In his opening remarks to the May 7 Health IT Policy Committee, Farzad Mostashari, M.D., national coordinator for health IT, spoke about work flow and business process changes that must accompany payment reform and technology infrastructure. Mostashari chose not to use the policy committee forum to address the recent suggestion by the College of Healthcare Information Management Executives (CHIME)that Stage 2 of meaningful use be extended for an extra year. “We are halfway through the process of computerizing and digitizing healthcare settings, but only 5 percent of the way through redesigning work flows,” he said.
Mostashari used an example from a recent discussion with clinics working with Beacon communities to try to get more diabetic patients under low-density lipoprotein (LDL) control. Only about 40 to 45 percent of patients are leaving clinics with good LDL control, he noted. “I was speaking with a medical director for one of these clinics and he asked if I had a silver bullet to solve this problem because they felt they had tried everything.”
Mostashari said the solution lies in answering the simple question: if 600 out of every 1,000 patients are leaving clinics without good LDL control, how are we losing them? The first principle, he said, is the application of data. It has to be broken down into processes that can be focused on and improved. Were labs drawn? Did the patient not start on the statin? Was it prescribed but the LDL remains high?
The first gate is can you identify the patients you need to address. Can you identify where the process is failing? “Addressing this issue of helping people with diabetes has opened up a wonderful window to the skills we are going to need to develop,” he said. “And we are only about 5 percent of the way through that process. Those are the skills we need to learn about.” Providers have to more effectively engage with patients who need follow-up. They must get better at the kind of things marketers do to couch language in ways that improve response, he added.
These are the kinds of changes the digital tools make possible, he said. Payment reforms also are in place to reward those changes. “But payment reform and tools without know-how will not in the short run accomplish improvements in quality and cost we are rooting for,” he said. “How do we scale up the hard-fought knowledge about what works?” he asked. We can’t just rely on large integrated delivery networks that have strong quality control infrastructure. This effort isn’t just about 3,000 hospitals; it is about 180,000 physician practices, he added. “That is going to be the most interesting challenge for the next few years,”
UPDATE: In a tweet to HCI's Gabriel Perna, Dr. Mostashari said in regards to the CHIME proposal, "we consider specific regulatory proposals through the well-established regulatory process (rules and comment."