Wednesday, February 29, 2012

Patients Need Actionable Knowledge

Meaningful use has defined the data that should be included in a clinical summary.  According to Stage I, the following demonstrates the minimum requirement necessary to qualify for this measure.

"Just the facts, ma'am." That about sums it up. This summary includes the required data and can easily be extracted from the EHR.

But it doesn't do much else. It certainly doesn't engage the patient, provide them with actionable knowledge or meet the spirit of the meaningful use measure.

However, with minimal provider data entry, well thought out templates and re-formatting with the goal of patient engagement, the clinical summary can be packed with actionable knowledge. That same visit could produce something like this:

Presenting patients with knowledge about their health is a key in engaging them as active participants in their care. As medical providers, we need to demand that EHR vendors provide us with tools that will meet this need.

Meaningful Use Stage II comment period opens next week. We need to provide feedback so that loopholes like the one above are eliminated. What good is meeting program requirements if we haven't met the needs of the patient?

Thursday, February 9, 2012

Meaningful Use and CKM


Meaningful Use: What Is It?

  • By definition, meaningful use refers to the use of certified electronic health record technology to perform certain tasks.
  • Meaningful Use Stage I is ultimately an outline for better and more affordable healthcare
  • While not yet established, it is hoped that Stage II and III will complete the first chapters of better and more affordable healthcare
  • Meaningful Use is an important infrastructure for improving healthcare
  • Meaningful Use limits its focus to using technology

 Meaningful Use: What Isn't It?

  • Meaningful Use is not a comprehensive plan to leverage technology for healthcare improvement
  • Meaningful Use is not focused on the use of data
  • Meaningful Use is not Clinical Knowledge Management

Meaningful Use and Clinical Knowledge Management

Meaningful Use is focused on the collection, storage, and reporting of data, not the creation of actionable knowledge. While MU creates outlines, paragraphs, and chapters in data collection, Clinical Knowledge Management creates volumes of knowledge to improve all aspects of healthcare. These volumes of knowledge are needed if we are ever going to bend the cost curve in the US healthcare system. 

MU needs to be built with this end in mind; if we don't take this opportunity to build the necessary infrastructure, we will not be able to generate the knowledge needed to make a sustainable US healthcare system. The conversations about MU need to expand beyond implementation dates, reimbursement, and vendor/physician concerns. We need to include discussions about which data needs to be captured to insure the generation of sufficient knowledge to allow optimal return from the investment in Meaningful Use.

Monday, February 6, 2012

Revealing Bias in Healthcare Decision Making


I've recently been reading the Song of Ice and Fire series (Game of Thrones) by George R. R. Martin. While the plot is engaging and intriguing, one of the things I enjoy about the book is that it is written from the third person multiple perspective. Each chapter is limited to a specific character's perspective, but many characters get to tell the story. With this narrator point of view, the story develops with more layers and nuance than other perspectives. Each character's biases are revealed, and the reader is able to develop their own opinion of the events in the story.

Bringing the bias of each character to the surface through the third person multiple perspective deepens the understanding of the setting of the book. Similarly, bringing the bias to the surface in healthcare decision making helps us develop better knowledge and make better decisions. Just as each character in the novel is limited by what they can sense and feel, so each type of healthcare knowledge is limited by the constraints of its data.

These constraints make the exclusive use of any single type of healthcare knowledge unwise. We need to use multiple types of healthcare knowledge to better understand the current environment. For instance, in any single healthcare decision making process, knowledge can be garnered through:

  • Institutional knowledge
  • Quality knowledge
  • Research knowledge
  • Financial knowledge
  • Operational knowledge
  • Medical knowledge
  • Direct Care knowledge
  • Transactional knowledge
  • Analytical knowledge
When we combine multiple types of healthcare knowledge we are able to develop a more layered and nuanced understanding of the challenge facing us and thus make better decisions and take more appropriate actions.