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Race to Health Info Tech--Tortoise or Hare?

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Bridging the costly gaps in patient experience and engagement, health care analytics, population health and precision medicine is fundamental to reform, but practitioners believe that kind of reform will increase the costs of care too much.  Here follow a few related comments and stats:

  • 61% believe "electronic health records (EHRs) could have a positive impact on their businesses"
  • 82% cited their biggest challenge in implementing HlT is cost.
  • 17% of providers are or are planning to participate in a Health Information Exchange (HIE) over the next 12 months.
  • "More than 50% of healthcare providers believe the billions of dollars from the American Recovery and Reinvestment Act (ARRA) [that are] earmarked for healthcare information technology (HIT) will have little to no success in encouraging HIT adoption."
  • Interoperability is a critical factor in the use of data and information by the various players–payers, patients, practitioners, and public entities. Indeed, without interoperability, the "value of an EHR is severely restricted," and providers will be facing fee reduction and other penalties from Medicare and other payers.

IVANS, a provider of healthcare connectivity conducted this survey. [Source:; link failed 2/22/16]

The opposing (i.e., a more optimistic) view is captured in "Investing in a Nationwide Health Information Interoperability Framework," American Health Information Management Association

Here’s what one well-informed IT manager says health IT should focus on:

1. Interoperability

Health informatics should be sure that relevant information is easily accessible and that it unimpeded.

2. Advanced Analytics

Practitioners should be able to translate data into information via advanced analytics and process and outcome measurement and management.

3. Automated Care Coordination

We need to be facilitating and automating communication, especially at the point of care and especially about the coordination of care, risk stratification (patient and condition), intervention or the lack thereof and follow through.

4. Patient-centric healthcare

[Information] "Technology now has the ability to accurately analyze a patient’s health, identify the inefficiencies and develop custom-made care plans for patients, suited to their needs."

5. Patients' awareness, engagement and experience

Anirudh Kanwar [InnovAccer]. "How has Health IT Failed Patients?" [LinkedIn commentary–modified from his original 1/31/17 post]  " He notes: "The Triple Aim of improving patient experience, improving population health at large and reducing the costs of healthcare is ultimately meant for the greater good of patients."

Why is it difficult to encourage Health Information Technology?  Inertia?  Cost?  Techno-phobia?  Lack of a hand-held (PDA) Interface?  Security? Less eye contact with patients? Having to type? Paradigm Paralysis?  (Take the HIT Survey)

Clearly, the government, networks and providers "all have different starting points, goals, and resources....We must understand, therefore, that building national scale health IT infrastructure is a problem entirely different from that of simply replicating a clinical system across may different institutions (in the manner, for example, that the Veterans Administration did in the United States). Building national healthcare IT systems involves defining a policy and standards framework that can shape the convergence of public and private, local and central systems into a functional national system. It is also about governments doing those things that only governments can do well, like supporting public sector institutions to join the NHIS, providing incentives for the private sector where the private business case for change is weak but the national interest is strong, supporting the development of public goods such as the skilled health informatics workforce essential to the success of any NHIS, and crucially, developing the legislative instruments needed to protect the privacy and legitimate interests of citizens. And government should avoid doing what it is not good at, like designing, buying, or running IT."

Colera E.* "Building a National IT System from the middle Out." J Am Med Inform Assoc. 2009;16:271-273.   DOI 10.1197/jamia.M3183 [pdf (free)]. © 2009 American Medical Informatics Association.
* Centre for Health Informatics, Institute for Health Innovation, University of New South Wales, Sydney, Australia.

Data are literally trapped by EHRs that don't communicate

The American Society of Clinical Oncology''s (ASCO) board of directors realized that only about 3% of adult cancer patients actually participate in clinical trials for their care. That leaves about 97% of such patients presuming they are "receiving the best [jgk, emphasis added] care as determined by their local oncologist."

Also, the "knowledge of what happens to them as a result of the everyday care experience is largely lost.... ASCO was hoping [it could] make all these data interoperable, allowing learning to occur from the care experiences of every cancer patient. So, they came up with this idea of creating a database whereby EHR data would feed into a single, aggregated database, and it would have to be de-identified for privacy protections, and that database could then be accessed by the broader cancer community."  

Robert Miller, MD. "ASCO’s CancerLinQ is Harnessing Big Data to Build a Learning Health System" Healthcare Informatics. Nov 22, 2016

"Never underestimate the complexity of a multi-faceted programme." 

Pagliari C. "Implementing the National Programme for IT: what can we learn from the Scottish experience?" Informatics in Primary Care 2005;13:105-111.  [(pdf; (free full text)]

Residents in Medicine in the U.S. and Canada were taught to use a rigorous protocol at change of shifts in a hospital (handoff is a known trouble spot in communication*) resulting in 30% less preventable events and 23% less medical errors.

Tools Used in Improving Communication:

The mnemonic, I-PASS, a framework for the patient handoff process was adopted from Starmer, et. al.,  Pediatrics; 129(2) Feb. 2012:

I: Illness severity
P: Patient summary
A: Action list
S: Situation awareness and contingency
S: Synthesis by receiver

This, in turn was "modeled after the SBAR acronym (Situation, Background, Assessment, Recommendation) developed in the Kaiser Permanente system a few years ago to facilitate handoffs there.

Beyond instruction on the mnemonic device, the I-PASS Handoff Bundle included six more elements: a 2-hour workshop to teach teamwork and communication; a 1-hour role play and simulation exercise; a computer module for independent learning; a faculty development program; direct observation tools for faculty to give feedback to residents; and a process-change and culture-change campaign."

"I-PASS Handoff System Leads to Decline in Medical Errors—Mnemonic device helps for oral and written handoffs." MedpageToday ; The Gupta Guide [last accessed, PM 12/6/14]

*  2001 Joint Commission Center for Transforming Healthcare report, "Crossing the Quality Chasm."

Why isn't health information technology transforming our health systems?

1) "HIT suffers from the same market failures that plague the health care system—too numerous here to cite."  2) "The health system itself creates barriers for HIT with byzantine organizational and reimbursement schemes more tailored to episodic care, not process-oriented care."  3) "HIT itself suffers from a lack of standardization, which inhibits data interoperability, exchange, and transparency."

Nicolas P. Terry, Information Technology’s Failure to Disrupt Health Care, 13 Nev. L.J. 722 (2013).