Tuesday, January 18, 2011

Constructing the Ultimate EHR

I just started a discussion on LinkedIn that focuses on answering the questions: How can the EHR be transformed into the cornerstone of a comprehensive health IT system that fosters continually increasing care value (cost-effectiveness)? This “Ultimate EHR” discussion follows a discussion at LinkedIn in which reasons for EHR failures have been examined thoroughly. The purpose of the current discussion is to use the knowledge of such failures to guide the construction of a blueprint of an EHR that helps providers achieve the best possible outcomes at the least possible cost. The link to the discussion is: http://linkd.in/hUPJqf

Here's the introduction

In addition to discussing conventional methods, participants in this discussion are encouraged to present their innovations, creative ideas, and novel strategies. We will examine and critique these technologies, concepts and approaches in order to define a next-generation EHR that helps transform clinical data into actionable information and evidence-based knowledge aimed at increasing healthcare value (quality and efficiency) ; e.g., see http://bit.ly/eal8CS and http://bit.ly/hoQKTG.

We will seek creative solutions to daunting challenges such as determining the best ways for EHRs to:
  • Evaluate data integrity to help assure the data contained are valid
  • Securely exchange patient data between disparate “silos”
  • Build lifetime medical records that provide the specific information tailored to the need of clinicians from every type of specialty/discipline, and in every healthcare setting, through use of different models that adapt the clinical terminologies, data sets, analytics/rules, forms, reports/views and overall UI to the end-users particular requirements
  • Promote a strong and productive link between scientific research and clinical practice (“bench to bedside”) by (a) delivering de-identified patient data from everyday clinical practice to central repositories where researchers use them in developing evolving evidence-based personalized guidelines (http://bit.ly/giw1kF) and (b) propagating those guidelines—using clinical decision support functionality—without fostering “cookbook” medicine or stifling innovation
  • Improve decision-making by providing patient-centered cognitive support (http://bit.ly/EzWgF)
  • Manage expansive and every-changing clinical data standards, including terminologies, care processes and outcome measures
  • Support the delivery of “whole-person integrated care” (http://bit.ly/7BVuA5)
  • Handle images of all kinds (http://bit.ly/hu3NCH)
  • Interoperate with other health IT tools
  • Accommodate ALL meaningful use requirements, now and forever?
 All questions, comments and ideas are welcomed.

Thursday, January 06, 2011

Healthcare Reform Models Focusing on Value to Consumers – Part 3

My two previous posts (starting at this link) and this one discuss on how to bring high value to the healthcare consumer. I examined the two important models of healthcare delivery--the Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs)--and explored meaningful financial incentives models. In this post, I discuss issues concerning health information technology (HIT).

I defined high-value healthcare as cost-effective products and services that keep people well and improve the health & wellbeing of people who are ill. Providers (clinicians and healthcare organizations) who want to deliver such high-value healthcare require more than a desire to give their patients top quality affordable care. They also need a wealth of knowledge about the best way to prevent, diagnose and treat a wide range of health problems. This not only means continually learning, but also having access to latest evidence-based research and the guidance needed to use one’s knowledge in a way that fosters the best diagnostic and treatment decisions.

The only way to achieve high-value healthcare is to reform our current healthcare system, so it focuses on these two goals:
  • Enabling all clinicians to continually learn how to make (and keep) their patients healthiest and happiest for longest, using the most cost-effective methods of treatment and prevention, and encourage/reward them for doing so.
  • Enabling all consumers/patients to continually learn how to make (and keep) themselves healthiest and happiest for longest, using the most cost-effective methods of self-care and self-maintenance, and encourage/reward them for doing so.
Such a high-value healthcare system presents daunting challenges, however. One is being overload with overwhelming amounts of new information appearing daily. Another is the limited capacity of the unaided human brain to acquire, retain, recall and apply complex information about the human body and mind. See, for example, this link about the knowledge gap. Add to this the fact that we have a broken healthcare system full of perverse incentives (e.g., pay for procedure/volume rather than for delivering value), and there’s little wonder why healthcare in America is lower quality and much more expensive than in many other countries.

One crucial element of a high-value healthcare system it the sensible use of advanced HIT. That’s because HIT has the potential to bridge the knowledge gap and foster providers’ ability to deliver higher value care. The HIT industry, however, is having difficulty understanding what has to do; it has largely failed to develop the tools providers and patients need to increase healthcare’s value.

Consider this: The cornerstone of HIT—the electronic health record (EHR)/electronic medical record (EMR)—has been around for about 30 years. One would think, therefore, that today’s EHR/EMRs are successful. Well, knowledgeable experts have been having a great discussion at the HIMSS Linked-In group about this topic, with well over a thousand comments posted thus far. While some of the commenters believe that EHR/EMRs have been successful, most do not. The group gave many reasons for their failure, which focused primarily on technology, people and money.

From an HIT perspective, I indicated that before we can discuss EHR/EMR success or failure, we should first describe its primary goals. We could then determine whether the tools are achieving those goals. I therefore created a chart that defines three levels of EHR/EMR capabilities (weak, moderate and strong), the requirements for achieving success at each level, and the degree of usefulness of each level.