Modern’s Medicine’s Joseph Conn wrote a two part set of interesting articles last week.
The first covered a review of a new report on Health IT developed by the Human Services Department of the US Government.
Posted: January 22, 2009 - 5:59 am EDT
There is too much good stuff in the recently released report, “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions,” to do it all justice in just one Health IT Strategist-length article, evidenced by an interview with one report co-editor, William Stead.
On a call for an interview that was scheduled for 15 minutes, we spoke for an hour and still didn’t cover everything. So we’ll be doing a two-part series based on the 138-page report and the discussion with Stead prompted by it.
Stead, a physician who is associate vice chancellor for strategy/transformation and the chief information officer of the Vanderbilt University Medical Center in Nashville, worked with Herbert Lin as co-editors of the report, prepared by the Committee on Engaging the Computer Science Research Community in Health Care Informatics, a committee of the Computer Science and Telecommunications Board of the National Research Council of the National Academies.
The report was funded by HHS, the National Science Foundation, Vanderbilt University, 10-hospital Partners HealthCare System, Boston, the Robert Wood Johnson Foundation and the Commonwealth Fund. Stead is a member of the Computer Science and Telecommunications Board and Lin is its chief scientist. Corporate members of the board include representatives from Google, IBM Corp., Microsoft Corp. and Yahoo! Research.
The study had two goals: to identify how computer usage might be applied more effectively to healthcare, and how the limitations of current technologies and approaches might be overcome through additional research and development. The study group focused on the information technology usage of major healthcare organizations, which its authors conceded is a limitation, noting “the majority of healthcare is delivered in small-practice settings (of two to five physicians) that lack significant organizational support.” (Actually, about 37% of office-based physicians are in solo practice, according to National Center for Health Statistics survey data.) Still, the authors say they hoped their efforts “would lay the groundwork for future efforts” of exploring unanswered questions raised by this study.
The study group visited eight hospital organizations deemed leaders in the use of health IT, including government, not-for-profit and for-profit organizations where “many of the important innovations” in IT would be found. They were the Palo Alto (Calif.) Medical Foundation; the 642-bed UCSF Medical Center, San Francisco; 18-hospital Intermountain Healthcare, Salt Lake City; 12-hospital Partners HealthCare System, Boston; 833-bed Vanderbilt University Medical Center, Nashville; TriStar Health System, Nashville; 291-bed Veterans Affairs Medical Center, Washington; and 12-hospital UPMC, Pittsburgh. In addition to site visits, the committee also leaned heavily on previous work by the Institute of Medicine, particularly its 2001 report, Crossing the Quality Chasm, as well as a review of other literature and the committee members’ own experience.
The report included several recommendations to the federal government along these lines, including the following:
- Any government incentives should be for clinical performance, not IT acquisition per se. These incentives should reward one-foot-at-a-time improvements in quality of care using an iterative process of software and system development.
- The government should encourage the development of performance standards and measures for decision support.
- It also should encourage interdisciplinary research into the design of healthcare systems processes and workflow, “computable knowledge structures and models for medicine” and “human-computer interaction” in a clinical setting.
- And the government should at the least not impede, but at best, encourage the aggregation of healthcare data, processes and outcomes “subject to appropriate protection of privacy and confidentiality.”
The full article is found here:
The second explores some simple and practical steps that can be taken to improve the current US situation
Posted: January 23, 2009 - 5:59 am EDT
Since almost everyone these days is giving advice to the Obama administration, I asked William Stead, co-editor of the report, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, what advice he would give to the new president, who mentioned healthcare reform in his inaugural address and who has proposed billions of dollars of federal spending on health information technology.
One draft of a stimulus bill made public last week by the influential House Ways and Means Committee includes $2 billion for HHS’ Office of the National Coordinator for IT grant-making, so rather than make recommendations to President Barack Obama, Stead directed his recommendations to Congress and to Robert Kolodner, the physician who at this writing remains the holdover head of the ONC.
Stead, a physician who is associate vice chancellor for strategy/transformation and the chief information officer of Vanderbilt University Medical Center in Nashville, volunteered that he served on the congressionally mandated Commission on Systemic Interoperability of heath IT, which served up several slickly bound reports in 2005 that have been scarcely heard of since. Asked if the previous administration erred in pressing for interoperability in its healthcare IT promotional activities, Stead bluntly indicated yes, in macrocosm, but no, in microcosm.
The suggested steps are here:
At the core of all this discussion are two central and important points in my view. First we already have the technology available to address many of the problems we face in Australia. The trick is to re-engineer and re-design the way healthcare is delivered and then provide the technology to optimise the way the new models work – not the other way around (develop software and force health system to use the technology).
The second major point is to move incrementally, driven by improvements in clinical, administrative and patient outcomes, rather than being driven by short term savings etc. That way the money that is invested will be spent where it does the most real good.
Both articles are worth a close read.