Medical Practice and Healthcare Delivery Issues
Mark Luczak 270005TAGV email@example.com | | Tags:  chart hcls industry healthcare ibmimpact life-sciences
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Guest post by Chris Schmitt, Worldwide WebSphere Industry Marketing Manager
The world faces three crucial healthcare challenges:
Just as important, though often overlooked, is another task -- creating a strategic approach to associating these three in a manner that is theoretically sound and practically feasible.
Plans may be made to improve access to care or to improve care quality. However, the cost of implementing a plan is problematic because of the numbers of expert staff and other significant costs. Applying more financial and human resources is neither feasible nor effective in light of increasing budget limitations and complexity of care.
These challenges all have three dimensions of mitigating action, the first two of which have been addressed in the United States with both legislation and regulations:
Of the three, medical science has received significantly less attention. Federal and private funding is provided for medical research. But applied research and development of cost-effective means for easing the navigation of “the bridge from bench to bedside” are sorely lacking.
More attention to the science of health promotion and care delivery helps mitigate not only medical practice shortcomings but also, indirectly, cost and complexity. If people are kept healthy, or diagnosed and treated promptly and cost-effectively, administrative and cost control problems are more likely to be minimized, too.
Currently in the USA, an IT-supported, prescribed and auditable clinical care process is needed for at least three federally legislated purposes:
As summarized in a recent IBM white paper addressing cloud enablement of accountable care, “The need to control costs and improve quality is driving new models for coordinating and providing healthcare… An example of a new model that seeks better management of cost and quality is the accountable care organization (ACO). ACOs are provider organizations that agree to be held financially responsible for the quality, costs and overall care of a defined population of beneficiaries. A vital precursor to the ACO that has shown tremendous promise is the patient-centered medical home (PCMH). A PCMH is most successful when the patient’s primary care physician has full access to the patient’s information and care/disease management tools. PCMH and ACO models are in early stages of development; access to patient and population level data will be a key to their success.”
These authoritative healthcare IT points of view characterize healthcare today:
“There's simply too much to know. The … problem we face is that there's too much information for physicians to master. If you had leukemia 100 years ago, they called it blood disease and you likely died. Sixty years ago, five different forms of leukemia or a lymphoma had been identified; today there are upward of 90 leukemia types or lymphomas combined. Last year, 700,000 articles were added to the referring biomedical literature. Ten years ago, it was 400,000. We must help those who deliver care be up-to-date on what the most current (and rapidly growing) knowledge or practice is in terms of both diagnosis and treatment.” 7
“[There is] failure to follow the evidence. Studies have shown that US health system performance continues to fall far short of what is attainable, especially given the enormous resources devoted to improvement efforts. For example, in 2003, Elizabeth McGlynn, Ph.D., and her colleagues at the RAND Corp.8 looked at some well-established treatment guidelines. They attempted to determine to what degree patients receive care according to the protocol. They found that only a little more than 50 percent did, indicating a massive failure to follow the evidence for a good amount of the care. Now, obviously, given reimbursement pressures and expectations, this type of failure is going to be less and less tolerable.” 7
“A lot of care processes just don't work very well. For example, extrapolated data from various studies of outpatient care clinical processes show that for every 1,000 women with a marginally abnormal mammogram, there appear to be 360 women who will not receive appropriate follow-up care. Similarly, for every 1,000 patients who qualified for secondary prevention of high cholesterol, 380 will not have an LDL-C screening within three years. As there's no argument about what constitutes an appropriate next step, the question is: Why is there such a remarkable failure of a process?” 7
“It is a widely accepted myth that medicine requires complex, highly specialized information technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads and stagnation in innovation -- while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their ‘civilian’ life … But we need now to take the next step: fitting EHRs into a dynamic, state-of-the-art, rapidly evolving information infrastructure -- rather than jamming all healthcare processes and workflows into constrained EHR operating environments … The IT foundation required for healthcare is the core set of health data types, the formalization of healthcare workflows, and encoded knowledge (e.g., practice guidelines, decision-support tools, and care plans). With those ingredients, existing … flexible software can support the automation of biomedical processes … Healthcare is ripe for this approach.”4
The required IT environment should support these clinical capabilities in a manner that is directly accessible by medical and healthcare delivery subject matter experts for development, deployment and operation: