10 essential population health IT tools

The 10 essential population health IT tools identified by the PCPCC are:

(PDF file here here )

Electronic health records, to document diagnosis, vital signs and other data needed for advanced analytics;

Patient registries, to serve as central databanks to identify care gaps and report quality measures;

Health information exchange, to coordinate care and share data between care team members;

Risk stratification, to classify patients by their current health status and identify who may need interventions to prevent hospitalization;

Automated outreach, to generate automatic messages to patients who need preventive care or chronic disease management;

Referral tracking, to ensure that providers receive results of consultations from specialists patients were referred to;

Patient portals, to share records with patients and encourage self management;

Telehealth/telemedicine, to allow remote examination and treatment;

Remote patient monitoring, to track vital signs of patients with chronic conditions and to alert providers when intervention is needed; and

Advanced population analytics, to evaluate how different segments of patient populations are faring and assess the performance of individual clinicians and provider organizations as a whole.