It was too predictable not to happen – proper exchange of data between disparate systems (interoperability), getting patients more involved in their own care (patient engagement) and transferring data into information (analytics) from the time healthcare first embraced using electronic systems. Why are these accomplishments for our healthcare delivery system really so important?
I would entertain, for a minute, to let go of all the detailed, complicated and sophisticated explanations found in the literature and vendor advertising and think logically.
The patient receiving the proper treatment for their condition has always been dependent on the provider having the right information at the right time. The rate-limiting step, however, is the patient’s input. This can take many forms.
Information about the patient’s history as captured by the previous medical provider can be only received by the current provider if there is interoperability between different IT systems and through appropriate standards. It is as of one computer is speaking Chinese and the other Spainish. HL7, CCD/CDAs, X12, 837, UB4 and other nomenclatures help the translation. But, as different vendors provide various translation engines or messaging portals, the end-user (provider) still gets lost in the weeds and, as a system, we still remain unable to fully connect with each other. Furthermore, maybe even more scary, is that fact, due to political differences and ego, we can’t still can’t agree on the one standard to adopt for the particular technology in question.
Information about the patient’s history directly from the patient. If the patient were to tell the provider all of what is needed to be revealed then there needs to be a couple of things that must happen. First, the patient must be totally knowledgeable on his/her own of what exactly the providers need in order to make the proper diagnosis. Of course, the patient is “a patient” because they don’t know all that needs to be revealed, and besides, providers can do a fair of asking leading questions. But, still providers may not be able to extract all the information as they themselves can’t ask about something they don’t know. Patients often will hide embarrassing or painful information.
Motivational interviewing has been helpful but can’t provide a behavior change in patients to have them repeatedly be open with their providers. But, if the patient was engaged -intensely involved in their care, constantly working hard to co-manage their own conditions by taking as much responsibility as possible -that would be so powerful. For example, diabetics insisting on keeping food and exercise diaries to be shared between visits. Mobile phone apps, patient portals and remote patient monitoring devices have been essential towards engagement; however, the emphasis has to be not just the technology but the system-wide training of patients and providers about the behavior change incited by connecting through the technology provided.
Finally, information about the patient and what is going on with them can only be accurate if it represents patient data over time and is analyzed. Tracking BPs, glucose and weight as a trend always helps make the decision easier at the point of care because today’s data can be then compared to a reference point. The other 2 points of focus- interoperability and patient engagement help provide the data for analytics. One functional by-product of Clinical Decision Support (where computers help doctors make decisions at the point of care based on intelligence post-analytics). There are many companies like Optum Health providing sophisticated IT programs providing analytics on many different parameters but the cost is only affordable to larger entities and small practices or hospitals may not be able to benefit. Until more adoption of this technology is possible the whole healthcare system will receive the intelligence for more safer care.
In conclusion, these three trends are talked about so much now because it’s about time. Medical care is based on the patient and the patient’s input must be obtained by a variety of means leveraging technology and the proper training of medical personnel on how to use that technology and change the way they interact with their patients.
