How Effective Provider Data Management Boosts Healthcare Success

In the classic Star Trek episode, “The Trouble with Tribbles,” a space station is overrun by small, fast-reproducing creatures that take up all available space and prove impossible to control. It’s sort of like the problems healthcare systems have with data.

Systems are struggling to harness their data and put it to use on their behalf. While a lot of attention is paid to patient data, the handling of provider information is equally as important.

Provider data is generated by individual practitioners and healthcare organizations. It generally can be divided into two types – information that helps identify and match individuals and information with value to business applications.

Individual information includes such things as names, addresses, phone numbers, NPI, state license, Drug Enforcement Administration ID and other Medicare and Medicaid IDs. The business application identity includes such things as application-specific IDs, credentials, specialties, education, languages spoken, accepted insurance networks, and relationship data on affiliations and volume of services performed along with referral patterns.

Provider data is critical for healthcare operations, powering important initiatives from smarter growth to better care. It affects back-of-house operations as well as patient-facing activities.

As healthcare organizations expand and systems merge, managing provider data becomes more challenging with additional providers to track, more sources of data and more domains exchanging information.

The state of provider data management

To ascertain the state of provider data management in healthcare systems, the College of Healthcare Information Management Executives (CHIME) recently surveyed members about their organizations.

Asked how important provider data management is to the overall success of their organization, four of five respondents on the CHIME survey rated it as “important” or “very important.” When the survey asked which organizational objectives rely on accurate and effective provider data management, the top three answers were all patient-related – efficient care delivery, patient safety and patient digital experience.

But for all the importance of information, healthcare organizations are not doing a good job of managing provider data. Asked to grade their organization’s handling of the data, 41 percent of survey respondents gave themselves a “C,” while 55 percent marked “B.” No one chose “A.”

Survey respondents then were asked to identify the biggest obstacles to provider data management. Among their top answers, 68 percent cited data conflicts across systems (no single source of truth); 63 percent said data is fragmented and siloed; and 59 percent said data is inaccurate, out of date or incomplete.

Provider data is a challenge to manage for several reasons.

First, it’s varied. It can represent different types of entities – a person, a location and sometimes, both. Also, it has an intricate structural hierarchy with limitless combinations of critical attributes. This can cause errors and exclusions, which further contributes to the complexity of rationalizing all forms of provider data.

Second, it changes constantly. As providers change when, where and what services they offer, it’s difficult to keep current.

Finally, it has different applications. The data is used and modified across many parts of the organization, making quality control difficult to achieve.

The upshot is that 68 percent of CHIME survey respondents said they were concerned about the quality of provider data at their organization, and 27 percent said their stakeholders do not trust provider data/analytics outputs. They want a single source of truth for data (95 percent say it’s critical) and to be able to manage provider and patient data together (mentioned by 59 percent).

Asked what qualities they’d like to see in provider data management at their organization, they cited accuracy, security, total cost of ownership, reference and enrichment data, and data stewardship tools.

Checklist for success in data management

Effectively managing provider data is crucial for healthcare organizations to streamline operations, maintain compliance and ensure the quality of care. To achieve this, organizations should focus on key capabilities and best practices. Here’s a comprehensive checklist for success in managing provider data.

Provider identity resolution. Ensuring accurate identification of providers across the organization and different applications is foundational. Best practices include:

Centralized data management. Creating a unified data hub that distributes accurate provider data throughout the organization is essential. Look for:

Data enrichment. Strengthening and completing data sets through enrichment with trusted, up-to-date information improves data accuracy and usability. Important considerations include.

Quick activation and value realization.  A swift setup and integration ensure that the solution delivers value quickly. Focus on:

Comprehensive and scalable solution. Ensure that the chosen solution offers an all-encompassing, scalable platform designed for healthcare needs. Best practices include:

Avishek Mukherjee is chief product and technology officer of Verato, a company that enables digital engagement, clinical interoperability, cloud transformation and provider data integrity.