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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7 Perspectives on Innovation
7 Perspectives on Innovation
Pages 185-196
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From page 185... ...
The papers point to the need for novel approaches to the aggregation of health data to improve population health, offer observations on challenges and opportunities given the current state of HIT, and provide perspective on the opportunities afforded by the vast quantities of health and health-related information collected by individuals and available on the web. Drawing from the assertion that population health is more than the aggregation of individual disease and, therefore, an understanding that population health cannot simply be gleaned by aggregating patient care data, Population and Public Health Information Services' Daniel Friedman advocates for the creation of a U.S.
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From page 186... ...
Looking to the future, Mr. Leibhold notes the need for methods to curate web-based health information, for interoperable health app stores, and for the development of a web of linked, open healthcare information and knowledge interoperability.
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With so many different websites, datasets are often duplicative, resulting in different definitions for statistical measures or different definitions for the same variables. The Population Health Record These burdens could all be solved -- not to mention the current benefits enhanced -- if there was a single easily accessible source with an overarching data model and theoretical framework.
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Information Model and Content A logical and agreed upon information model will also be necessary for achieving a PopHR. As opposed to an individualized population health records system absent standards, adopting a standardized and agreed upon information model will reduce the burden of overlapping and inconsis FIGURE 7-1 Influences on population health.
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From page 189... ...
A good example of such a model is the Australian Institute for Health and Welfare National Data Model and its more recent metadata directory called Meteor.1 Itnew.eps Figure 7-2 is also important to consider infor redrawn as vector from original cited source mation content. The PopHR would need to include information on health, and the determinants ofis outline rather than real type NB: type health, from existing data sources such as ongoing population surveys; public health surveillance systems; environmental sampling; Medicare claims; and population census.
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From page 190... ...
In response to a user query of the PopHR, the PopHR system would retrieve information from either the PopHR with precalculated measures (a standard PopHR information retrieval) , or one or more primary or intermediate datasets (an "on the fly" PopHR information retrieval)
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From page 191... ...
Innovation in decision support will need to move through three stages: avoiding bad decisions caused by faulty or nonexistent data, integrating streams of data to provide optimally accurate and specific data, and supporting better decisions with clinical guidance. Many organizations are actively involved in work on all of these stages, with considerable progress being made on the first.
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Remote Models of Care The third challenge facing health care is the reconfiguration of the health delivery system toward integrated care models (such as accountable care organizations) as a result of ACA.
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Capturing Personal Health Data Discussions on the digital infrastructure for a learning health system tend to focus on clinical information ecologies and the notion of standardized and interoperable electronic health records (EHRs)
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, a simple grammar for describing relationships in terms of the subject, predicate, and object. RDF is also the basis for almost all semantic web applications used for health information exchange.
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From page 195... ...
Institute for the Future In this new climate there are several major contact points that need to be kept in mind: the relationship of our personal health information and the public health commons, the relationship of our personal information and contextual health information, the relationship of our clinical information and contextual health, and the relationship of the scientific evidence base with the clinical information. All of these pairs of relationships have to be explored as a coherent system, and at the Institute for the Future we are looking at what can be achieved with massive computing capability and an abundance of rich data.3 The examples discussed above are the types of technologies our teams have been working with -- most recently in a project called Healthcare 2020 -- to develop tools for precise clinical health information and adaptive health coaching.
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From page 196... ...
2009. Bandit solutions provide unified ethical models for randomized clinical trials and comparative effectiveness research.
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