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IHI's Goldmann: Where HIT Can Help Quality Improvement

May 1, 2014
by Gabriel Perna
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Don Goldmann, M.D., the chief medical officer of the Institute for Healthcare Improvement (IHI)

There is a lot of potential for healthcare informatics tools to be used to improve healthcare within the scope of clinical paradigms, but right now a lot of that technology is limited, surmises Don Goldmann, M.D., the chief medical officer of the Institute for Healthcare Improvement (IHI).

In the Mark Hopkins Intercontinental Hotel in San Francisco at this year’s Healthcare Informatics Executive Summit, Dr. Goldmann spoke extensively about how healthcare informatics technology (HIT) can be used in conjunction with improvement science, to allow healthcare providers to reach the “Triple Aim.” In his opening keynote speech, “What Quality Improvement Experts Need from HIT,” Dr. Goldmann outlined the possible places healthcare informatics technology could be used to improve care through its use in a clinical pathway or planned care model.

Dr. Goldmann says HIT can be an enabler of real-time learning, keep data updated, automate guidelines, assist in decision support, and measure results. These are all critical elements in a successful clinical pathway.

Yet, the technology is currently limited and not used, Goldmann noted. Earlier in the talk, he talked about how EMR systems aren’t equipped to support the basic functions of a patient-centered medical home. They struggle to support transitions of care, communicate with care managers and community health workers, don’t refer to specialists, and lack rich data mining capabilities. He also says clinical guidelines are hard to develop within these systems, clinical decision support systems are currently overwhelming, and they don’t take the human factor into account.  Ultimately, he says that if EMRs were developed based on provider and patient needs, and not administrative and billing needs, they’d be a lot more effective in this realm.

While noting that we have only started to tap the potential of basic EMR and data analytic capabilities and this should be the first order of business, Dr. Goldmann said that we will need to leverage rapid advances in big data, predictive models, combined application of granular GIS and personal health data to find "hot spots," and natural language processing to find critical information that probably will never be coded prospectively.

The IHI is a small, not-for-profit based in Cambridge, Mass. that advocates for transformational change in healthcare.  Dr. Goldmann began his talk defining the attributes of improvement science, including having a very clear, measurable aim, and a measurement framework to help reach that aim.