By JACOB REIDER<\/p>\n
I haven\u2019t blogged this yet, which kinda surprises me, since I find myself describing it often.\u00a0\u00a0
Let\u2019s start with an overview. We can look at health information through the lens of a lifecycle.\u00a0<\/p>\n
The promise of Health Information Technology has been to help us \u2013 ideally to achieve optimal health in the people we serve.<\/p>\n
The concept @ the beginning of the HITECH act was: \u201cADOPT, CONNECT, IMPROVE.\u201d<\/p>\n
These were the three pillars of the Meaningful Use Incentive programs.<\/p>\n
Adopt<\/strong>\u00a0technology so we can\u00a0connect<\/em><\/strong>\u00a0systems and therefore\u00a0improve<\/em><\/strong>\u00a0health.<\/p>\n Simple, yes?<\/p>\n Years later, one can argue that\u00a0adoption<\/em><\/strong>\u00a0and even\u00a0connection<\/em><\/strong>\u00a0have (mostly) been accomplished.<\/p>\n But the bridge between measurement and health\u00a0improvement<\/em><\/strong>\u00a0isn\u2019t one we can easily cross with the current tools available to us.<\/p>\n Why?<\/p>\n Many of the technical solutions, particularly those that promote\u00a0dashboards<\/strong><\/em>, are missing the most crucial piece of the puzzle. They get us close, but then they drop the ball.<\/p>\n And that\u2019s where this \u201csimple\u201dAAAA\u201d model becomes useful.<\/p>\n For data and information to be truly valuable in health care, it needs to complete a full cycle.<\/p>\n It\u2019s not enough to just collect and display. There are four essential steps:<\/p>\n 1.\u00a0Acquire<\/strong>. This is where we gather the raw data & information. EHR entries, device readings, patient-reported outcomes\u00a0 \u2026\u00a0 the gamut of information flowing into our systems. \u00a0Note that I differentiate between\u00a0data<\/strong><\/em>\u00a0(transduced representations of the physical world: blood pressure, CBC, the DICOM representation of an MRI, medications actually taken) and\u00a0information<\/strong><\/em>\u00a0(diagnoses, ideas, symptoms, the problem list, medications prescribed) because data is reliably true and information is\u00a0possibly<\/em><\/strong>\u00a0true, and possibly\u00a0inaccurate. We need to weigh these two kinds of inputs properly \u2013 as data is a much better input than information.\u00a0 (I\u2019ll resist the temptation to go off on a vector about data being a preferable input for AI models too \u2026 perhaps that\u2019s another post.)<\/p>\n 2.\u00a0Aggregate<\/strong>. Once acquired, this data and information needs to be brought together, normalized, and cleaned up. This is about making disparate data sources speak the same language, creating a unified repository so we can ask questions of one dataset rather than tens or hundreds.<\/p>\n 3.\u00a0Analyze<\/strong>. Now we can start to make sense of it. This is where clinical decision support (CDS) begins to take shape, how we can identify trends, flag anomalies, predict risks, and highlight opportunities for intervention. The analytics phase is where most current solutions end. A dashboard, an alert, a report \u2026 they all dump advice \u2013 like a bowl of spaghetti\u00a0\u2013 into the lap of a human to sort it all out and figure out what to do.<\/p>\n Sure \u2026 you can see patterns, understand populations, and identify areas for improvement \u2026 All good things. The maturity of health information technology means that aggregation, normalization, and sophisticated analysis are now far more accessible and robust than ever before. We no longer need a dozen specialized point solutions to handle each step; modern platforms can integrate it all. This is good \u2013\u00a0but not good enough<\/em><\/strong><\/p>\n A dashboard or analytics report, no matter how elegant, is ultimately passive. It shows you the truth, but it doesn\u2019t\u00a0do<\/em>\u00a0anything about it.<\/p>\n <\/span><\/p>\n Act<\/strong>. This is where the rubber meets the road. It\u2019s about translating insights into tangible interventions.\u00a0What should happen (or not happen) next?<\/em><\/strong><\/p>\n What good is knowing a patient is at high risk for readmission if that knowledge doesn\u2019t trigger a specific follow-up protocol, a social work consultation, or an adjusted discharge plan? What\u2019s the point of identifying a prescribing pattern if the system doesn\u2019t facilitate a change in practice, provide immediate feedback to clinicians, or adjust order sets?<\/p>\n We have relied on human intervention to bridge this gap. A clinician might see a trend on a report and then manually initiate a change. We see a need for screening and make an order \u2026 (one-by-one-by-one).<\/p>\n So sad.<\/p>\n The true power of health IT, especially with the advancements we\u2019ve seen, lies in\u00a0closing this loop<\/em><\/strong>. We should be building systems that not only acquire, aggregate, and analyze data but also\u00a0facilitate the next best action<\/em>, prioritizing what\u2019s best for the person we serve, and (of course)\u00a0who<\/em>\u00a0should be the recipient of this guidance?<\/p>\n Imagine a system that not only flags a potential issue but also:<\/p>\n * Automatically generates a personalized patient education document. \u00a0<\/p>\n * Suggests an updated medication order (or a set of orders) with one click. \u00a0<\/p>\n * Schedules a follow-up appointments with the appropriate specialists . \u00a0<\/p>\n * Pushes a notification to a care coordinator to intervene.<\/p>\n This isn\u2019t about removing human judgment; it\u2019s about empowering it. It\u2019s about making the right thing to do the easiest thing to do.<\/p>\n The beauty of this cycle is its iterative nature.<\/p>\n The actions we take then generate new data and information, feeding back into the \u201cAcquire\u201d phase, allowing us to continuously refine our understanding and improve our interventions. And the faster and more frequently we can cycle through these four steps, the more responsive, efficient, and patient-centric our health care teams become.<\/p>\n Next time you\u2019re evaluating a new Health IT solution, ask the crucial question: how does this system help us\u00a0Act<\/strong>?\u00a0<\/p>\n Jacob Reider MD is a family physician who previously served as Deputy National Coordinator at ASTP\/ONC, CMIO at Allscripts and Albany Medical Center, CEO of Alliance for Better Health and currently doing angel investing, advising\u00a0and pickleballing.\u00a0 Find his occasional thoughts at\u00a0http:\/\/www.docnotes.net<\/a><\/em> which is one of the few blogs older than THCB<\/em>!<\/p>","protected":false},"excerpt":{"rendered":" By JACOB REIDER I haven\u2019t blogged this yet, which kinda surprises me, since I find myself describing it often.\u00a0\u00a0Let\u2019s start with an overview. We can look at health information through the lens of a lifecycle.\u00a0 The promise of Health Information Technology has been to help us \u2013 ideally to achieve optimal health in the people…<\/p>\n","protected":false},"author":0,"featured_media":8973,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-8974","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8974"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8974"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8974\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/8973"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8974"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8974"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8974"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}