Evidence-Based Medicine and the Changing Nature of Health Care 2007 IOM Annual Meeting Summary (2008) / Chapter Skim
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5 The Promise of Information Technology
5 The Promise of Information Technology
Pages 109-126
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From page 109... ...
, notes that information overload makes it difficult for healthcare providers to easily integrate evidence into practice. For example, information sources such as journals each have their own way of organizing and presenting information, which is not easily adapted to clinical practice.
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From page 110... ...
If, on the other hand, the starting point is the messy informational milieu of front-line clinicians, then even the most meritorious evidence is useless unless practitioners are supported with • Convenience -- because all the right information is available in the right place at the right time; • Discrimination -- because relevant and important information is filtered by the unique needs of community, group, and individual; and
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From page 111... ...
A variety of Internet technologies have emerged. They have the following characteristics: • Simplicity -- with uncluttered, straightforward, and consistent pre sentation of information and an intuitive interface that requires a minimum effort to use without training • Accessibility -- with rapid access wherever healthcare decisions are made • Sensitivity -- to individual and group information preferences • Efficiency -- with important information resources organized under a single log-on to reduce the clinicians' total burden of information management An iterative approach to developing "embedded evidence" systems has benefited from close collaboration with national and regional care societies, health professional organizations, and diverse healthcare institutions in Australia, Canada, and the United States.
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From page 112... ...
are met 5. Rewarding -- because users experience at least five practice-changing rewards per week of system use If busy clinicians experience a decreased total informational burden, they will return and use a decision support environment consistently.
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From page 113... ...
Quality resources are made actionable with shortcuts, integrated search engines, and a technology that embeds evidence access within digital health records. Clinicians can highlight any word or phrase, anywhere in any product, then select from a list of information needs.
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From page 114... ...
Evidence management -- because clinicians are able to record and organize questions as they arise, note evidence application issues, and selectively collaborate with colleagues to tap tacit knowledge about using evidence in context 5. Evidence literacy training -- because decision makers are supported with embedded continuing professional development tools and resources that allow them to learn and improve their evidence literacy in practice Working with organizations such as the Nemours Foundation, the CHE implements systems that monitor evidence behaviors.
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From page 115... ...
Embedded information literacy training and evidence literacy training support the emergence and empower ment of organizational change agents within the organization. Informed choice is facilitated when information about health is connected with information about how to improve health.
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From page 116... ...
The promise of personalized medicine is exciting, but that promise can be realized only if information is made available to the right people, at the right time, and in the right context. The last decade has also been a time when consumers have connected themselves to a global information system -- the World Wide Web -- in unprecedented numbers, creating a society that has access to, and demands TOMORROW • Continuous location tracking • Constant vital signs monitoring • Transcutaneous monitoring of glucose, ETOH, etc.
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From page 117... ...
The healthcare universe has traditionally revolved around the physician, the person that we as patients relied on implicitly to guide us and make decisions for us, to keep us alive and in good health; the person that served as our gatekeeper to health plans; the person that served as our liaison to pharmaceutical companies. Today's health information systems all center on the "facility" -- whether it is the hospital, doctor's office, or insurance work flow.
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From page 118... ...
that sees more focus on prevention and wellness, and more focus on selfmanagement -- chronic care management that moves away from hospitals and specialty clinics and into the home environment, with support from family doctors and community institutions. The consumer is being asked to take on an increasing amount of responsibility as it relates to his or her health, and is asking in turn for best practices and actionable information that enables informed decisions around disease prevention and chronic patient care.
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From page 119... ...
With the advent of the Internet came the birth of the "self-directed consumer," and financial services institutions were forced to become more flexible, consumer-centric businesses. Transformation of the industry has enabled financial services organizations to provide a seamless experience for customers, consolidating their interactions across the industry with banking, lending, and brokerage services integrated into a single account.
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From page 120... ...
An online solution tied to the platform that makes it easier for con sumers to collect, persistently store, share, and act on their health data -- private data that are entirely under their control This platform needs to be inclusive of standards, and it needs to have the principles of privacy in place to earn the trust of consumers, while enabling the reuse of data. The same platform has to connect consumers with information from their physicians and extended care team, their health plans, pharmacies, and any number of devices that they use to track health and fitness behaviors.
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From page 121... ...
In developing HealthVault, we decided to make it free to users, and free to software developers, as the best way to spark innovation across the industry, and to encourage adoption and data liquidity. The individual consumer is the aggregator, pulling the information together from across data sources such as dispersed patient records, prescription drug records, fitness and diet plans, and vital signs through external medical devices (blood pressure monitors, blood glucose monitors, etc.)
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From page 122... ...
. We developed HealthVault Search as an entry point to the Microsoft HealthVault platform and as a way to ensure that consumers are finding the information they need, when they need it.
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From page 123... ...
Our HealthVault Search also sets a new industry benchmark for consumer privacy, as shown in Table 5-1. Consumers can store and control an array of health information in their Microsoft HealthVault records, including prescription medication lists, health histories, hospital discharge summaries, lab results, fitness data, and HealthVault Search results.
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From page 124... ...
can be intercepted and read Identifies users using cookies for 90 days Will put a persistent identifier on a user's computer and use it to track users as they travel across the Web for years We do not use behavioral targeting using Will target ads based on past searches, information in HealthVault accounts past advertising responses, demographic information, time of day, etc. We delete our server and application logs Keeps search information, including unique after 90 days identifiers, for long periods of time We do not keep track of individual query Knows what you searched on over your past histories across sessions visits Battling Health and Aging Trends As our population ages and loads the system with a proportional increase in health issues, our current approach to managing health and delivering care is not sustainable from an economic standpoint.
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From page 125... ...
U.S. health consumer survey, 2007: Understanding search behavior.
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