There’s a deluge of data in healthcare, but it has little meaning if providers lack the skills to manage or use it

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janice_NicholsonHealth care has entered a brave new world of data – a world where data permeates and influences every aspect of our industry. The consequences are enormous and long term. In order to keep up with growing data demands, there is an unwavering need to establish quality resources. Electronic Health Records (EHRs) have sparked the necessity for new positions that no one really envisioned, creating new opportunities, new challenges and the risk of accidental complexities – unintended consequences arising from the adoption of EHRs.

Today’s state of health care is best illustrated by a documentary I recently watched about the natural hurricane protection created by New Orleans’ vast mangroves. As a major United States port, New Orleans is the largest city and metropolitan area in the state of Louisiana. While its location and environmental landscape give the city its tourist appeal, these features also present a terrifying problem for its residents. New Orleans is surrounded by mangroves – trees and shrubs that grow in saline coastal sediment habitats – which created a natural barrier from hurricanes entering the area, as they would die down as soon as they hit the swampland. When the Army Corps of Engineers cut trails through the mangroves, the ocean water made its way to the fresh water and sediments, killing the mangroves and weakening the barrier. The Army Corps did not anticipate this effect, and over time the swampland receded so much that most of it is now dead, enabling hurricanes to enter and damage the city more fiercely than ever before. 

Adjust to the Accidental Complexities

Just as the Army Corps forged a path through the mangroves in New Orleans, the government is paving a road for the health care industry into a new technology era. However, the speed at which we are being forced to move and the choices made to get us to this state have introduced various accidental complexities. Like the diminishing number of mangroves made New Orleans more susceptible to hurricanes, the lack of health care providers with the right skill set are making their organizations more susceptible to becoming overwhelmed and ineffective by the downpour of data that is available today.


A Growing Need for New Roles

This new health care delivery system has created the need for organizational roles that were unforeseen. As I mentioned in my last blog, a “data steward” is a vital individual who monitors and advocates for clean data, but there are numerous other roles that are needed to meet today’s demands. You must also consider hiring data extractors and data translators who can gather all the data needed to meet various requirements.

This industry shift is resulting in many Quality Improvement (QI) professionals having to re-focus and update their skill set in order to meet increasing demands. QI Experts sift through charts and track data, but today, they must be able to do more – they need the skill set required to logically go through steps to solve a problem in a technology environment, i.e., data analyst skills. Without this proficiency, they will be lost and unable to address the needs of their organization.

The Ultimate Intersection of Knowledge

The reality is – we are living in a much more technical world, requiring your staff to have more technical knowledge in addition to their clinical knowledge. We are trying to merge these two worlds at such a high speed that organizations are struggling to keep up. If someone on your team knows a lot about health care, what is the likelihood they will also know a lot about technology? Our brave new world has not just introduced a new technology, but it has also introduced the need for a new level of staff. Everyone on the team has to be clinical and technology informaticists. The expertise of the ideal staff member is the key place where population health intelligence, technology and clinical knowledge intersect.

Fitting Old World Staff into the New World is Creating Struggles

Health care organizations have invested a great deal of money and time into implementing their EHRs. However, while they try to fit their staff into the new world, their current infrastructure is deep-seated in the old world. Think of blacksmiths at the start of the 20th Century as automobiles started to take hold. In a sense, everything that they once knew no longer applied. Achieving successful, sustainable change is as much about people as it is about technology.

We see many of the health care organizations we work with taking all their resources and putting them into their EHR. Their under-trained staff members are then left to manage all their data, make sense of it and drive change. As a result, many are struggling to do even the most basic population health management. It is clear from our clients that the transformation to the EHR has shifted their world and made managing, delivering and improving care much more demanding.

Travel the Road to Transformation

We must have patience in our industry and realize that this process is a journey – and we are only at the beginning of it. We need to learn how to manage change and understand that we are living in a brave new world of data. Accidental complexities are inevitable, so we have to open ourselves to the transformation, realize the steps and embrace them. This transformation has a road to travel and we have no choice but to travel it.

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Janice Nicholson

By Janice Nicholson i2i Systems

Janice Nicholson is co-founder and CEO of i2i Systems. Janice is known in the healthcare industry as a thought leader and visionary in the area of information technology. With over 20 years focusing on the needs of health care organizations, Janice has experienced firsthand the challenges of managing the flow of clinical data. Before founding i2i Systems, Janice had an extensive background as a software engineer. She has played a major role in developing a patient management system for private practice; has successfully managed over 10 major product releases; and, prior to its acquisition by WebMD, was Vice President of Product Engineering at HealthPro Solutions. Janice led her development team at HealthPro in creating one of the leading patient management software products still on the market today.
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Michael Barbouche
Michael Barbouche

I would echo Ms. Nicholson's comments on the need to advance data stewardship and the continued challenge of very messy data.  Last year, we both gave testimony to a joint session of ONC committees about these barriers to improvement.

The goal should be to move physicians out of the health IT/data business and advance them into the improvement business.  When talking with very busy, very stressed out practices, we use Ms. Nicholson's same language--the practice needs to begin its performance improvement journey.  Crummy data can be a significant barrier to starting the journey.  We must move practices past that blockade.  Changes in organizational culture, structure, compensation, staffing, and workflows must all be tackled.  Accurate data can shed light on the path...but it is only the first step in the journey.

Michael Barbouche


Forward Health Group, Inc.