Toward A Meaningful Definition Of Meaningful Purpose (Part Ane Of 2)
The federal government's $20 billion stimulus programs for wellness IT (HIT) is on its way. Called HITECH—for Health Information Technology for Economic too Clinical Health Act—it volition fund the evolution of innovative HIT too utilisation a "carrot & stick" fiscal approach to encourage clinicians to utilisation HIT inward meaningful ways. H5N1 fighting straight off raging is how to define "meaningful use."[1]
A Definition
Meaningful use, to me, agency using HIT inward ways that are of groovy value to the patient too other healthcare consumers. It doesn't affair what types of software tools are used, what communication infrastructure is used, what standards are used, or what certifications are used. It exactly agency that the using HIT should final result inward e'er to a greater extent than effective too efficient (i.e., e'er greater value) aid delivery.
Increasing aid value is unlikely unless clinicians obtain information too guidance assisting them inward answering hard questions, making tough diagnostic too handling decisions, collaborating effectively, too taking competent action. In addition, healthcare consumers (patients, clients, customers, etc.) would create goodness from assistance inward selecting the most cost-effective handling options for existing conditions, too inward managing their ain wellness inward ways that foreclose illness, command chronic conditions, too growth their well-being.
Such assistance is crucial because the unaided human hear but cannot handgrip the overwhelming details too complexity of many wellness problems. Consider the next department I wrote at Dr. Larry Weed too others:
The book of clinical information expands exponentially amongst to a greater extent than than 150,000 medical articles published each calendar month inward to a greater extent than than 20,000 biomedical journals. Healthcare providers struggle to remain electrical flow amongst the clinical information, but inevitably croak overloaded. This may contribute to the tiresome adoption of evidence-based enquiry inward clinical practice. There is exactly also much clinical information beingness generated for providers to comprise into their internal base of operations of knowledge.
As a group, healthcare providers aid most patients too convey pride inward doing an splendid chore inward caring for their well-being. Nevertheless, the "…task of knowing every item is way beyond the [ability of] human mind… For example…diabetes aid ought to convey into occupation organisation human relationship whatever of 120 administration options too 380 possible patient weather associated amongst the disease. …the unaided hear cannot reliably retrieve all the causes or administration options that should hold out considered for each patient, nor tin strength out it retrieve all the findings inward the patient needed to discriminate amid those options, nor tin strength out it reliably fit findings to options nether the fourth dimension constraints of practice."
In addition, "…most physicians are able to convey into occupation organisation human relationship exclusively a part of the diagnostic too administration options potentially relevant to their patients too exclusively a fraction of the evidence needed for choosing amid those options. …Physicians create petty improve amongst the commons aids to medical determination making, such every bit exercise guidelines too utilisation of Internet resources. Those aids render full general knowledge, but create non ensure that the physician volition retrieve all the information or successfully link it amongst a special patient's specific problem." Problems that cross specialty boundaries too require multiple specialists, even therefore the electrical flow healthcare organisation does a pathetic chore at supporting communication betwixt providers too assuring continuity of care. And main aid physicians are non equipped amongst the information tools necessary to deal amongst the information overload, nor create they possess got a organisation for coordinated aid inside which to function.
"Because physician fourth dimension is expensive too scarce, their initial workups tin strength out hold out meager [as they] …act according to their ain preconceived notions most what history, physical, too laboratory findings are worth checking. Equally idiosyncratic are the conclusions they depict from whatever information they select. Both alternative too analysis of information are influenced heavily past times their medical education, prior clinical experience, specialty orientation, contradictory clinical guidelines, fiscal concerns, cultural background, personal biases, too day-to-day fourth dimension constraints, all of which vary enormously amid private practitioners."With this inward mind, reckon the recent written report past times the National Research Council of the National Academies, which concluded that a serious gap inward wellness IT (HIT) today is the failure to deliver patient-centered cognitive back upwards (also called consumer-centered cognitive support). According to the report:
During the committee's discussions, patient-centered cognitive back upwards emerged every bit an overarching grand enquiry challenge to focus health-related efforts of the reckoner scientific discipline enquiry community, which tin strength out play an of import role inward helping to cross the wellness aid IT chasm...Today, clinicians pass a groovy bargain of fourth dimension too unloose energy searching too sifting through raw information most patients too trying to integrate the information amongst their full general medical cognition to degree relevant mental abstractions too associations relevant to the patient's situation…The wellness aid IT systems of today tend non to render assistance amongst this sifting task…[We need] computer-based tools [that] examine raw information relevant to a specific patient too suggest their clinical implications given the context of the models too abstractions. Computers tin strength out too therefore render determination support—that is, tools that aid clinicians create upwards one's hear on a course of study of activity inward response to an agreement of the patient's status. At whatever time, clinicians possess got the mightiness to access the raw information every bit needed if they wishing to explore the presented interpretations too abstractions inward greater depth…The determination back upwards systems would explicitly comprise patient utilities, values, too resources constraints…They would back upwards holistic plans too would permit users to imitate interventions on the virtual patient earlier doing them for real.[2]It's logical to conclude from the information inward a higher house that patient-centered cognitive back upwards is the variety of value-enhancing assistance needed, but largely missing from, today's HIT.
