Tuesday, September 22, 2009

Kudos to Dr. Blumenthal!

As reported at this link in a new items item titled "Blumenthal calls for more study on uses of health IT," Dr. David Blumenthal, the national coordinator for health IT, said much more research is needed to determine the effectiveness of health information technology while it's being deployed with support of stimulus monies.

According to the article, Blumenthal indicated that more documented research will help providers put their systems into practice and use it effectively because, until now, research about health IT (HIT) has been limited. It went on to say:

To be eligible for increased Medicare and Medicaid payments, the stimulus requires that healthcare providers be meaningful users of health IT. Meaningful use will result in a more accountable healthcare system and one that produces more value, Blumenthal said.

The Health IT Policy Committee, which Blumenthal leads, has laid out the steps providers must take by 2011 to use health IT to collect data for improved patient management, care processes and to assure better outcomes for patients..Blumenthal called for building an infrastructure for continuous clinical improvement through the use of decision-support technology that can bring research results and new treatment information to a clinician's fingertips.

"One thing we haven't done is apply the scientific method in the practice of healthcare and medicine," he said.

Well said! Dr. Blumenthal wants HIT to be used meaningfully in a way that supports decisions and promotes scientific research to bring greater value to the patient/consumer. EXCELLENT!

I've been echoing these sound principles over the past few years on this blog and on our Wellness Wiki. Take, for example, this two-part post on meaningful use of HIT starting at this link in which I wrote:

Meaningful use, to me, means using HIT in ways that are of great value to the patient and other healthcare consumers. It doesn't matter what types of software tools are used, what communication infrastructure is used, what standards are used, or what certifications are used. It just means that the using HIT should result in ever more effective and efficient (i.e., ever greater value) care delivery…This definition raises the bar over other definitions being offered because it focuses realizing the benefits of ever-increasing care value (effectiveness and efficiency), which is something mainstream HIT does not do.

I then cited a recent report by the National Research Council of the National Academies, which addresses the issue of decision support. It concluded that a serious gap in HIT today is the failure to deliver patient-centered cognitive support. According to the report:

During the committee's discussions, patient-centered cognitive support emerged as an overarching grand research challenge to focus health-related efforts of the computer science research community, which can play an important role in helping to cross the health care IT chasm...Today, clinicians spend a great deal of time and energy searching and sifting through raw data about patients and trying to integrate the data with their general medical knowledge to form relevant mental abstractions and associations relevant to the patient's situation…The health care IT systems of today tend not to provide assistance with this sifting task…[We need] computer-based tools [that] examine raw data relevant to a specific patient and suggest their clinical implications given the context of the models and abstractions. Computers can then provide decision support—that is, tools that help clinicians decide on a course of action in response to an understanding of the patient's status. At any time, clinicians have the ability to access the raw data as needed if they wish to explore the presented interpretations and abstractions in greater depth…The decision support systems would explicitly incorporate patient utilities, values, and resource constraints…They would support holistic plans and would allow users to simulate interventions on the virtual patient before doing them for real.

In addition to debating ways to insure all Americans, we ought to be discussing how exactly we will bring ever-greater value to the patient/consumer, including the kind of HIT innovations we desperately need to help achieve this vital objective.

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