Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
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4 Imperative: Capturing Opportunities from Technology, Industry, and Policy
4 Imperative: Capturing Opportunities from Technology, Industry, and Policy
Pages 111-130
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From page 111... ...
Each morning, patients in the program use home telemonitoring technology to take their own weight, blood pressure, pulse, and oxygen levels and answer questions about their symptoms. The data from these tests are sent to a telemonitoring nurse, who reviews patients' vitals and takes appropriate follow-up steps for out-of-parameter readings, including calling the patient or coordinating care with the patient's care team (Partners HealthCare Center for Connected Health, 2012)
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From page 112... ...
Progress in these areas has the potential to improve health care by increasing the reach of research knowledge, providing access to clinical records when and where needed, and assisting patients and providers in managing chronic diseases. Another area of opportunity lies with the human and organizational capabilities developed by diverse industries to improve safety, quality, reliability, and value; many of these capabilities can be adapted to health care settings to improve performance.
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From page 113... ...
The infrastructure for this type of connectivity, however, is largely lacking. As of 2011, only 34 percent of office-based physicians used a basic electronic health record system (although projections are for 90 percent to have access by 2019)
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From page 114... ...
. Increasing the diffusion of a digital infrastructure that supports health care processes and access to information provides the necessary foundation for a continuously improving, learning health care system (President's Information Technology Advisory Committee, 2001, 2004)
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From page 115... ...
Several examples exist of initiatives, such as the National Library of Medicine's MedlinePlus Connect and Kaiser Permanente's Clinical Library, aimed at seamlessly inte rating clinical information with an electronic medical record. Evidence g indicates that clinicians already have started to take advantage of these BOX 4-2 Gleaning Real-Time Insights from Clinical Data Although there has been an increase in the clinical knowledge being pro duced (see Chapter 2)
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From page 116... ...
Digital technologies also provide a paradigm for managing chronic diseases. Remote monitoring, such as devices that monitor heart conditions and blood sugar levels, can feed data in near real time to electronic health record systems (Manyika et al., 2011)
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From page 117... ...
Projections are for 90 percent of physicians to have access to fully operational electronic health records by 2019, up from 34-35 percent in 2011. • Digital capacity to provide electronic decision support prompts at the point of choice holds promise for transforming the safety and effectiveness of care.
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From page 118... ...
One initiative, for example, introduced several methods drawn from aviation, such as checklists and a focus on teamwork and communication, to address catheterrelated bloodstream infections. These methods eliminated such infections in the intensive care units of most hospitals and resulted in an 80 percent
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From page 119... ...
. While not all industry safety methods will be effective in a health care setting, these examples illustrate the potential for practices pioneered in other industries to improve patient safety when adapted to a health care environment (Lewis et al., 2011)
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From page 120... ...
Several of these tools, including statistical process controls, supply chain management, modeling, and simulation, could be applied to improve health care processes (Agwunobi and London, 2009; IOM, 2005; IOM and NAE, 2011)
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From page 121... ...
The convergence of these novel partnerships, a changing health care landscape, and investments in needed knowledge infrastructure establishes a potentially unique opportunity in the nation's history to achieve a learning health care system. Many states have been at the forefront of initiatives to expand health insurance coverage, improve care quality and value, and advance the overall health of their residents.
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From page 122... ...
. These reforms build on Vermont's 2006 health care reform legislation, which established the Catamount Health Plan to provide an insurance option for uninsured individuals with incomes below 300 percent of the poverty level, and developed initiatives to create a statewide, integrated electronic health information infrastructure (Kaiser Family Foundation, 2007)
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From page 123... ...
Another ACA provision focused on value is the creation of the Center for Medicare & Medicaid Innovation. The Center is charged with testing and evaluating innovative payment and delivery system models that could improve care quality while slowing cost growth in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP)
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From page 124... ...
These reforms are an ongoing process and will evolve over time in response to changing national conditions. Federal and state government actions are complemented by multiple initiatives on the part of employers, specialty societies, patient and consumer groups, health care delivery organizations, health plans, and others seeking to improve the health care system: • In 2012, the American Board of Internal Medicine (ABIM)
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From page 125... ...
States ranging from Massachusetts to Utah to Vermont have introduced initiatives aimed at expanding health insurance coverage, improving care quality and value, and advanc ing the overall health of their residents. • Incentives for the adoption of health information technology may promote learning and yield substantial savings.
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From page 126... ...
1999. The impact of computerized physician order entry on medication error prevention.
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From page 127... ...
2012. Small, non teaching, and rural hospitals continue to be slow in adopting electronic health record systems.
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From page 128... ...
2007. Redesigning care delivery in response to a high-performance network: The Virginia Mason Medical Center.
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From page 129... ...
2004. Computerized physi cian order entry and medication errors in a pediatric critical care unit.
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