Health Organizations Count on Clinical Informatics to Improve Patient Health and Reduce Healthcare Costs, Finds PwC Report on Clinical Informatics in Healthcare

New York, March 2, 2012 – Clinical informatics may hold the key to better population health and a reduction of the healthcare costs in the United States if health organizations can use it to engage patients in managing their own health.  A new PwC US Health Research Institute (HRI) report published today suggests that health organizations view clinical informatics – the integration of information technology into healthcare – as paramount to their financial success and ability to effectively and affordably manage patient care and wellness.

While improved patient care and safety is a top goal of their clinical informatics efforts, few health organizations have found ways of using health information to engage patients in managing their own health. A recent PwC HRI survey of more than 600 health management professionals across the country found:

  • Only 15 percent of health insurers and 13 percent of hospitals, physicians groups and other providers believe they have been able to successfully influence patient behavior through their informatics efforts.
  • Nearly eight in 10 providers (79 percent) are looking to clinical informatics to help reduce medical errors, 61 percent hope to use it to improve population health, and 52 percent hope it will help them reduce costs by involving patients in preventative care routines.
  • Eighty-five percent of health insurers are counting on clinical informatics to improve management of complex cases such as care for patients diagnosed with cancer, 80 percent are seeking a reduction in preventable emergency room visits and hospital readmission rates, and 56 percent hope that findings from their clinical informatics programs will lead to earlier diagnosis and prevention.

The HRI report, titled Needles in a haystack, Seeking knowledge with clinical informatics, looks at the state of clinical informatics in the industry and the needs, goals, barriers and opportunities that health organizations face in expanding their informatics capabilities.  To inform its findings, PwC US surveyed health management professionals, including those from hospitals and physician groups, health insurers, pharmaceutical companies and life sciences companies, and conducted in-depth interviews with 30 chief information officers, chief medical informatics officers, and clinical leaders at health organizations across the country.

PwC found that all of the organizations it studied are now focused on clinical informatics capabilities, a nascent, fast-growing field that combines technology, patient care, financial reporting and collaborative information-sharing. While organizations have different needs, expectations for their informatics programs, the one common informatics goal PwC found they all share is a better understanding of medication compliance. Billions of dollars a year in wasteful healthcare spending can be attributed to excess hospitalizations, premature deaths and other avoidable expenditures caused by patients who do not take medications as prescribed.  PwC’s survey found:

  • Nearly 60 percent of providers and 91 percent of insurers said that improving patient compliance and adherence to prescribed medication is a goal of their clinical informatics program over the next two years. 
  • Nearly three-quarters (71 percent) of pharmaceutical companies believe that access to information in electronic health records could help them better understand what factors lead to noncompliance as well as the factors affecting the safety and efficacy of patients’ drug usage.

“Health organizations recognize the value of effective informatics and analytics, but they are struggling to institutionalize the insight, make it actionable and use it for competitive advantage,” said Daniel Garrett, Health Information Technology practice leader, PwC.  “They need strategies for mining data, conducting and integrating evidence-based research, translating findings into practice, and influencing patients to participate in the process.”

The state of clinical informatics in the health industry

PwC reports that clinical informatics is likely to become even more important in healthcare as the reimbursement landscape shifts from a fee-for-service or volume-based model to an outcomes-based model.  Comparative effectiveness research has made it incumbent upon providers, drug makers and medical device manufacturers to understand and demonstrate how different treatments, tests, or procedures work compared to others.

PwC’s research found:

  • More than half (56 percent) of health organizations now have a formal clinical informatics program in place.
  • Six in 10 (61 percent) hospitals and physician groups have a formal clinical informatics program, compared to 59 percent of health insurers and 33 percent of pharmaceutical / life sciences companies, which have been more likely to outsource their informatics functions.
  • All health organizations – especially health insurers – have plans to increase informatics staffing over the next two years.  Nearly half (48 percent) of providers plan to increase technical analysts and 35 percent will add clinical informaticists.  Among insurers, 70 percent will increase technical staff and 30 percent will add clinical informaticists.  Among pharmaceutical / life sciences companies, 39 percent intend to add technical staff and 38 will add clinical informaticists.
  • Within the next two years, nearly two-thirds of providers will look to clinical informatics to help them improve care delivery by better understanding variances in performance, while 60 percent of health insurers will use clinical informatics to identify lower-cost, high-quality providers. 
  • Health organizations that already have formal informatics programs have made greater progress than those that do not on business strategies that position them to compete for patients and revenue in the new health market. They are: 
  • More likely to be sharing data outside the organization and participating in new care delivery models.
  • More likely to have advanced informatics functionality needed to meet requirements for meaningful use of electronic health records, such as the ability to integrate and aggregate data, measure performance and deliver information to the point of care.
  • More likely to be considering new collaborative strategies to expand informatics capabilities with other organizations and patients.

Health industry converges around clinical informatics

The nature of the once adversarial relationship among payers, providers and pharmaceutical / life sciences companies is becoming more collaborative in an outcomes-based reimbursement environment as health organizations discover they need each other and access to one another’s information and capabilities.

Clinical informatics is spurring an increase in collaborative agreements, partnerships and deal activity among health organizations, suppliers, private equity firms and other market participants.

PwC’s research found barriers that may slow collaboration and progress in the use of clinical informatics. 

  • Fewer than half of health companies are exchanging information externally today. Only 31 percent of providers, 47 percent of insurers and 49 percent of pharmaceutical / life sciences companies participate in external data exchange.
  • Despite the need for clinical information, the two biggest challenges health organizations face in expanding their clinical informatics efforts is data integration and lack of industry-wide data standards, leading to distrust in the data itself and its usage.
  • Nine in 10 (90 percent) of pharmaceutical / life sciences respondents said that access to the clinical  data stored in electronic health records would help with drug research and development, and 85 percent said it would help clinical trial protocol design and recruitment, yet 87 percent also expressed concerns in the quality of EHR data.  Pharmaceutical companies, which have historically purchased clinical information, have decreased purchasing activity from 45 percent in 2009 to 24 percent in 2011. 
  • More than half (54 percent) of providers said they would like to provide feedback into evidence-based protocols, yet only 20 percent of health insurers are “very confident” in their ability to offer providers access to evidence-based protocols.
  • Seven in 10 providers and health insurers said that their top technical goal is integrating data from multiple sources, and only 17 percent of providers and 16 percent of health insurers are very confident that their health information exchange vendor will be able to meet their analytic and integration needs over the next two years.

A copy of PwC’s clinical informatics report is available for download at www.pwc.com/us/hitinformatics.

About PwC’s Health Research Institute (HRI)

PwC's Health Research Institute provides new intelligence, perspectives, and analysis on trends affecting all health-related industries. The Health Research Institute helps executive decision makers navigate change through primary research and collaborative exchange. Our views are shaped by a network of professionals with executive and day-to-day experience in the health industry. HRI research is not sponsored by businesses, government, or other institutions.

About PwC’s Health Industries Group

PwC’s Health Industries Group (www.pwc.com/us/healthindustries) is a leading advisor to public and private organizations across the health industries, including healthcare providers, pharmaceuticals, health and life sciences, payers, employers, academic institutions and non-health organizations with significant presence in the health market. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About the PwC Network

PwC firms help organizations and individuals create the value they’re looking for.  We’re a network of firms in 158 countries with close to 169,000 people who are committed to delivering quality in assurance, tax and advisory services.  Tell us what matters to you and find out more by visiting us at www.pwc.com.

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Lisa Stearns
The Hubbell Group, Inc.
lstearns@hubbellgroup.com
(781) 878-8882