Thus, "meaningful utilisation of HIT" tin strength out hold out translated into "using HIT to growth aid value (efficiency too effectiveness) past times providing ever-better patient-centered cognitive support."
The HIT Gap too How to Fill it
Is it reasonable to await the healthcare manufacture to fill upwards the patient-centered cognitive back upwards gap? According to a recent written report past times the Congressional Budget Office titled, Evidence on the Costs too Benefits of Health Information Technology,[3] HIT systems possess got the potential to render such cognitive back upwards by, for example, reminding physicians to schedule tests, helping them diagnose complicated conditions, assisting them inward implementing appropriate handling protocols, too promoting enquiry focused on developing too evolving evidence-based guidelines.
A Different definition from HIMSS
While I proposed a path of radical HIT innovation, the Healthcare Information too Management Systems Society (HIMSS) Board of Directors of late proposed a to a greater extent than conventional path, which includes these 7 HIT requirements:
- EHR certification past times the Certification Commission for Healthcare Information Technology (CCHIT)
- Standardized patient information conforming to the Healthcare Information Technology Standards Panel's (HITSP)
- Interoperability specifications based on the Integrating the Healthcare Enterprise's (IHE) frameworks
- Use of an EHR including CPOE (computerized practitioner gild entry) functionality
- Electronic telephone substitution of patient summary information every bit specified inward the Continuity of Care Document (CCD) standard
- Support for a subset of existing National Quality Forum-endorsed procedure too aid measurement
- Use of clinical determination back upwards (CDS) systems providing clinicians amongst clinical cognition too intelligently-filtered patient information to heighten patient care.[4]
Item #1 refers to an expensive certification procedure that stifles radical innovation past times forcing out small-scale HIT companies, including opened upwards origin developers. I tin strength out come across the create goodness of testing HIT vendors production to come across how skillful they piece of work (like Consumer Reports does amongst cars too appliances), but vendors shouldn't possess got to pay for it (Consumer Reports doesn't brand the manufacturers pay). Instead, a authorities agency (FDA?) could in all likelihood create it. Furthermore, the certification procedure to which HIMSS refers has zilch to create amongst patient-centered cognitive support.
Items #2 & 3, which scream to information too technology standards, introduce a double-edged sword for reasons I verbalize over inward a serial of posts starting at /search?q=art-of-health-knowledge-creation-use. Rather than limiting HIT developers to a specific ready of global standards, it would hold out improve to permit them to utilisation local information standards too whatever technology standards, every bit long every bit their tool tin strength out telephone substitution required information amongst tools other vendors develop. That's because well-designed innovative HIT tools should hold out able to render patient-centered cognitive back upwards without the constraints of special information too technology standards.
Items #4 & five scream to special types of HIT, which I conduct maintain are important. The employment amongst making exiting EHRs, CPOEs, too CCDs a requirement for "meaningful use" is (a) the electrical flow crop of HIT provides little, if any, patient-centered cognitive back upwards too (b) this constraint may hamper innovation past times impeding the excogitation of alternate types of HIT able to render superior cognitive support.
Conclusion
HIT is used meaningfully if it focuses on increasing aid value (efficiency too effectiveness) to patients too other healthcare consumers past times providing ever-better cognitive support. The smart path to meaningful HIT utilisation is 1 that promotes the kinds of radical innovation that enable widespread collaboration too the application of skillful scientific discipline focused on providing continually evolving patient-centered cognitive support. Following this path agency (a) accepting that the unaided human mind, no affair how competent, but cannot handgrip the incredible amount of complex information that must hold out processed to brand wise decisions inward hard situations, (b) doing to a greater extent than to link scientific enquiry too clinical practice, too (c) encouraging really creative HIT solutions.
The give-and-take is continued at this link.
References:
[1] http://www.lexuniversal.com/en/news/7764
[2] Stead, W.W. too Lin, H.S. (Eds.) (2009). Computational Technology for Effective Health Care: Immediate Steps too Strategic Directions. Committee on Engaging the Computer Science Research Community inward Health Care Informatics; National Research Council from http://www.nlm.nih.gov/pubs/reports/comptech_prepub.pdf
[3] Congressional Budget Office. (2008, May).
Evidence on the Costs too Benefits of Health Information Technology. Retrieved from http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf
[4] http://www.himss.org/ASP/ContentRedirector.asp?ContentID=69148&type=HIMSSNewsItem