Friday, March 06, 2009

Case for a Collaborative Health-Support Software System - Part 1 of 3


In our current economy, improving healthcare value is absolutely essential since the current system is unsustainable (unaffordable) long-term.[1] High-value comes from consistently delivering top quality care at a good price.[2] In other words, we have to focus on making healthcare much more cost-effective[3] by assuring consumers (healthcare patients, clients, customers)[4] receive the sick-care and well-care they need—delivered efficiently, safely and at a good price—without unnecessary tests and procedures, and without wasting money on products and services that provides little benefit to consumers.

Part of the solution is reforming healthcare economic models,[5] changing how care is paid,[6] and redirecting the way healthcare providers compete[7] because current methods fail to offer high value products and services to consumers.

Arguably more important, however, is the need for healthcare professionals and consumers to:

  • Know the most efficient and effective ways to prevent, treat and manage health problems
  • Use this knowledge competently and consistently to improve outcomes and control costs.
Sadly, while drowning in oceans of information, the healthcare industry lacks the knowledge and motivation needed to deliver high-value care.[8] This is evident by:
  • The disconnection between quality and cost; research has proven that more expensive care rarely results in better care
  • The fact that healthcare providers often don't know what treatments work best for a particular patient
  • The unaided human mind, no matter how competent, simply cannot focus on all the necessary details nor possess all the knowledge needed for continually making the best clinical decisions
  • Our country failure to focus adequately on making existing healthcare knowledge useful and applicable to clinical practice.
  • Obtaining the knowledge to improve decision-making requires a commitment to ongoing clinical outcomes research and a focus on continuous quality improvement, things that the healthcare industry has largely avoided
  • Knowledge about prescription medication safety and effectiveness can be greatly enhanced.
How can this troubling situation be improved? By using and evolving collaborative health-support software.

Health-Support Software Described

Let's begin by describing what health-support softwareis, what they do, and how using it in collaborative networks is an essential ingredient for increasing healthcare value.

What Health-Support Software Is and Does


Health-support software consists of computer programs (applications) designed to help people making health-related decisions or taking specific actions to deal with (potential) health problems. Good health-support software accomplishes two basic objectives; they are:
  1. Increasing awareness and understanding about people’s health status, threats, problems, and care options
  2. Guiding subsequent action to avoid the threats and deal with the problems.
Good health-support software accomplishes these objectives by providing personalized recommendations, instructions, feedback, and alerts.

To be truly useful, health-support software should manage (obtain, analyze, exchange, and present) comprehensive personal health information about a person’s:
  • Physical and psychological (body & mind, whole-person)[9] health and susceptibility, past and present
  • History of treatments, the clinical outcomes (the results of care), and the costs
  • Influences of one's environment and culture
  • Personal preferences.
Furthermore, the recommendations, instructions, feedback, and alerts generated by the software should be based on evidence-based guidelines that help people:
  • Assess (diagnose) and define health risks and conditions
  • Prevent risks from becoming serious health problems
  • Treat and cure existing problems
  • Manage chronic conditions (such as diabetes, obesity, and heart disease), so debilitating complications do not happen.
It's important to note that models differ in many ways; for example, different models:
  • Take into account different health data
  • Employ different math and logic to analyze the data
  • Make different assumptions
  • Base their recommendations, instructions, feedback, and alerts on different information resources (such as evidence-based guidelines[10])
  • Present their recommendations and instructions in different ways.
This means that certain health-support software is more useful than others depending on the people using them and the particular circumstances in which they are used. Yet despite these differences, they still share the same purpose: to increase care cost-effectiveness, a goal requiring collaboration.

How Health-Support Software Enables Effective Collaboration


Collaboration is essential for bringing ever-greater value to the healthcare consumer. Increasing healthcare efficiency and effectiveness depends, in part, on loosely-coupled networks of people collaborating to support shared decision-making and facilitating care coordination. This is why collaborative health-support software is so important.

Loosely-Coupled Networks


A "loosely-coupled network" is a dispersed group of people from multiple locations and with different roles, responsibilities, experiences, and awareness. These people collaborate to make more valid decisions and competent actions by taking advantage of their collective intelligence.[11] When such collaboration is among people with wide diversities of knowledge, ideas and points of view, the collective provides a greater assortment of intellectual resources, and offers access to a wider variety of non-redundant information and understandings [12] on which to base decisions and guide actions. This is unlike a tightly-coupled network that limits participation to people within the same discipline, department, region, etc. who have access to the same information sources and who share similar experiences. Loosely-coupled collectives provide the greatest opportunities for stimulating multifaceted discussions and creative solutions.

