Claims, EMR, And CRM Data
Strong evaluations usually combine three data types: administrative claims, EMR clinical data, and CRM workflow data. Each data source answers a different part of the effectiveness question.
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1. Administrative claims data
Claims data is collected primarily for reimbursement, but it is the backbone of population-level evaluation.
- What it includes: admissions, outpatient visits, SNF/hospice use, DME, pharmacy claims, and coded diagnoses.
- Strength: available consistently for broad populations, making treatment/comparison design feasible.
- Strength: supports total-cost and long-horizon utilization analysis across all settings.
- Limitation: weak on nuanced clinical or social context (for example, functional status or living arrangement details).
2. Clinical EMR data
EMR data captures what clinicians observe and document during care delivery.
- What it includes: vitals, labs, functional status, care plans, symptom burden, and patient preferences.
- Strength: identifies disease stage and care needs that claims codes alone may miss.
- Strength: helps test mechanism (for example, whether blood pressure control improved before admissions fell).
- Limitation: often unavailable for external comparison groups, which complicates causal inference.
3. CRM data (often overlooked, often valuable)
CRM data is operational metadata about engagement, coordination, and follow-through. It can be messy, but it is highly useful for implementation evaluation.
- Examples: outbound call attempts, successful contacts, missed follow-up reasons, referral status, care-manager notes.
- Examples: appointment scheduling lag, task completion timestamps, closed-loop referral completion rates.
- Strength: reveals whether program activities actually happened with enough intensity and timeliness.
- Limitation: definitions vary by team, and fields are often inconsistently maintained without governance.
How to use all three together
- Claims for primary outcomes and fair comparisons.
- EMR for mechanism and clinical plausibility.
- CRM for implementation fidelity and operational bottlenecks.
In practice, the best programs show a coherent chain: CRM intensity improves, EMR indicators move in the expected direction, and claims outcomes follow.
Related methods
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