Digital Infrastructure for the Learning Health System The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary (2011) / Chapter Skim
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4 Engaging Patient and Population Needs
4 Engaging Patient and Population Needs
Pages 125-148
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From page 125... ...
Mark McClellan from the Brookings Institution details the essential components of a digital infrastructure that can more closely align quality measurement and improvement in order to achieve high-value health care. He notes that patient-centered measures, repurposing data already being used to coordinate care for performance measurement, and alignment of these processes with other reform efforts -- namely, value incentives -- will be necessary to improve care and lower costs.
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From page 126... ...
Chang points to the lack of common nomenclature, data formats, and protocols for incorporating patient-generated information as barriers to aggregating and translating health data into useful decision support. Pointing to Kaiser Permanente and the Veterans Health Administration as examples of institutions that have successfully used electronic health records (EHRs)
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From page 127... ...
The essential features of the data collection infrastructure are implementing technically sound strategies to obtain patient-centered measures, utilizing electronic data that are already being used to coordinate care for performance measurement, and ensuring that this process is consistent with the implementation of other related reform efforts. The overarching goal for an improved data collection infrastructure is to be able to measure performance with the same data being collected during the routine delivery of care.
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From page 128... ...
Data they provide on their experience of care and their demographic backgrounds will help us improve patient satisfaction and track and reduce healthcare disparities. Additionally, patient Electronic Feedback: Data Exchange data exchange, patient lists, decision support, alerts, etc.
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From page 129... ...
. Better Diabetes Care at Lower Cost Diabetes, one of the leading chronic diseases in the nation, highlights many ways in which improvements in electronic data exchange can enhance care and reduce costs (Figure 4-3)
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From page 130... ...
Accountable Care Organizations Many of the lessons learned from how to utilize existing data to improve quality and reduce costs are being applied on launching performance measurement programs for five pilot accountable care organizations (ACOs) supported by the Brookings-Dartmouth Learning Network for Accountable Care Organizations.
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From page 131... ...
Finally, the use of incentives will contribute to quality improvement efforts such as e-prescribing and HIT payments, quality reporting payments, shared savings, and other performance-based payments. Using Pilot Programs to Improve Quality Reporting Pilot programs, such as those funded by the Office of the National Coordinator (ONC)
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From page 132... ...
Intermediate Phase -- Limited Clinical and Survey Measures ACOs use specific clinical data (e.g., electronic laboratory results) and limited survey data ACO Impact Quality Improvement Measure Care effectiveness/ Immunization rates for children and adolescents population health Patients with diabetes whose blood sugar (A1c)
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From page 133... ...
The overarching goal of such efforts is to assemble the electronic infrastructure with currently available data sources, while promoting pilot programs to improve methods. n ctio olle C Data and ent rem IT su of H Mea Use ful ning Increasingly tion Mea rega sophisticated, gg nd A patient-centered na atio ards tegr information about tand In Data yS quality, costs, and bilit ra s rope tem care experience Sys Inte HIT nd ical IT a Clin H nic tro Elec of ility ilab Ava 2009 2010 2011 2012 2013 FIGURE 4-4 All aspects of quality igure 4-4.eps work in concert to improve F improvement must care.
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From page 134... ...
Emerging patient-oriented health information technologies will transform the research enterprise, helping to establish a learning health system. Following are four near-term predictions all informed by our experiences in developing, evaluating, and diffusing the Indivo personally controlled health record (PCHR)
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From page 135... ...
That time has been slow to arrive. Studies have shown that, even now, very few outpatient or inpatient settings have a complete electronic health record (EHR)
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From page 136... ...
The Health Information Technology for Economic and Clinical Health Act provides that for covered entities using or maintaining an EHR, "the individual shall have a right to obtain from such covered entity a copy of such information in an electronic format." By 2013, this feature of EHRs will be required under the final rule for "meaningful use" of certified EHR technology. In preparation, early-stage efforts have arisen to promote this data liquidity, including the very well marketed "Blue Button" initiative (Chopra et al., 2010)
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From page 137... ...
The for-profit online social networking community PatientsLikeMe has demonstrated that individuals with a severe chronic disease are highly willing -- even without compensation -- to contribute data and observations to a patient community in order to accelerate learning about their disease (Frost and Massagli, 2008)
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From page 138... ...
Leveraging Patient Health Data As the most powerful actors in care, actively engaging patients in the management of their chronic conditions is going to be vital to any system 3 See www.geneparnership.org (accessed February 24, 2011)
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From page 139... ...
While we progress toward the paradigm of engaging patients in the management of their own electronic health data, an important stepping stone is the clear understanding that data within the record belong to the patient and not to either the provider or the institution (Ralston et al., 2010; Walker et al., 2009)
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From page 140... ...
That is, the review and use of EHR data for clinical management play a significant role in providing validated data for research purposes. Challenges and Next Steps Small physician offices not affiliated with a large system have, to date, had less opportunity to receive rapid-cycle quality improvement feedback and participate in clinical research.
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From page 141... ...
Our • expanding Health Insurance Portability and Accountability Act privacy framework is a start, but a clearer continuum for data use -- quality improvement, system improvement, clinical effective ness, and health services research -- is needed. There is a blurring of the lines between real-time data feedback, measuring to improve care processes, and improving clinical outcomes when EHR data can be used to meet all these needs.
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From page 142... ...
In a similar fashion, treating disease at the bedside and addressing healthcare disparities in the population will require an integrating health and social care systems with a focus on clinical, behavioral, and environmental determinants of health. Demographic Trends and Challenges Several national trends suggest the pressing need for this type of integrated approach to population health and health disparities.
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From page 143... ...
As such, advances in health information technology (HIT) , electronic health records (EHRs)
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From page 144... ...
With the evolution of EHRs, personal health records, consumer health informatics, and social media, we are entering an era when this synthesis and analysis are possible at the bedside in real-time. In the future, working from this integrative perspective, we may find that understanding single etiologies or factors (bacteria, viruses, poverty, race, ethnicity)
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From page 145... ...
2006. Chronic disease in California: Facts and figures.
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From page 146... ...
2009. Use of electronic health records in U.S.
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From page 147... ...
2010. Sharing medical data for health research: The early personal health record experience.
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