Friday, January 9, 2009

Good Enough? The IOM Report on Technology for Effective Health Care

On January 9, 2009, an Institute of Medicine / National Research Council report (Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions) reviewed use of healthcare information technology at a number of sites including Partners HealthCare, the University of Pittsburgh Medical Center, HCA Tristar, Intermountain Healthcare, the Palo Alto Medical Foundation, the University of California (San Francisco), Vanderbilt University Medical Center, San Francisco General Hospital, and the Veterans Administration.

The report says in part that "the committee observed a number of success stories in the implementation of health care IT. But although seeing these successes was encouraging, they fall far short, even in the aggregate, of what is needed to support the IOM’s vision of quality health care. IT-related activities of health professionals observed by the committee in these institutions were rarely well integrated into clinical practice. Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data. Care providers spent a great deal of time in electronically documenting what they did for patients, but these providers often said that they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care. Health care IT implementation time lines were often measured in decades, and most systems were poorly or incompletely integrated into practice."

"Although the use of health care IT is an integral element of health care in the 21st century, the current focus of the health care IT efforts that the committee observed is not sufficient to drive the kind of change in health care that is truly needed. The nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade. So that the nation can cross the health care IT chasm, the committee advocates re-balancing the portfolio of investments in health care IT to place a greater emphasis on providing cognitive support for health care providers, patients, and family caregivers; observing proven principles for success in designing and implementing IT; and accelerating research related to health care in the computer and social sciences and in health/biomedical informatics."

Link here for more on the "Good Enough" debate in Healthcare Technology.

2 comments:

Bob Coli, MD said...

The leadership change in federal and state government and the billions of dollars now being budgeted to purchase health care IT systems is stimulating the current lively national debate over whether existing systems are really “good enough.”

The new IOM book,“Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions” offers additional confirmation that the existing “information silo” HIT business model cannot offer the valuable combination of user-friendly clinical applications and a "single window" paperless environment with comprehensive data standards, data integration and harmonization and seamless, end-to-end information exchange within and across state borders---at any price.

http://books.nap.edu/catalog.php?record_id=12572

For decades, many physicians have been impatiently waiting for the creation of financial and market incentives that would induce the hundreds of competing suppliers of ambulatory and hospital EHR, PHR and HIE platforms to design or redesign their systems specifically to provide clinicians with what is now only rarely available at any patient care site---an integrative view of patient data, support for data-driven process improvement and work flow-friendly, evidence-based decision support and feedback. In other words, IT business incentives that would be compelling enough to transform the market from one directed by sellers’ proprietary solutions to one driven by buyers’ work flow needs and time constraints.

Until four years ago, when the four cornerstones of value-driven, patient-centered healthcare were first delineated by HHS Secretary Mike Leavitt and ONCHIT Director David Brailer, physician-user complaints of expensive, difficult-to-use,disruptive to implement ambulatory and hospital EHR systems were largely ignored.

However, in 2009, with the toxic combination of fiscal and health care cost, quality and access crises, the need to cross this critical health care IT chasm is great, the benefits are expected to be significant and, in the pursuit of excellent health, ideal care and controlled costs, some things are just the right things to do.

As sagely noted by Donald M. Berwick, MD, President and CEO of the Institute for Healthcare Improvement (IHI), one of the nation's leading authorities on health care quality and improvement issues, “The excellence of the status quo is a sentimental illusion.”

Deborah Leyva said...

Yes, a lively debate is definitely in progress. I read a story on another blog that attributed the lack of "good" patient care to computer malfunctions. To hear/read this was upsetting.

No, that's not a good enough excuse, nor should it be. "Disaster Recovery" or a "Plan B" is an absolute necessity even if it means carrying a cell phone, pad and pencil with you at all times.

In order to gain the purported "benefits and use of "enabling technologies" for improvements in patient care, and induce providers to invest, it may just need an infusion of the $$ kind.

As Bob quoted from Donald Berwick, “The excellence of the status quo is a sentimental illusion.”