Patients Charting the Course Citizen Engagement and the Learning Health System: Workshop Summary (2011) / Chapter Skim
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5 Health Information Technology as the Engine for Learning
5 Health Information Technology as the Engine for Learning
Pages 119-136
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From page 119... ...
Using HIT wisely is central to building a real-time knowledge engine, tools for care improvement, and a portal for practical patient involvement. For primary care physicians and patients, electronic data permit tracking of health status, outcomes, selfmanagement, and more.
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From page 120... ...
Harvard University As the entity charged with coordinating efforts to implement and use advanced HIT and develop capacity for nationwide health information exchange, ONC plays a critical role in laying the groundwork for a learning health system. In its work to meet these critical short-term requirements, ONC also seeks to provide a pathway for achieving the potential of HIT to serve as an engine for continuous learning and care improvement.
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From page 121... ...
This act creates both the need and the requirement for ONC to lay a foundation for moving data from individual health records into some other form, as well as the need to enable solo physicians to exchange data in a way that is clinically meaningful to their patients and their practice. In so doing, the act also provides an opportunity to create capacity to support the collection and analysis of health information for addressing a variety of questions, including those involved in the study of technologies and medications or trends in public and population health.
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From page 122... ...
ONC is working to develop the Nationwide Health Information Network, which has many of the technical features required to support such robust information exchange and the kind of inquiries necessary for metadata analysis. Cognizant of the importance of reaching clinicians where they are, ONC also seeks to provide simple, alternative methods of information exchange that may not have all the properties needed to achieve long-term aims, but will contribute to improved care for patients and providers in the short term.
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Vanderbilt University Medical Center The concept of a learning health system intersects in a compelling way with the wisdom that one cannot manage what one cannot measure, or the more useful correlate that one can manage what one can measure. The society-transforming power of information technologies has been amply demonstrated by the spontaneous cultural shifts that have accompanied the global adoption of cell phones, electronic messaging of various types, and the web.
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From page 124... ...
For example, it is recommended that patients on ventilator support in intensive care units undergo a set of preventive measures to reduce risk of ventilator-associated pneumonia (VAP) (Coffin et al., 2008)
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125 HEALTH INFORMATION TECHNOLOGY AS THE ENGINE FOR LEARNING FIGURE 5-1 Ventilator-associated pneumonia prevention "dashboard." Figure 5-1.eps bitmap FIGURE 5-2 "Improvement opportunity" web display of summary compliance for each ventilator-associated pneumonia preventive measure. SOURCE: Vanderbilt University Medical Center.
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From page 126... ...
A National Institutes of Health-sponsored consortium named eMERGE (electronic MEdical Records and GEnomics) 1 has demonstrated that phenotypes extracted from EHRs as a byproduct of health care delivered and documented for healthcare service rather than research purposes can replicate the observations drawn from carefully constituted research cohorts and also yield new observations (Ritchie et al., 2007)
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From page 127... ...
Biological variability predicts that all unexpected effects are unlikely to be negative, but beyond the initial drug development process, there exists no systematic means of harvesting such serendipitous outcomes, and providers have no incentive to seek this information from patients or record it. An institutional review board–approved pilot project undertaken within the MyHealthAtVanderbilt portal offered recipients of newly prescribed medications the opportunity to participate in an online survey of expected and unexpected drug effects.
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From page 128... ...
Harvard Medical School and Partners HealthCare "Connected health" is a term used to describe a model for healthcare delivery that uses technology to provide health care remotely. Technology is used to deliver patient care outside the hospital or doctor's office, thus em
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From page 129... ...
powering patients to monitor their condition and obtain relevant feedback and coaching to achieve the best possible clinical outcomes. The Center for Connected Health,3 a division of Partners HealthCare 3 See http://www.connected-health.org (accessed October 12, 2010)
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From page 130... ...
The programs follow a similar structure, based on the following four cornerstones. Accurate Physiologic and Behavioral Data The connected health programs harness physiologic and behavioral data using technologies that obtain these data objectively, such as wireless scales and blood pressure cuffs, smart glucometers, and pulse oximeters.
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From page 131... ...
Most connected health programs currently rely on coaching delivered by nurses who are working at the primary care level. These educators contact patients on a regular basis, provide feedback on their progress, and guide them to help improve control of their condition.
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Mobile phones have proven to be an inexpensive, effective, and culturally acceptable means of keeping patients engaged with connected health programs. Mobile text messaging has been used in various programs as a tool to improve engagement.
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Patients have reported higher awareness of how better to manage and control their clinical parameters and a greater sense of control over their disease condition. Diabetes Connect: An Illustration of Lessons Learned Diabetes Connect was started in February 2009 with two practices in the primary care network at Partners HealthCare that vary significantly in administration, activity, and success in the program.
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From page 134... ...
Conclusion The recent healthcare reform legislation has opened up possibilities for changing reimbursement patterns and definitions of what is considered acceptable care. The connected health programs described in this paper show promise for helping physicians achieve clinical goals with their patients not only to meet reimbursement targets, but also to raise the standard of care provided to each patient.
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From page 135... ...
:382-385. Center for Connected Health.
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