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There may be a whole lot of data systems out there in the healthcare space, but the power of data remains grossly underutilized. Traditionally, healthcare organizations rely only on claims data or clinical data to analyze patient population. Amidst the myriad of data systems, if healthcare organizations need to find an accurate, data-driven understanding of population health and see a return on their investment, they might require something more to create a holistic picture.How clinical and claims data can complement each other?Claims data usually have all the billable information regarding a patient and their particular health details and can provide deep insight into how the population health resources are being utilized. Being highly structured, claims data can be easily assembled and evaluated in only a few days. Despite all of this, claims cannot provide the information of current health state of the patient. This is where the clinical data dives in. Clinical data comes largely from electronic medical records (EMRs), providing a wealth of data not usually found in claims. This could range from vital signs and lab test results to disease registries and provider information. Unlike claims data, clinical data from EMRs is real-time and causes no lag in its availability. Why bringing them out together is a necessity?Both the claims and clinical data have their own advantages and drawbacks, but the silver lining in this situation is that they both fix to each other like puzzle pieces. Claims data can only provide an overview of the population health but doesn’t give a good understanding of an individual patient in care in real time. This problem could be overcome by integrating clinical data. With the integration, physicians can easily keep track of health needs of the patient like care planning, relieving care transitions, dealing with care gaps, and many more. Additionally, physicians don’t have to deal with overburdening administrative operations and data interfacing and can focus on what they do best- ensure seamless care. Overcoming the challenges of clinical and claims data integrationAt Innovaccer, we looked at the challenges of incomplete data profiles, and realized both clinical and claims data have their own, unique offerings- but if we were to combine them, we might be able to deliver superior actionable insights. Innovaccer’s health data platform deploys a Hadoop-based Big data repository, an Integrated Data Lake that can ingest multiple data sources such as EMRs, CCDA, X12 837/835 files, HL7 feeds- among many others. The data lake integrates these varying data sets together, normalizes them, and stores them in longitudinal records. Such integration provides a comprehensive record that has crucial information, right from a patient’s ID and demographics to their risk scores and their episode history. Access to these records not only allow providers to easily identify the gaps in care for every individual patient in a few simple clicks but also allows them to chase the right metrics in this new world of value-based care. Delivering value-based outcomes across the networkWorking with various healthcare organizations, we realized that data serves two most important objectives of any healthcare organization- one, drive efficient operations and two, enhance their reporting capabilities. Not to mention how integrated clinical and claims data can be leveraged to drive effective, real-time outcomes improvement. Once clinical and claims data are linked together, it can be thoroughly analyzed to determine if there are any looming gaps in the network and what could be the best way to proceed with quality and cost improvement. The providers can observe their adjudicated as well as pre-adjudicated claims to observe their performance and enhance it. And if they find a growth opportunity they can tap into, they can always drill down to understand their progress on a deeper level and take the best measures. Once the anomalies are eliminated, the providers can accelerate towards a network driven by information transparency. The best part about integrating clinical and claims together is that it not only provides a holistic view of the population, it also allows monitoring of the impact of clinical decisions providers undertake. With real-time data integration, providers can be notified of care gaps for every patient at the right time. Plus, with two-way interoperability, this information can also be viewed right on their screens- without having to leave the EMRs. The Road AheadIn short, quality of the healthcare systems can be greatly improved by the intelligent use of clinical and claims data coupled in a coherent manner. The right kind of infrastructure that can ingest claims and clinical data together and is scalable enough to grow as the amount of data increases could be a start. When data is bound together, connecting the dots, providers can have access to the most recent data that can identify unique patients as well as offer insights into population health. Together, this knowledge will lead us into the dream of better care delivery in a world driven by quality, aimed to make us all healthier and happier.

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