I was recently introduced to Dr. Stephen Beller and Mr. Sabatini Monatesi’s work at the WellnessWiki. I really liked what they were doing there so I asked them to write up an article on “The Healthcare IT Gap” to help us get their perspective on why existing HIT systems may not be enough to automate and improve healthcare. Steve is a licensed clinical psychologist with heavy expertise in software and has been working in the health informatics field since 1981. Over the next 25 years, Steve and his associates worked to create a universal lifetime electronic patient records system integrated with evidence-based clinical pathways/guidelines tools, as well as outcome data collection, analytics and reporting capabilities. Sabatini runs an independent consulting business focusing on change & project management, system integration, and IT training. Together they are attempting to use off the shelf and custom developed solutions to fill the healthcare IT gap and I encourage you to visit their site.
Is Your HIT System Giving You What You Need?
There is a huge gap between “what HIT needs to be” and “what HIT is now.” Only by closing this gap can an HIT system deliver what the healthcare industry needs today.
What HIT Needs to Be
As the USA struggles to deal with the healthcare crisis, mandates for change — such as the National Health Information Infrastructure (NHII) initiative — focus on the use of HIT to help increase healthcare effectiveness and safety, and reduce errors and costs, by:
- Deploying decision support tools with guidelines and research results
- Fostering collaboration and accelerating diffusion of knowledge
- Improving use of resources
- Increasing workflow efficiencies
- Reducing variability in care quality and access
- Advancing the consumer role
- Strengthening privacy and data protection
- Promoting public health and preparedness.
Achieving these objectives requires changes in healthcare policies and practices, as well as interoperable HIT that:
- Helps people know the safest and most cost-effective ways to care for each patient and deliver that care in a coordinated manner across the entire healthcare continuum with minimal error and omissions (see Consumer-Centered Care).
- Helps people understand each patient’s health problems and needs in fine, clear detail, to support accurate diagnostic and treatment prescription decisions (see Personalized Care).
- Helps people create and use evidence-based practice guidelines.
- Helps people know how to prevent illness and promote wellness for each person, and deliver such wellness/prevention programs.
- Promotes consumer/patient participation through increased knowledge and decision-support, which benefits them by increasing their ability to select the right providers and health plans, prevent illness/complications/accidents by focusing on self-care and wellness, and reduce complications of chronic disease by complying with plans of care.
- Promotes provider participation through increased knowledge, decision-support, and workflow efficiencies, which benefits them by increasing their ability to deliver more cost-effective treatment and increase patient safety (reduced errors and omissions).
- Promotes payer participation through increased knowledge, decision-support, and workflow efficiencies, which benefits them by increasing their ability to contain costs and take advantage of new business opportunities.
- Promotes purchaser participation through delivery of more cost-effective care to employees, which benefits them by reducing healthcare expenditures, absences, and turnover, as well as improvements on-the-job productivity.
- Enables collaborative networks to improve healthcare quality by helping them;
- Perform clinical research in the field and lab through streamlined collection, sharing, and analysis of large quantities of diverse clinical outcomes data
- Build evolving health science knowledge bases based on the clinical research and transform this knowledge into evidence-based practice guidelines
- Disseminate, implement, and evolve the guidelines
- Communicate easily and efficiently to share observations and lessons learned, handle disputes, and help run collaborative organizations.
- Protects populations by offering an efficient and effective way to obtain, transmit, and analyze biosurveillance and post-market surveillance data and by assisting first responders in the event of a wide-spread emergency (e.g., bioterrorism, epidemic).
- Helps utilize resources more efficiently.
- Helps people transfer data and information in a shared environment.
- Helps people use scaleable, integrated software applications.
What HIT is Now
Efforts these days focus on the most basic functional level of HIT, i.e., the development of interoperable architectures and the use of applications for inputting, validating, storing, securing, and exchanging basic patient data. Current HIT also offers some decision-support through reminders (e.g., of follow-up appointments, inoculations, etc.) and alerts via medication prescription checks, and streamline certain workflows. All this is a necessary first step, but it is grossly insufficient.
Defining the HIT Gap
The HIT gap is a result of not making six essential needs a top priority; that is, current HIT does not adequately focus on:
- Bridging the knowledge void — using comprehensive, detailed knowledge of each person and the scientific research to (a) make the best possible treatment decisions within a personalized care framework, (b) deliver that care efficiently and effectively, and (c) enable all consumers to be informed participants in the healthcare decision process and in promoting their own health.
- Managing care execution — Helping providers execute their plans of care.
- Coordinating care — Coordinating care across multiple providers in the healthcare continuum, so such tools are needed.
- Protecting public health — Implementing processes for ongoing biosurveillance, post-market surveillance, and first-responder assistance in case of emergencies, so such tools are needed.
- Enabling complete connectivity — Enabling all stakeholders — patients, providers (including RHIOs, facilities, and individuals across all healthcare specialties/disciplines), purchasers, and payors — to compile and share all the data they need for which they are authorized.
- Managing extensive data sets — Fostering the fluid access, exchange, analysis and reporting of an enormous diversity of healthcare data sets, including a wide range of physiological (medical and non-medical) and psychosocial data, across patients’ entire lifetimes, about (a) people’s disease/dysfunction-specific symptoms and functioning levels; (b) treatment-specific process, clinical outcomes, and practice guideline variance data; (c) genetic data; and (d) expense/financial/utilization data.
Filling the HIT Gap
For a description of an HIT system blueprint developed by the authors, which satisfies many unmet HIT needs, see the Filling the HIT Gap page. It’s got some practical ideas that you can implement quickly.