To date, the application process for the use of an EHR for healthcare has required the use of the Kaizen Principle for improving its proposed benefits on effectiveness (quality) and efficiency (cost). Nationally, health spending continues to worsen faster than economic growth and our nation's maternal mortality incidence continues to worsen, as it has for more than 40 years. It is likely that the Kaizen Principle has now become the Kaizen Paradox, viz. the electric light bulb was not discovered by the continuous improvement of the candle. In short, the emphasis on the scientific, technical mandate for healthcare needs realignment with its humanitarian, trustworthy mandate. To begin, if a person has been exposed to influenza and has a chronic disease, he should immediately call his Primary Physician. The phone is answered by a person with only a high school degree. This medical assistant writes a note and adds it to a thick pile for the physician. Realize, the patient needs to start a preventive flu medication within a few hours. If the phone had been answered by a registered nurse with an officed based protocol for managing the patient's needs, she (or he) could have arranged with the patient to call the prescription since she already knew of his chronic illness status. The reverse causality between trust and self-reported health has already been demonstrated. The trustworthy character of Primary Healthcare begins with its medical triage process, 24/7. So far, none of the studies on Primary Healthcare and its cost or quality have specified the underlying medical triage capabilities offered by the involved Primary Healthcare clinics. To fully implement our nation's EHR capabilities, we must first ensure the high-quality Primary Healthcare is equitably available to each person in every community. Eleanor Roosevelt said it best: "It's better for everybody when it gets better for everybody." Think about it!
Submitted by
Paul J. Nelson, md
on Tuesday, January 28th, 2020 at 21:39 pm
I read with interest the recent posts from Niall Brennan and Melinda Buntin discussing the complex nature of our digital health ecosystem. They highlight the truism that I’ve experienced first-hand as Chief Innovation Officer, Medicine at Mount Sinai: the typical siloes of health care don’t work for digital health. There’s too much overlap between research, policy, patient views, and the tech industry for anything to get done unless we work together.
And of course that’s not easy. As Melinda noted these folks don’t even approach problem solving the same way, let alone use the same lingo and tools. That said, I think we can all take heart at the progress made over even the past two to three years. Next month I’m joining a meeting that will draw the research, policy, patient, and the tech worlds together. This co-located meeting of the Health Datapalooza and the National Health Policy Conference reflects the progress we’ve made and emphasizes the diversity of expertise we need to take the next step in digital health.
Past Progress Was Hard Fought and Full of Lessons
As Niall pointed out, our questions are now less about access to data and tech and more about data governance and the use of health data can make tangible changes in care delivery, value, and outcomes. But getting to this point was a hard fought path forged by a multitude of different stakeholders.
We wouldn’t be where we are today without the efforts of data liberators who saw the need to accelerate the pace and multiply the volume of data available to innovators in order to foster the creation of products and services to improve health and health care. And these folks were from all walks of life: journalists, researchers, policymakers and, even, humanitarian aid workers. So that’s lesson number one from the past: Progress requires the effort and expertise from every corner of the health care ecosystem.
One corner of that ecosystem has been particularly productive in the past few years is the tech industry. The advances we’ve seen in technological capabilities have made it possible to collect, organize, store, and analyze data faster and at a volume we couldn’t have even imagined in years past. Cloud computing, artificial intelligence, and self-service business intelligence tools are making it possible to get actionable insights from data across all aspects of health care. Progress has required investments in technology and careful consideration of how to implement in a way that’s safe and fair.
Past Progress Sets a Course for the Future
While we celebrate the progress, I am watching several trends on the horizon that we’ll be wise to approach with the successful attitudes of the past and leave the unsuccessful ones behind.
First, we are beginning to see a way to leverage new data – data beyond the electronic health record (EHR) that has the potential to surpass traditional data in terms of meaningfulness. Things like patient-and device generated data, for example. At NODE.Health, a network I founded in 2016 of societies, organizations, and innovators dedicated to digital transformation in health, our members are pushing the envelope in this area and finding ways to leverage patient-generated data. For example, we are supporting a consortium of multiple health systems to integrate app generated data for IBD patients into clinical care. Through our partnership with national societies, we are enabling remote patient monitoring, which would not have been widely adopted without the hard work of policy makers who proposed a shift in the payment system. Physician practices can now, for the first time, bill their time to looking into data generated by patients.
The most exciting thing about non-traditional data is that it is not only diverse, multi-dimensional and longitudinal with low cost of acquisition from home or work, but that it is far better predictor of patient’s health status at a given time unlike limited snapshots of health we get from EHR or claims data. Furthermore, it can be owned by patient and with proper consent, shared with multiple stakeholders. And while that can make things complicated, it also can serve as a push to collaborate. NIH All of Us research program and Apple Heart Study are good examples of how this can be done successfully.
I know there’s even more innovation happening across country so I can’t wait to see what’s presented at next month’s meeting. I hope you’ll join us!