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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10 Accelerating Progress
10 Accelerating Progress
Pages 239-250
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From page 239... ...
These activities represent participants' views on the necessary next steps to accelerate progress in four domains: stakeholder engagement, technical progress, infrastructure use, and governance. When discussing necessary follow-up activities, participants continually referenced the potential held by the next stages of the meaningful use guidelines for growing the digital health infrastructure.
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From page 240... ...
240 DIGITAL INFRASTRUCTURE FOR THE LEARNING HEALTH SYSTEM BOX 10-1 Priority Action Targets Discussed Stakeholder Engagement The case: Analyses to assess the potential returns on health and economic dimensions Involvement: Initiative on citizens, patients, and clinicians as active learning stakeholders Technical Progress Functionality standards: Consensus on standards for core functionalities -- care, quality, public health, and research Interoperability: Stakeholder vehicle to accelerate exchange and interoper ability specifications ULS system test bed: Identify opportunities, implications, and test beds for ULS system approach Technical acceleration: Collaborative vehicle for computational scientists and HIT community Infrastructure Use Quality measures: Consensus on embedded outcome-focused quality measures Clinical research: Cooperative network to advance distributed research ca pacity and core measures Identity resolution: Consortium to address patient identification across the system Governance Governance and coordination: Determination and implementation of govern ing principles, priorities, system specifications, and cooperative strategies
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From page 241... ...
Additionally, to attend to concerns around privacy, security, trust, and additional work burden, participants stressed the importance of honesty and transparency in facilitating support and understanding. Ultimately, discussions noted that demonstrating the value of a digital health infrastructure through the use of case studies that point to improved outcomes and efficiency was likely the most compelling strategy to appeal to stakeholders.
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From page 242... ...
, query and analyze distributed repositories of data for research purposes, ensure care decision support, and enable quality improvement initiatives and public health surveillance and reporting. Discussions also touched on the need for the digital infrastructure to interface with next-generation systems including mobile health applications and the way in which these and other capacities could help engage patients and the public through improved information access.
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From page 243... ...
It was stated several times that in order to support the quality improvement and research activities required for a learning system, consensus around useful outcome-based measures is needed. Participants suggested that this would motivate vendors and users to incorporate these measures into their systems, driving seamless integration of quality measurement and reporting into the digital infrastructure.
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From page 244... ...
This poses a problem for issues around care coordination, including the goal of being able to make care decisions based on comprehensive health information, as well as the development of a useful knowledge generation engine that can incorporate all relevant information and deliver useful, accurate support. Privacy and system security are paramount, but participants noted that approaches are available to address these issues responsibly and the barrier appears to be one of cultural hesitancy rather than a lack of technical capability.
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From page 245... ...
In order to further the utility of EHRs in clinical research and population health, participants suggested core data elements for EHRs and seamless access to information from immunization registries. Reflecting the extensive discussion on the opportunity for using the digital infrastructure to better engage patients in their health care, participants suggested the addition of lay-interpretable language for patient-accessible
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From page 246... ...
Stage 2: 2013-2014 Stage 2 of meaningful use is under development by the Health Information Technology (HIT) Policy Committee, including consideration of further focus on advanced clinical processes such as: clinical decision support, disease manage ment, patient access to health information, quality measurement, research, public health, and interoperability across information technology (IT)
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From page 247... ...
Opportunities to build on the foundation laid by the HITECH requirements for work on standards, requirements, and certification criterion in meaningful use of EHRs include cooperation with other federal agencies in the development of a strategic plan for national HIT efforts; establishment of a governance mechanism for the Nationwide Health Information Network; accelerating, in cooperation with the National Institute for Standards and Technology, work on standards for exchange and interoperability; and work with the Federal Communications Commission, FDA, and CMS to identify standards and reconcile regulations to facilitate wireless transmission of medical information. Participants noted that, as the HITECH funds are used,
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From page 248... ...
This work would have the potential to transform the functionality and capacity of the digital health infrastructure, as well as to shepherd the establishment of collaborative vehicles for the ongoing partnerships between the HIT and computational science communities. Similarly, it was noted that progress in the quality and knowledge generation dimensions of the digital platform will require leadership from federal health agencies.
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From page 249... ...
Similarly emphasized was the need to cultivate strong counterpart capacity outside of government to partner in coordination and governance responsibilities. State and Local Government Leadership Given the regional emphasis of many of the ongoing efforts related to the digital learning health system -- such as the establishment of regional health information exchanges -- state and local governments and health departments have experience establishing governance structures and developing programs for engaging local stakeholders.
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From page 250... ...
As the stewards of the largest stores of clinical and transactional information outside of the federal government, insurers, payers, and product developers have an essential role to play in development of the digital infrastructure. Their use of transactional health data to assess utilization patterns, effectiveness, and efficiency is a foundational block on which strategies for broader knowledge generation can build.
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