A summary of the gaps in healthcare reform - emphasis is on heatlh IT research as enabling infrastructure without unwanted consequences.

1. National Health IT Vision<br />David M. Paschane, Ph.D. | 202-256-5763<br />National health IT is moving faster than the research paradigm it needs to sustain itself.<br />P.L. 111-148 and P.L. 111-152 do not specify critical analyses for supporting major decisions, especially in evidence-based, IT-enabled service coordination for preventing ill health and managing chronic conditions (70% of costs).<br />The Acts have at least 36 unaddressed major knowledge dependencies in (1) updated evidence in effectiveness of prevention services, (2) evidence-based standards for chronic and promotion care, (3) evidence-based designs for consumer-tailored informatics, (4) independent analysis of demographic-based variability, and (5) iterative behavioral and organizational outcome factors.<br />The Acts do not specify a Federal Performance Architecture for managing the major management nodes in the causal pathways to outcomes in access, quality, and costs.<br />In general, there is a lack of coherent healthcare infrastructure for health IT solutions, and the Office of the National Coordinator (ONC) may address this, but there are unexamined risks of unwanted consequences in how the organization of medical services and patient information affects knowledge, control, and opportunities.<br />The ONC can help prevent these consequences by enabling interagency research that provides contextualized, continuous, recursive analyses applied to population segmentations, and focus on (1) population-based, clinical modeling of care standards across conditions of management, (2) patient agency as a nexus of personalized education and psychology of self-care, and (3) organizational performance as sustainable and systemic improvements in outcomes.<br />These three research priorities ensure a balanced research agenda in health IT—evidence of the interactions between providers, patients, and institutions—with an emphasis on continuous, applied knowledge, especially as it is interpreted by different people in different contexts.<br />A national-scope research agenda can facilitate a comprehensive collaboration of academic, industry, government, and consumer applications of healthcare innovation in short-term, recursive analyses, revealing practical and transferable knowledge to other places, under similar economic and institutional conditions.<br />Internal-facing studies require the Performance Architectural Science Systems (PASS) discipline for maturing analytic capacities, and effect (1) management cultures, (2) agile integration of methodological best-practices, (3) IT-enabled awareness and training of staff, (4) incremental optimization of IT-enhanced business services, (5) robust capacity for sharing knowledge of outcome causes, and (5) natural openness to collaboration among communities of interest. <br />Efficient care seeking is the domain where national health IT research is weakest, and given that 60% of primary care visits are attributable to an underlying, unaddressed psychological driver of stress, depression, or anxiety, it is critical that we utilize patient self-management (30% of cost is attributed to non-compliance) through online interactivity as training services, early amendable communications, and tools in decision-making and service logistics (e.g., MedTech and MedTalk).<br />