Tuesday, May 08, 2007

Knowledge, Standards, and the Healthcare Crisis: Part 1

There is widespread acknowledgement that our healthcare system needs radical transformation since:
  • All patients “…are at risk for receiving poor health care, no matter where they live; why, where and from whom they seek care; or what their race, gender, or financial status is”[1]
  • Healthcare is increasingly more expensive and less accessible[2], with more than 46 million uninsured in the U.S. from every age group and at every income level, 8 out of 10 being in working families[3]
  • There is a “knowledge gap”—the healthcare community is drowning in oceans of information, yet doesn't know the best ways to prevent health problems and treat them cost-effectively.[4]
In this next series of posts, I will offer an answer to this daunting question: What can be done to drive continuous improvements in care safety, quality and efficiency, which would enable people to remain healthy longer, manage chronic conditions more effectively, and receive the best possible healthcare delivered in the safest and most economical way?

My answer focuses on the creation, use and evolution of valid health knowledge. Why? Because, I contend, the quality of care would improve dramatically and costs would drop precipitously if everyone:
  • Knew the best ways to prevent illness, to avoid complications of chronic diseases, and to treat health problems in the most effective and efficient manner
  • Used this knowledge to promote wellness, self-management, and recovery
  • Participated in evolving this knowledge to make it ever-more useful and effective.
So, what would it take to foster widespread knowledge creation, use and evolution in our healthcare system?

Well, since knowledge emerges from information,[5] it is essential that both consumers/patients and providers have access to useful health information, including patient health data, care outcomes, and evidence-based guidelines. Furthermore, the information must be presented in a way tailored to each person’s needs and be made available whenever it’s needed. Unfortunately, this is much easier said than done for many reasons.

One daunting core problem involves exchanging patient data between disparate electronic record systems. After all, knowledge can’t grow and care can’t improve unless patients share their health information with their providers, providers share patient information with each other, and researchers have access to this information to develop evidence-based guidelines. And this must be done in a convenient and secure manner that protects patient privacy.

With cost estimates for developing a national health record system enabling patient data exchange being between $100-276 billion,[6] the question is, why must it be so expensive? Aren’t there any easy, inexpensive ways to do it? Let’s examine these questions.

One way to reduce health information exchange costs is by developing and using standards that promote interoperability between disparate health record systems.

Standards are models, principles, policies, or rules that provide an agreed-upon framework for doing and understanding things. When it comes to health information exchange and knowledge growth, at least two types of standards come into play: data and technology standards. These standards describe how health data are categorized and defined, how health outcomes and healthcare performance are measured, how healthcare knowledge is used, and how different software systems communicate with each other when exchanging data.

In my next post, I examine this double-edged sword of standards, pointing out their benefits and the thorny problems they create.

[6] Linking Providers Via Health Information Networks by The Alliance for Health Reform (2006) and Dying for Data by R.N. Charette (2006)

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