Wednesday, October 12, 2011

Putting the IT in Care TransITions

On Friday, October 14th, I look forward to attending a meeting in Washington DC called Putting the ‘IT’ in Care Transitions. That will be followed closely by the ONC S&I Framework Face-to-Face meeting in DC on October 18-19, which will also feature a track on Transitions of Care. Meanwhile, Meaningful Use Stage 2 standards definition marches on, as I wrote in my last blog. Many initiatives are converging (I hope).

The October 14th meeting will consider three specific patient scenarios: an elderly isolated widow with many chronic conditions; a young child with serious asthma and exacerbating home environment; a homeless man with diabetes and schizophrenia. The premise is: “if the system is designed to assist the most complex patients, then the system will function effectively for all.” I agree with the premise as far as capabilities (more complex scenarios often require more robust capabilities), but I don’t think it’s always true from an adoption and usability perspective. How often have you and I felt that a process or a gadget or a computer UI was “over-engineered” because it was designed for a complex but rare scenario, but was cumbersome for the most common scenarios?

The October 14th meeting also has a premise that “even the most advanced provider and community organizations acknowledge that new innovation is needed to improve the efficiency and effectiveness of delivering transitional care interventions to large numbers of patients, particularly in an environment in which technology adoption is rapidly growing and the state of technology is changing.” Right on, and so I suggest that these are some key areas for “much new innovation:”
  1. Innovative and Usable Presentation of a "just right" level of information to clinicians that avoids the extremes of "information overload fatigue" vs. overly aggressive filtering of information, especially when much information exchange occurs. Can HIT be smart enough to anticipate what a clinician needs? Or must HIT be passive and "do no harm" by leaving all decisions up to the clinician?
  2. Policies and guidelines for which electronic information a clinician must read, vs. what they do not need to read. While this is often viewed as a bigger problem for HIE/"Pull" models, it’s a concern even for "push" exchanges, especially if a sender sends information to one provider and copies many others on the "care team." 
  3. Reconciliation principles for many types of data, not just medications. E.g., lists of problems/diagnoses, allergies, procedures, and immunizations. The risks vs. rewards of merging, aggregation, deduplication, normalizing across multiple information sources whose vocabularies are not fully standardized. Should HIT strive for “a single source of truth” or just accept that “here is what other sources have said?”
  4. Who or what makes a care team? The term is used a lot, but is it clear what makes one? Just knowing who other providers are, and even having access to their records, doesn’t necessarily create a team or a care plan. My hometown football team, the Philadelphia Eagles, has so much talent that some dubbed them a “Dream Team” and surely they know each other’s names and roles, but they aren’t an effective team at the moment. And to play off the meeting title, how will putting the T (Technology) into Team result in better patient Care?
I look forward to blogging about the outcome of these next two meetings.

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