Integrated Patient Data for Optimal Patient Management: The Value of Laboratory Data in Quality Improvement

Managed care organizations are shifting from tradi-tional utilization management programs to focus on initiatives that improve the health of an insured popu-lation. This strategy requires sophisticated data integra-tion to identify at-risk individuals and track outcomes. Laboratory data are becoming increasingly valuable tools for managed care organizations and healthcare providers. The HEDIS ® Effectiveness of Care measures have incorporated laboratory data into several key per-formance indicators. By building a comprehensive re-pository of laboratory data that includes both procedure codes and laboratory values, managed care organiza-tions can realize substantial savings by avoiding the costly medical record reviews required when adminis-trative data are incomplete. In addition to tracking clinical outcomes, laboratory data provide the ability to risk-stratify a population to target high-risk individuals for case management and disease management interven-tions. Healthcare organizations face several challenges in the integration of laboratory data into medical data-bases and practice management software. Confidential-ity is a key consideration in view of recent healthcare regulations. Providers of laboratory services should work collaboratively with organizations setting stan-dards for healthcare informatics to facilitate the pooling of data for quality improvement and outcomes research