Here are four interlocking issues that must be addressed if we Americans are ever to fix healthcare:
- Meaningful use of health IT vs. Minimally acceptable usefulness. I contend that health IT is used "meaningfully" only if it helps increase the effectiveness and efficiency of care (i.e., increases care value to the consumer). Although the Federal government is focusing on this value proposition, pressure from the healthcare industry may end up watering down the meaningful use definition to one of "minimally acceptable usefulness." And to be TRULY meaningfully used, EHRs ought to provide data and functions that support the following three value-enhancing models & processes...
- Patient-Centered Medical Homes (PCMH) vs. Uncoordinated care. The PCMH model, which provides oversight and coordination in the delivery of care is, thankfully, gradually gaining acceptance.
- Patient-Centered Cognitive Support (PCCS) vs. Inadequate information (ignorance), Information overload, and Lack of computerized decision support. PCCS, which consists of advanced software systems that help clinicians make informed decisions without information overload, is slowly gaining traction.
- Pay-for-Value (P4V) vs. Fee-for-Service (FFS). P4V, which focuses on the delivery of cost-effective care (i.e., high value to consumers) is being endorsed by some, but it has a long way to go before crowding out the FFS model in which "pay for volume" or "pay more for doing more" is actually a disincentive for cost-effective care (i.e, cost-effectiveness means less provider income/revenue under FFS).