Evolving Health-Support Software through Collaboration in Loosely-Coupled Networks


Collaboration helps evolve (improve) health-support software by making them more effective in:
  • Increasing people’s awareness and understanding of health risks, problems, and remedies
  • Providing useful recommendations, guidance, feedback, and instruction.
Evolving health-support software in this manner is accomplished when collaborators share the software and scrutinize it by:
  • Comparing and testing its ability to reflect reality accurately
  • Testing it in different scenarios
  • Discussing the assumptions and results it produces.
When they find models that disagree or generate invalid results, they:
  • Examine the fundamental assumptions built into the software’s underlying models[10]
  • Look for logical flaws and inconsistencies in the software’s models
  • Question the program’s authors’ perception of reality
  • Debate about the assumptions and practical value of the software.
By challenging the model's assumptions in these ways:
  • Useful counterintuitive insights often emerge
  • Innovative thought is sparked
  • New questions arise
  • Relationships between collaborators are developed
  • The influence of an organization's culture and politics are revealed
  • Compelling and unexpected management issues are discovered.
This all means that sharing and playing with health-support software is an effective way to evolve the software to increase its validity and usefulness.

Failure to evolve models in this manner can be disastrous! Take, for example, the famous mathematical model[13] that helped bring Wall Street to its knees. The model was used for the past five years to justify risky mortgage-based investments, even though few understood it and even fewer questioned its assumptions. Invented by a mathematician, the model was based on the faulty assumption that home prices would continue to rise and few homeowners would be unable to pay back their mortgages. While some financial experts realized this was a seriously flawed model, it helped bring great wealth to many for years, so there was little incentive to criticize it. This very model is a root cause of the world's current financial meltdown.

The healthcare industry ought to learn a valuable lesson from that fiasco by continually evaluating end evolving the diagnostic and treatment models underlying clinical guidelines and decision-support tools!

Enabling Loosely-Coupled Networks with Decentralized Communication Architectures


Collaborators in loosely-coupled networks would benefit from a low-cost decentralized (peer-to-peer) communications architecture. One example is the “mesh” network architecture,[14] which grew out of the need for a distribution network in telephone, power, and water, and oil pipeline businesses. It enables anyone to communicate directly with anyone else at any time, from anywhere. It’s like using the telephone to communicate with a single person, or to set up a conference call where each person can communicate to many other people. The mesh network architecture, therefore, provides a simple, flexible, low-cost way for loosely-coupled networks to collaborate.

In my next post, I'll discuss how to use health -support software in loosely-coupled networks to provide high-value care by promoting coordinated care, delivering consumer-centered cognitive support, and fostering shared decision-making.

References:
[1] http://wellness.wikispaces.com/The+Current+Situation
[2] http://curinghealthcare.blogspot.com/2007/10/path-to-profound-healthcare.html
[3] Cost-effective mean economical in terms of tangible benefits produced by money spent (http://www.merriam-webster.com/dictionary/cost-effective)
[4] The term “consumer” is used throughout this paper to refer to people who “consume” (use) healthcare products and services. Depending on the healthcare products and serviced used, a consumer may be a patient, client, customer, member, etc. In contrast, the term “provider” is used to refer to any professional who provides (delivers, renders) healthcare services. They include physicians and non-physician doctors, nurses, therapists, counselors, wellness coaches, physical trainers, health educators, etc.
[5] http://wellness.wikispaces.com/Tactic+-+Reform+Current+Economic+Models
[6] http://curinghealthcare.blogspot.com/2007/11/patient-centered-life-cycle-pclc-value_19.html
[7] http://wellness.wikispaces.com/Tactic+-+Redirect+Competition
[8] http://wellness.wikispaces.com/The+Knowledge+Void
[9] http://curinghealthcare.blogspot.com/2008/02/patient-centered-life-cycle-value-chain.html
[10] http://wellness.wikispaces.com/Tactic+-+Improve+Care+Quality+with+Evidence-Based+Practice+Guidelines
[11] http://en.wikipedia.org/wiki/The_Wisdom_of_Crowds
[12] Software programs have underlying models that guide its operations. The models may include mathematical formulas, logic rules, text functions, formatting instructions, and other procedures (routines).
[13] http://www.wired.com/print/techbiz/it/magazine/17-03/wp_quant
[14] http://wellness.wikispaces.com/Network+Architectures

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