Plan includes several key initiatives employing multiple strategies to meet its goals. These include: (1) finalizing and implementing an interoperability roadmap; (2) protecting the privacy and security of health information; (3) identifying, prioritizing and advancing technical standards; (4) increasing user and market confidence in the safety and safe use of health IT; (5) advancing a national communication infrastructure; and (6) collaborating among all stakeholders.

Challenges to address

Creating an interoperability roadmap

There are three fundamental challenges to be addressed: (1) variation in how standards are tested and implemented; (2) variation in how health IT stakeholders interpret and implement policies and legal requirements; and (3) reluctance of health IT stakeholders to share and collaborate in ways that might foster consumer engagement. The ONC is working to develop a policy advisory for health information exchange by 2017 that will define and outline basic expectations for trading partners around health information exchange, interoperability and the exchange of information. Current federal and state law only prohibits certain kinds of information blocking in limited and narrow circumstances, for example, under the

Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy– Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1 ...

(HIPAA) or the Anti-Kickback statute.

Protecting privacy and security

In addition to HIPAA, many states have their own privacy laws protecting an individual’s health information. State laws that are contrary to HIPAA are generally preempted by the federal requirements unless a specific exception applies. For example, if the state law relates to identifiable health information and provides greater privacy protections, then it is not preempted by HIPAA. Since privacy laws may vary from state-to-state, it may create confusion among health IT stakeholders and make it difficult to ensure privacy compliance.

Establishing common technical standards

Use of common technical standards is necessary to move electronic health information seamlessly and securely. While some clinical record content, such as laboratory results and clinical measurements are easily standardized other content, such as provider notes may be more difficult to standardize. Methods need to be identified that allow for the standardization of provider notes and other traditionally “free form text” data. The ONC HIT Certification Program certifies that a system meets the technological capability, functionality and security requirements adopted by HHS. ONC will assess the program on an ongoing basis “to ensure it can address and reinforce health IT applications and requirements that support federal value-based and alternative payment models.”

Increasing confidence in safety and safe use of health IT

Health care consumers, providers and organizations need to feel confident that the health IT products, systems or services they are using are not only secure, safe and useful but that they can switch between products, systems or services without loss of valuable information or undue financial burden. Implementation of the Federal Health IT Strategic Plan 2015-2020, along with the 2013 HHS Health IT Patient Safety Action and Surveillance Plan and 2012

Food and Drug Administration Safety and Innovation Act The Food and Drug Administration Safety and Innovation Act of 2012 (FDASIA) is a piece of American regulatory legislation signed into law on July 9, 2012. It gives the United States Food and Drug Administration (FDA) the authority to collect user ...

will attempt to address these concerns.

Developing national communications structure

A national communications infrastructure is necessary to enable the sharing of electronic health information between stakeholders, including providers, individuals and national emergency first responders. It is also necessary for delivering telehealth services or using mobile health applications. “Expanded, secure, and affordable high-speed wireless and broadband services, choice, and spectrum availability will support electronic health information sharing and use, support the communication required for care delivery, and support the continuity of health care and public health services during disasters and public health emergencies.”

Stakeholder collaboration

The federal government in its role as contributor, beneficiary and collaborator “aims to encourage private-sector innovators and entrepreneurs, as well as researchers, to use government and government-funded data to create useful applications, products, services, and features that help improve health and health care.” HHS receives funds from the Patient-Centered Outcomes Research Trust Fund to build data capacity for patient-centered outcomes research. It is estimated HHS will receive over $140 million for the period between 2011 and 2019. These funds will be used “to enable a comprehensive, interoperable, and sustainable data network infrastructure to collect, link, and analyze data from multiple sources to facilitate patient-centered outcomes research.”

Legislation

Meaningful Use The Health Information Technology for Economic and Clinical Health Act, abbreviated the HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009 (). Under the HITECH Act, the United States Department of Health ...

