Building a Foundation for Health Care Transformation
Evidence-based medicine will improve the quality of care and impact of each health care dollar spent.
Guest commentary from Marc Perlman, global vice president, Healthcare and Life Sciences Industry, Oracle
The U.S. health care industry is challenged like never before to improve outcomes while reducing costs. Our current rate of spending is unsustainable, and more important, the results we achieve do not always reflect the resources expended on care delivery.
As our national leaders debate the future of health care, it appears certain that evidence-based medicine (EBM) -- which integrates individual clinical expertise with the best available external clinical evidence from systematic research -- will play an expanded role in helping the health care community to improve quality of care as well as the value and impact of each health care dollar spent. Health information technology (HIT) will be essential to realizing this mission.
While many providers champion the use of electronic health information to improve outcomes and reduce costs, the health care industry has faced many hurdles in realizing this vision, including resistance to change, privacy considerations and funding issues. The American Recovery and Reinvestment Act, with its provisions for HIT funding, is revealing a path forward in terms of providing incentive and funding for investment.
The balance of the journey, however, is not without obstacles. For example, the wide variety of electronic health records (EHRs) in use and the presence of many disparate systems in the health care enterprise remain hurdles to the deployment of fully functional EHRs across the clinical enterprise -- crossing practice and provider boundaries. A lack of consistent standards across health records in a number of pertinent areas (e.g., content, terminology, clinical relevancy, interoperability, code sets and clinical practice) also impedes adoption.
How can the industry move beyond these challenges to pave a path forward for more informed and effective care? We offer four strategies to optimize the impact of HIT -- which is essential to successful EBM initiatives -- in the pursuit of more effective and cost-efficient health care.
Modernizing the health care infrastructure
One of most important first steps to widespread HIT adoption and optimization is the standardization of data-sets across care delivery organization (CDO) networks (encompassing hospitals, clinics, public health organizations and more), between CDOs and public and private payers -- and even to medical instrumentation, pharmaceutical manufacturers and regulatory bodies. This process creates the foundation for a grid for sharing information and automating process execution.
We are making progress on this front. Organizations, including the Office of the National Coordinator of Health Information Technology (ONCHIT) and Clinical Data Systems Interoperability (CDSI) are striving to make standards available and building standards-based reference architectures and reference implementations. In addition, standards such as HL7 for medical information in message packet format have been established along with schemas for transformation of legacy records from a vast array of systems and formats into a common XML-based schema and record. The end goal is to enable comprehensive records assembled from disparate information to be consumed and viewed by commercial solutions.
Ensuring security first and always
In order for HIT to be enthusiastically embraced across the health care industry, systems can and must ensure the security and privacy of patient information. Clinical data must be available only to those with the appropriate permissions based on role and need-to-know. The Health Insurance Portability and Accountability Act (HIPAA) provides strict regulations regarding access to medical information, and full compliance with HIPAA requirements is a key component of any health care information system.
Enabling intelligence
As EHR systems are integrated and new ones built to replace legacy environments, information will become more extensive and widely available. Data proliferation, however, can create the same types of challenges as too little information unless the health care community and providers can turn that data into actionable intelligence. Decision support and business intelligence systems are essential to transforming health and associated demographic and financial data into knowledge that drives more informed decisions and effective and efficient care.
The resources required to securely store and manage this vast amount of data is also an important consideration. With trillions of laboratory tests, diagnostic images and prescriptions filled, and millions of pages of patient visit logs written each year in the United States, health care data storage requirements are daunting. This represents just the start of the data necessary to build better decision-making. In addition, metadata on financial transactions; provider and payer details; and temporal, demographic, even spatial information must also be incorporated into an EHR to support EBM, making it a multi-modal dataset which, for a large hospital network or regional health information organization (RHIO), could generate EHR data warehouses in the high petabyte ranges. With the right analytics and health care intelligence tools attached to the EHR data warehouse, health care organizations can reveal new insight unavailable today.
Expanding collaboration
The fourth step required to optimize the use of HIT in health care to improve care and reduce costs is to create avenues for practitioners and patients to collaboratively leverage the grid and their past decisions and experience. This approach would augment the decision- making process by providing a far larger, near-real-time, intelligent evidence base to support a clinician's practice of medicine.
Consumers increasingly turn to the Internet for health care information. However, physician-only social networks, including Sermo, iMedExchange and Osmosis, are just launching. The biggest issue with these social networking sites is that they are not connected to the EHRs and to business intelligence tools that could be used to build hypotheses worth socializing. Furthermore, they do not have any guidelines, training or mandate for use, nor are they embedded in the diagnosis process in a way that a doctor would think to leverage the community as part of standard operating procedure. For EHRs and decision-making tools to be fully applied while at the same time safeguarding patient information, social networking tools must be modified and built on top of RHIOs and other networks that will serve as the basis of EBM platforms.
As our nation enters a new era for health care, HIT will play an essential role in our transformation -- with the potential to guide us toward improved care and cost efficiency. While challenges remain, they are by no means insurmountable as we have the tools required to capture data and crystallize our decisions in support of EBM initiatives and, the ultimate goal, improving health care outcomes and efficiency.