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Difficulty accessing high-quality provider data is creating obstacles to health information exchange, according to a new study by non-profit healthcare alliance CAQH.
In “Defining the Provider Data Dilemma,” CAQH said that as the healthcare industry continues its rapid transformation toward value-based care, it faces a “daunting but necessary task” of assembling provider data accurately and securely in order to manage risk, meet consumer demand, improve care quality, control costs, and support decision making.
“Accurate provider data is crucial for healthcare business processes and patient care,” the report argued. “Health plans and providers produce and use it to process payments, detect fraud and abuse, validate credentials, exchange clinical information, manage and coordinate care, and develop insurance products.”
Noting that healthcare data is being generated and used by a growing number of stakeholders – including health plans, providers, consumers, government agencies, and regulators – CAQH outlined how each group of stakeholders is adversely affected by poor-quality data. For example:
· Inaccurate electronic addresses can prevent clinical data exchanges among care team members
· If health plans and provider organizations can’t collect and evaluate provider qualifications in a timely manner, it may delay when a provider can begin seeing patients
· Incorrect provider contact information can lead to providers and consumers being unable to locate specialists or other providers
“The industry lacks definitions and benchmarks for provider data quality, leaving individuals and organizations to define, measure and improve quality in silos,” CAQH said.
The alliance recommended a framework containing six quality domains – accuracy, completeness, consistency, timeliness, process-ability, and accessibility – that could be used to assess the quality of data generated by producers.
“Development of standard definitions and an industry-adopted governance framework and approach would create efficiencies and have a significant impact on provider data quality, while reinforcing accountability,” CAQH said.
You can read the full CAQH study here.