Real health reform is about helping clinicians make better decisions
“An 84-year old woman lies in the cardiology unit of a Boston hospital. Hospital staff complain to her physician daughter, ‘She’s not able to give me her medical history,’ even though the woman is too ill to remember and share her health information. Healthcare professionals make decisions with little access to information on the woman’s previous tests, medications and treatments. Near-lethal mistakes are made, but the woman survives – largely because her highly educated daughters take on the role of healthcare navigators.”
From an editorial in the Jan. 31, 2011, issue of The Boston Globe, this real-life scenario is all too typical. Providers make decisions absent easy access to a patient’s complete medical history as well as guidelines, best practices, checklists and scientific findings that support them in providing the best possible care to patients.
The debate over reforming the nation’s healthcare system may come down to politics.
But providers, payers, patients and healthcare vendors can still take heart. No matter what occurs in Washington or in state legislatures, or which components of reform are sustained, rejected or rolled back, improvements are already under way and will touch on multiple facets of healthcare – from expanding insurance coverage and revamping privacy regulations to the adoption and meaningful use of new and emerging technologies.
What’s really needed, and what’s been missing from past reform pushes, is a real-world grasp of what physicians, nurses, pharmacists and other medical professionals need in order to deliver higher quality patient care. The government’s meaningful use objectives are trying to do just this. By tapping the power of evidence-based medicine (EBM) and clinical decision support (CDS), such as best practices, guidelines and checklists, providers can improve clinical decision-making, cost performance and patient outcomes while also building capacity to support the expanded coverage needs of health care reform.
The stuff on reform seems a bit distracting.
Unfortunately, the American timeline, especially since the 1970s, is cluttered with lackluster reform experiments – from Medicare reimbursement fixes to the launch of HMOs designed to keep patients healthy and contain costs. But few reforms have made a lasting impact, especially on cost control.
Healthcare costs now top $8,000 per person, and Medicare is running out of cash, with insolvency predicted as early as 2016. Healthcare’s share of the gross domestic product could rise from 16.2 percent to 20.3 percent in 2018 as public payers pay for more than half of national health spending.
So why did previous attempts at healthcare reform founder? Healthcare has chronic problems: fragmentation, duplication, inefficiency, cost, access, medical errors and uneven quality of care. Expanding coverage and changing how healthcare is paid for won’t address the root causes of healthcare’s cost crisis. Healthcare reform and transformation will fail unless the American people insist on solutions that help providers improve routine decisions about care delivery, including how and why they select tests, medications and treatments.
Healthcare transformation will come about through the expanded use of EBM and CDS, which support physicians, nurses, pharmacists and other healthcare professionals in making more timely, accurate decisions about prevention, diagnosis and treatment. While electronic health records are important, “EHRs do not improve quality; they facilitate improved quality,” according to Carolyn Clancy, director of the Agency for Healthcare Research and Quality. The adoption of EHRs will never in itself improve care quality. In other words, EHRs are only as productive as the content inside, which is why the federal government is correct to insist on the meaningful use of EHRs.
Healthcare providers must combine EHRs with EBM, CDS and other tools to help physicians, nurses, pharmacists and other professionals measure and improve the quality of care. With EBM and CDS, providers can achieve meaningful use of technology while accessing peer-reviewed medical content and tested professional guidelines on how to best deliver care to a particular type of patient. The result: improved decision-making, better control of medical errors and reduced medical complications and costs.
While the HIT Policy Committee of the Office of the National Coordinator for Health Information Technology has issued draft CDS recommendations for 2013 and 2015, the jury is still out on how quickly and easily providers will adopt and use CDS. In the years ahead, providers will increasingly adopt what’s known as “smart content,” which refers to text that’s been broken down into knowledge “nuggets” and then recombined to deliver the right information on the right patient at the right time to the right clinician.
But making more rapid, evidence-based decisions won’t be enough to resolve healthcare’s problems and improve quality. Providers must also curtail costly hospital admissions and readmissions. Addressing a joint session of Congress in September 2009, President Barack Obama reported how Pennsylvania’s Geisinger Health System had reduced hospital admissions 15 percent by applying predictive analytics technology in its community clinics. The Geisinger lesson is clear: CDS and other knowledge-based technologies make a significant difference in resolving healthcare’s problems.
To boost healthcare efficiency, as well as quality, productivity, access and outcomes, all healthcare players – payers, providers, patients, pharma and supply chain companies – must work together, focusing on how professionals on the front lines make life-saving medical decisions and deliver care to patients and families. Content is indeed king. The best content, delivered in a timely fashion and in highly usable form, will help providers and payers deliver higher quality, safer and more efficient care to patients. And for that, we don’t need to wait for Washington to find consensus.
Michael Hansen is the CEO of Elsevier Health Sciences, one of the largest medical publishers and providers of evidence-based electronic medical content in the world. Its headquarters are in Philadelphia.