, the Patient Protection and Affordable Care Act (ACA) and the declining cost of data storage results in health data being stored, shared, and used by multiple providers, insurance companies, and research institutions. Concerns exist about how organizations gather, store, share, and use personal information, including privacy and confidentiality concerns, as well as the concerns over the quality and accuracy of data collected. Expansion of existing regulation can ensure patient privacy and guard patient safety to balance access to data and the ethical impact of exposing that data.

Balancing Interests – innovation, privacy, and patient safety

Complete freedom to access to data may not provide the best protection for patient rights. Expansive limits on the collection of data may unnecessarily limit its potential usefulness. In addition to data collection, there are concerns regarding risk of statistical errors, erroneous conclusions or predictions,< and misuse of results. Appropriate policies could support gains in process improvements, cost reductions, personalized medicine, and population health. Additionally, providing incentives to encourage appropriate use may address some concerns but could also inadvertently incentivize the misuse of data. Lastly, creating standards for IT infrastructure may encourage data sharing and use, but those standards would need to be reevaluated on a regular, ongoing basis as the fast pace of technological innovation causes standards and best practices to become quickly outdated.

Potential areas to address through legislation

Limiting data collection

The needs of healthcare providers, government agencies, health plans, and researchers for quality data must be met to ensure adequate medical care and to make improvements to the healthcare system, while still ensuring the patients right to privacy. Data collection should be limited to necessity for medical care and by patient preference beyond that care. Such limits would protect patient privacy while minimizing infrastructure costs to house data. When possible, patients should be informed about what data is collected prior to engaging in medical services.

Limiting data use

Expanding availability of big data increases the risk of statistical errors, erroneous conclusions and predictions, and misuse of results. Evidence supports use of data for process improvements, cost reductions, personalized medicine, and public health. Innovative uses for individual health can harm underserved populations. Limiting use for denial and exclusion prevents use to determine eligibility for benefits or care and is harmonized with other U.S. anti-discrimination laws, such as

Fair Credit Reporting Act The Fair Credit Reporting Act (FCRA), 15 U.S.C. § 1681 ''et seq'', is U.S. Federal Government legislation enacted to promote the accuracy, fairness, and privacy of consumer information contained in the files of consumer reporting agencies. It ...

, and is harmonized with anti-discrimination laws like the

Civil Rights Act Civil Rights Act may refer to several acts of the United States Congress, including: * Civil Rights Act of 1866, extending the rights of emancipated slaves by stating that any person born in the United States regardless of race is an American citi ...

and the

Genetic Information Nondiscrimination Act The Genetic Information Nondiscrimination Act of 2008 (, GINA ), is an Act of Congress in the United States designed to prohibit some types of genetic discrimination. The act bars the use of genetic information in health insurance and employment ...

Providing incentives to encourage appropriate use

Increasing vertical integration in both public and private sector providers has created massive databases of

electronic health record An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared throu ...

s. The ACA has provided Medicare and

Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...

incentives to providers to adopt EHR's. Large healthcare institutions also have internal motivation to apply healthcare analytics, largely for reducing costs by providing preventative care. Policy could increase data use by incentivizing insurers and providers to increase population tracking, which improves outcomes. To enforce compliance with regulations, the government can use incentives similar to those under the ACA for Medicare and Medicaid to use electronic health records.

Creating standards for the IT infrastructure

Inappropriate IT infrastructure likely limits healthcare analytics findings and their impact on clinical practice. Establishing standards ensures IT infrastructure capable of housing big data balanced with addressing accessibility, ownership, and privacy. New possibilities could be explored such as private clouds and “a virtual sandbox” consisting of filtered data authorized to the researchers accessing the sandbox. Standards promote easier coordination in information collaboration between different medical and research organizations resulting in significantly improving patient care by improving communication between providers and reducing duplicity and costs. Minimum standards are necessary to balance privacy and accessibility. Standardization helps improve patient care by facilitating research collaboration and easier communication between medical providers. The research can yield preventive care concepts that can reduce patient caseload and avoid long-term medical costs.