The Latest IOM Report: Moving the Industry Towards “Continuously Learning Healthcare in America”

Yes, you got it absolutely right. This is why we started out two decades ago doing this; we didn’t have the same context that we do today, but even back in the 1980s, we saw where our system was headed. For one thing, with all the advances in medicine, in the literature, and in everything else, doctors simply can’t keep up. And the result could be that people wouldn’t get optimal care, even while what we’re doing for people is bankrupting this country. So then obviously, we had to ask what we could do about it. And so we really focused on a couple of things: making things available in terms of knowledge, and then capturing that knowledge in ways that everyone could take advantage of it.

With regard to the 10 core recommendations [above], you can put them in three buckets. One, we’ve got to create a data and knowledge foundation, a digital foundation.  Second, we’ve got to apply that to each and every patient and to the community at large; and third, we’ve got to apply this information to the right policies.

And what are the implications? Fortunately, we had this thing called HITECH [the Health Information Technology for Economic and Clinical Health Act] that has given us a lot of the tools, and particularly the meaningful use objectives. So the broad objectives of meaningful use are very well aligned with the goals of this report. For example, in the first group of recommendations, we have clinical decision support as a key component of that group.

And we’re moving towards a major emphasis on this infrastructure, a big piece of which is the electronic health record [EHR], of course. Because you have to capture all this information on the front line, and you can’t do that without an EHR. And in order to engage patients, not only should patients be able to access information, they should be able to contribute information—thus, the need for patient portals.

Paul Tang, M.D.

Can you comment on the Stage 2 final rule requirement for patient engagement through patient access to and downloading of information, and the pushback on the part of the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), against providers’ request for the elimination of that requirement?

Just to put that 10 percent now five percent requirement, into context, 73 percent of our patients at Palo Alto Medical Foundation are online with us. And in today’s world, 5 percent is very achievable throughout the country. Now, 73 percent may not be achievable throughout the country, but that statistic [the 5 percent requirement] just shows what can be done. And the biggest progress takes place when physicians personally encourage their patients to get online with them; and the most common opportunity is during the patient visit. And it’s very easy for me to say to a patient when I’m giving them their lab result, would you get online? And it’s natural for them to say, yes, sure. And the thing is, patients really love this stuff, and get a lot out of it. And just having their information online encourages them towards healthy behaviors. So it’s really a try-it-you’ll-like-it technology, both on the patient and physician side. And you do have to have a little kickstart, but it’s very worthwhile.

The pioneering organizations in this country have all committed to continuous performance improvement and continuous learning, as recommended in the report. What are your thoughts on that?

Well, the pioneering organizations in performance have all long ago committed to investing in the information technology needed to support their work, and invested their own money, long before HITECH. Unfortunately, when you talk about the folks whose organizations haven’t achieved that continuous learning state, it’s because they haven’t achieved the infrastructure they’ve needed. The pioneering organizations’ leaders spent the money, ahead of the curve, on the infrastructure, and then moved ahead and improved; that’s why we have that divide between types of organizations. And that’s where HITECH comes in.

Do you think that we’ve reached a turning point of awareness in our industry now, with regard to healthcare leaders’ realization of the need to engage in concerted, coordinated performance improvement?

Yes, I do. We’re reaching that tipping point on health IT now because of HITECH. But also, everyone is in touch and regularly uses a computer in their lives now, and is accessing information and knowledge. So the cultures are being transformed for us because of the instant availability of data and information. And computing mobility is pushing us over that point.

In the context of the report and everything we’ve discussed here, what should CIOs and CMIOs and their teams be doing right now? What are your personal recommendations?