Availity Blog

How Real-Time Data Can Transform Healthcare


6.29.2016 by MARK MARTIN – Director Payer and Vendor Portfolio


“Sudden” changes in the information we have and how we use it are usually not all that sudden, and it’s almost impossible to predict their effects. Whether it’s pinpoint accuracy in location data or efficient sharing of health care information, improved technology, changing attitudes about the technology, and government pressure often lead to unexpected consequences.

Real-time location data changes navigation

When the U.S. military started exploring ways to accurately track troops, ships, and airplanes, they developed a series of global positioning satellites (GPS). The first systems in the 1960s were installed in Navy submarines, and the location data was only updated once an hour. The equipment was huge, expensive, and so specialized it could only do one thing.

Thirty years later, GPS receivers were introduced to the general public for use in cars, boats, and other modes of travel. The data used in these early receivers was stored locally, so the maps were static and had to be manually updated about once a year. While the GPS was a giant step forward for everyday consumers, people would occasionally get lost following instructions because their maps didn’t account for new roads or recent road construction.

In the early 2000s, things changed when the government required smartphone makers to include location services in their devices to help emergency responders locate people who called 911. Suddenly, everyone with a cellphone had access to pinpoint location accuracy. Just a few years later, mapmakers, advertisers, and a wide variety of apps not only know where you are, they can warn you about traffic jams on your commute or tag the location of your vacation photos. Suddenly location data is being used in ways no one had considered.

Healthcare experiences the data shift

In many ways, the way data is used in health care is following the same path as location data. Back in the 1960s and 70s, you needed an entire room to house the computers that handled actuarial calculations. With the rise of the personal computer and then the internet, doctors started carrying laptops into patient rooms. But innovations in technology alone wouldn’t be enough for healthcare to experience a true shift in the way data is used.

As the GPS analogy demonstrated, it was government intervention that spurred huge investment in new ways to use data. We are seeing that today with the passage of the Affordable Care Act, the transition from fee-for-service to value-based care, and this year’s mandates surrounding provider directories. The regulatory environment is pushing the healthcare industry to find better, faster ways to capture, store, and use data.

Health care data use isn’t as well-developed as location information, but real-time, accurate clinical, financial, and administrative data is almost within our reach. We need to think about what we might be able to do with the wealth of information.

A look at what’s coming

What would it look like – how would health insurance, in particular, change – if health plans were as good at capturing, storing, and using health data as Google Maps, Waze, and Facebook are at managing location data?

Physicians would not only be able to see their patients’ complete medical history, but they could predict the need for future appointments as effectively as Amazon knows when we need more household goods. Clinical and administrative information could be shared, with the patient, providers, and plan all able to see not just procedures, outcomes, and costs for past care events, but what’s needed to achieve and sustain the best possible health into the future.

Providers and patients could work together much more efficiently. Treatment plans would be available before check-in at the front desk. Providers would get authorizations and referrals before the visit. Patients and physicians would both know the exact reimbursements and out-of-pocket costs before office visits and medical procedures, and care could be adjusted to be both cost-efficient and outcome-based. Imagine how conversations between a patient and provider might change if the provider had access to the patient’s real-time enabled medical chart. Even quality and risk-based milestones could be shared in real-time, rather than playing catch-up using 30-day-old claims.

In addition to clinical information, better access to better data will streamline administrative processes. What if a health plan’s request for additional claim details could go directly to the person in the provider’s office who’s already handling that claim? Could data embedded in an authorization request or claim be used to improve other transactions, to the same degree that allowing a web application to know my ZIP code helps me get a discount at a local restaurant?

How much time and effort could be redirected to improving patient care, instead of manually gathering, entering, and updating data?

These are just some of the obvious implications of disruptive uses of technology in healthcare – and that’s not considering the possibilities of medical devices being connected through the “Internet of things.”

What’s really fascinating is to consider what kinds of uses will emerge as easier access to accurate data makes developing new tools simpler and faster. Navigation methods didn’t change for centuries, and when real-time, precise data became available, it still took 50 years to put a Yelp in every pocket. Health care is moving in the right direction – what do you think it will look like when we get there?

Data accuracy is the foundation for new uses

All of the “what if you could” questions assume that the data being used is both accurate and timely. Health plans have made great improvements in capturing, storing, and using data about their members. The next big shift could well be improvements to managing information about providers. That goes far beyond national identification numbers and service locations. Directories may be the hot topic now, but effective use of provider data goes far beyond the government’s requirements.

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