My thesis on Nurse-Physician Collaboration (1997) began with a quote by Meg Wheatley, “It is all about relationships”. It is so true when you try to achieve quality working relationships and quality patient outcomes.  For the Practice-Technology Collaboration era we are now entering, the new macro mantra is, “It is all about partnerships”. There are some key points worth highlighting in Bousfield’s Outsell posting today:

• Care crosses clinical lines – period! The fact that leading healthcare vendors are merging to address the care gap between inpatient and outpatient is logical.  What is needed “inside” each of these EMR inpatient-outpatient solutions is a systems-thinking evidence-based professional practice framework to enhance the care coordination and clinical decision support required to reduce fragmentation and redundancies as well as achieve quality outcomes. In other words, “integrated product offerings” will require more than “integrated technology”.

• Meaningful use is about practice & technology. The ARRA Meaningful Use criteria should not address one without the other.  Elsevier’s CPM Resource Center recognized this long ago and began partnering and integrating evidence-based interdisciplinary content within EMR vendor applications as early as the 1990’s leading the practice-technology polarity that will be our new reality in healthcare.  While we all study the 800+ page CMS/ONS Meaningful Use Final Rules posted just yesterday (7/13/10 Link) we can celebrate the focus on results, “certified EHR technology should result in health care that is patient centered, evidence-based, prevention-oriented, efficient, and equitable.” In other words, it will require more than technology.

• Usability and design are key to adoption. So glad Bousfield addressed this important aspect.  The new challenge for EMR vendors is how to best leverage CDS tools and evidence-based content to really meet the needs of clinicians as well as “meaningful use criteria”.  In the new market place, selling clinical applications without usable and well-designed evidence-based CDS solutions is no longer an option. In other words, technology alone is not the answer…..let the new competition begin!

Costs continue to rise and quality measurements remain flat. The US currently spends more than twice as much on each person for healthcare as most other industrialized countries, but it has fallen to last place among those countries in preventing deaths through the use of timely and effective medical care. According to the WHO, the US proudly ranks as the 37th best health system in the world – just ahead of Slovenia.

Below the surface, it gets much, much worse. We are bombarded with stories on CNN and The New York Times about healthcare reform, electronic medical records, and “universal” healthcare, but industry fragmentation and poor coordination of services portends a further decay of our healthcare system.

According to a 2008 study by the Commonwealth Fund, 47 percent of adults reported serious failures of care coordination including: specialists not receiving basic medical information from primary care physicians, test results not being available at the time of an appointment; and, not being contacted or needing to repeatedly call to obtain test results.

Despite the individual technological advances that have been adopted throughout the industry, the system itself remains terribly siloed, and thus ineffective. Currently, seventy-five cents of every health care dollar we spend is on treatment of chronic disease, most of which is preventable if evidence-based medicine is practiced.

Predictive modeling offers a solution that directly addresses these issues. By aggregating data from multiple stakeholders and combining it with advance data mining and forecasting abilities, we can now successfully identify the specific individuals who will account for a majority of future health-care costs. With early detection comes early intervention.

Proactive identification of patients not following evidence-based treatment protocols, and the provision of that information to providers and patients leads to more effective and efficient care, particularly around chronic diseases. Leveraging a technology like predictive modeling across the care continuum will simultaneously address fragmentation, provide stakeholders with what they need to know when they need to know it, and facilitate physician engagement — all leading to improved quality and decrease spending.