Noelani FoxUniversity of TexasHIT InstituteHow Health Information Technology can Improve Community Health OutcomesThe Current State of AffairsAn increasing amount of political and popular attentionis being focused on the state ofour national health care system. OrdinaryAmericans are realizing what politicians,medical experts, and public health authorities have known for a long time: our healthcare system is poorly designed to keep our population healthy. The organization of ourhealth care delivery system today is the result of unplanned construction, and the timehas come to apply intentional reforms and systemic changes that can positively affecthealth outcomes. Although we provide top quality medical schools and ground breakingresearch, have access to the most effective medical equipment and technology, andhave some of the most skilled specialists in the world, the overall health of ourpopulation compares unfavorably to many other countries with fewer resources. Inorder to impact our out-of-control health care costs, elevated chronic diseaseprevalence, and declining wellness metrics, we must focus on the fundamental changesto our health care delivery system that can generate improved community healthoutcomes.A national health care delivery system is anintricatecomposite of many attributes.Types of providers and care settings, payments structures, quality oversight andreporting, government policies, and patient attitudes all contribute to the form andfunctionality of health care. From the standpoint of a wellness based approach, each ofthese areas is deficient in America today. Our focus is on tertiary instead of primarycare, our performance on adverse medical events is very discouraging,and we do notactively support preventive care, have public policies or coordination of care thatencourage health. Finally, as citizens, we are not encouraged to be proactive in ourown care, and live lifestyles that are hazardous to our health.There is no easy fix for the multitude of dysfunctional components of American healthcare. Recent policies in Washington are beginning to address fundamental failings;providing increased access to the healthcare system for those to whom care is currentlyunavailable, developing measures to improve quality of care, and recognizing the needfor better management of information, both patient specific and up-to-date evidence-based information. The medical profession is an information intensive industry. Aphysician cannot possibly keep current with all the new research, diagnoses, guidelines
and best practices that are constantly evolving. Without automated communication, hecannot know all the details of care a patient is receiving from an array of specialists.Being that we live in the information age, it is high time we brought medicine out of thedark ages of paper charts, information silos, and 17 year delays in getting researchfindings to the front lines of care.The United States is experiencing a crisis in chronic illness, and the tertiary focus onacute care does not support management of these conditions. There are two majorcontributors to this predicament. Modern medicine has eliminated most of the acuteillnesses that kept life expectancy low for thousands of years. We have an agingpopulation, and elderly people are more likely to develop multiple diseases that requiremanagement. Modern efficiencies and commercial interests have also contributed toour declining health, in that low nutrient convenience foods have replaced whole foods,very little physical effort is required to work, transport, and care for ourselves, and ourenvironment is polluted and, often, a contributor to ill health. People are developingchronic conditions at progressively earlier ages.In 2007, heart disease, cancer and stroke were the top three causes of death, followedby lower respiratory diseases and accidents. The Institute of Medicine has estimatedthat nearly 100,000 accidental deaths are attributable to medical errors.Prescriptionerrors and adverse medical events are increasing causes of emergency room visits.Inadequate management of chronic diseases and iatrogenic injuries are having a hugeimpact on our mortality and morbidity statistics, and our national health.Health Information TechnologyThere are many ways health information technology can contribute to our healthcaredelivery system. Chronic disease management, improved patient safety, carecoordination, and public health are four main categories of benefits to be directlyderived from widespread use of integrated health information. Immediate results can beobtained through better chronic disease management and decreased injuries. Longterm benefits can be derived from the genesis of patient centered medical homes,where care is accomplished through partnership between the patient, all of herproviders, and family, facilitated by information technology. Additionally, de-identifiedaggregate information extracted from nationwide databases can contribute to the bodyof knowledge and to the management of public health crises and national health.Patient registries and clinical decision support are functions that have the potential tosignificantly augment population health management. Computerized systems can trackand alert providers to the need for vaccinations, preventive screenings, and lifestyleeducation and counseling. Once a patient is identified as having a specific condition,hisneeds for monitoring and treatment can be automatically linked to current evidencebased care guidelines. On-screen alerts and regular reports can be valuable tools tohelp the provider ensure that he is providing high quality care.
Electronic prescription management is a measure that is widely acknowledged ashaving the potential to prevent adverse events. Electronic medical records have thecapability to check for possible drug interactions at the time of initial prescription;electronic transmission of the prescription order eliminates concerns of illegibilityandother translational errors; and, interoperable systems can ensure complete andaccurate information on all medications prescribed to an individual.Coordination of care across settings is crucial to improving quality and decreasingduplicated or unnecessary services. Communication with the patient is essential, as iscollective informationamong primary care providers, specialists, hospitals, nursinghomes and home health agencies, ancillary services, and community resources. Healthinformation exchanges can support partnerships between providers, patients and theirfamilies in the patient centered medical home, and ensure that patients get care whenand where they need it. Open communication and shared information can informeveryone involved of their roles and responsibilities in the care of the patient, andincrease accountability.Health and wellness are not solely in the domain of health practitioners. Patients mustbe encouraged to take responsibility for their own role in determining their health.Patient education through counseling, support groups, handouts and internet basedinformation can empower patients to make choices that prevent potential disease, or toself-manage disease once it has presented. Providers can be encouraged to providepreventive and educational measures if the ease of access and distribution isautomated, and if they can be properly compensated through documentation of theseefforts. Additionally, patient adherence to treatment plans can be encouraged throughcomputerized home monitoring of vital measurements such as glucose levels or bloodpressure and electronic monitoring of prescription bottles, which can also feed datadirectly into an EHR and inform the provider. Finally, improved communication betweenthe patient and provider can be enhanced through patient portals and other electroniccommunication technology.Public policy is being written to support the extensive changes necessary for therenovation of our healthcare delivery system. A significant component is the investmentin widespread electronic health record implementation and information technologyinfrastructure. Complete, accurate,structured, patient-centered information frommultiple sources can be intelligently filtered through up-to-the-minute guidelinescontained in clinical decision support engines to support best practices of quality care.Patients can be given the appropriate kind and intensity of support to self-manage theirdisease under the care of a fully informed physician. Aggregate information from manysources can provide regional and national planners and policy makers with thenecessary data to inform enhanced preventive measures and public health policies.Community health outcomes can be positively impacted at the personal level, providerpanel level, and national health level through the widespread adoption of healthinformation technology.
AcknowledgementThank you to Dr. Vince Fonseca, Director of Medical Informatics at Intellica Corporation, for hisadvice and insight.ReferencesA Health Care Cooperative Extension Service: Transforming Primary Care and CommunityHealth, Kevin Grumbach, MD; James W. Mold, MD, MPH, JAMA. 2009;301(24):2589-2591.HIT Connections: HIT and Flu Preparedness, National Association of Community HealthCenters Newsletter, http://www.nachc.com/magazine-article.cfm?MagazineArticleID=147,accessed 7/12/2010CDC, HIT firms working to curb public health crises,Joseph Conn,http://www.modernhealthcare.com/article/20090501/REG/304309942#, accessed 7/12/2010e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice,Schade, CP, et al, Journal of the American Medical Informatics Association, Volume 13, Issue5, September-October 2006, Pages 470-475National Vital Statistics Reports: Deaths: Final Data for 2007http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf, accessed 7/17/2010