Inside IT

Keith J. Figlioli

If you look at the majority of issues in American health care today-whether they relate to quality of care, process inefficiencies, or determining how to disseminate best practices and gain buy-in for them-you'll find that a lack of coordination and scale are often to blame. But what happens when we have an inverse of these problems-when there is so much scale, so much of a particular supply, that it overwhelms us?

Consider an example from many of our own lives.

As individual investors, we might think we have all the answers after watching "Squawk Box" at breakfast, "Power Lunch" at mid-day, and "Closing Bell" before our day ends. We can check the Japanese market at 1 a.m. and the British market at 4 a.m. Clearly we have lots of data. But do we have the intelligence?

The truth is, data only give us part of the story. There is so much information-so much inside insight-that is not flowing down to us. Moreover, the data aren't being shaped for us in a way that enables us to take action. And without predictive capabilities and the intelligence to support action, investors are playing with fool's gold.

The sad reality is that we're playing with fool's gold in health care, too, when we don't have the ability to manage data in a meaningful way.

Data Are Not the Problem- and Not the Answer

On average, there are about 100 relevant components to a person's medical history. These may include previous medical procedures and tests, medication allergies, and prescription dosage-the information needed to ensure the best possible care is received without duplication of effort.

But a physician may have access to only 10 or 20 of these critical pieces. As a result, individuals are often treated episodically by providers who have access only to a limited amount of necessary clinical information.

Take the example of a 45-year-old male with chronic diabetes. He has a primary physician, a dietitian, a diabetes educator, an eye doctor, a foot doctor, a dentist, a case management nurse, and a physical trainer. In an ideal world, these care providers would all be linked with the same information about an individual's medical history. They would be talking with one another, developing treatment plans, and making sure everything they do is complementary.

Unfortunately, this information sharing isn't happening. Instead, the individual is bouncing between providers that are creating reams of data that are not integrated and might actually be unreliable due to the number of manual inputs and inconsistent hand-offs.

Consider that the individual is expected to monitor, measure, and report his blood glucose each day. He may bring these results to an appointment on a sticky note. The provider must then take this information and input it manually into a paper-based "diabetes flow chart" to manage and track the individual's course of care.

This is an antiquated way of doing business. And this example illustrates where gaps in communication and intelligence can be found. When any part of this communication chain breaks down, individuals are at risk. If we have this much difficulty providing coordinated, integrated care for a single individual, is it any wonder that we have the same issues systemwide? Let's be clear: It's not that we need more data. We have an excess of data, growing every day. In the case of the diabetic patient, every time he pricks his finger and draws blood, there are data to collect. The issue is we don't have the ability to manage these data in a meaningful way.

Even in health systems with sophisticated electronic medical records, there is still a ton of paper flowing around that may not be shared or inputted into electronic systems. And when information does make it into an electronic warehouse, providers often do not have access to a full history. Different systems often do not "talk" with one another, making it difficult for providers to evaluate whether treatments were effective over the long term or compare how their care stacks up against that which others provide.

Often, when we talk about data or the ways in which we gather intelligence, people assume that we're talking about measurement. Measures are just one piece of this puzzle: They benchmark, but they don't predict. They show an organization where it stands, not where it is going.

Instead, we need centralized, automated intelligence. We need insights to manage across an entire care episode, and the right cues to understand what is happening and whether the best care protocols are being used. We need a system where caregivers are equipped with thousands of evidence-based examples regarding how to customize and tailor treatments to produce the best possible outcomes. No more paper "diabetes flow charts" or confusion fueled by systems that don't speak the same language. Rather, we'd have clinical decision support provided at the point of care delivery, helping physicians, nurses, and other providers make faster, better choices.

A World of Watsons

This past February, IBM's Watson, an artificial-intelligence-driven computer, beat two of "Jeopardy's" all-time winningest contestants. How great would it be if all providers had access to a Watson? They could say, "Watson, here is a 45-year-old diabetic's medical records and a full history of his treatment. What should we do now to generate the best health outcomes?"

There are a growing number of providers-such as Geisinger Health System in Danville, Pa., and Summa Health System in Akron, Ohio-that have the capability to connect these data. And with this capability, these organizations are able to deliver higher-quality-and more connected-care for the millions of people they serve.

But the capability can't remain isolated. It needs to be scaled so that providers nationwide can connect data in a meaningful way. And it needs to mirror what we're trying to build in health care: a system that is coordinated and integrated, where efforts aren't unnecessarily repeated or replicated.

A Bridge, Not a Barrier

The future of healthcare delivery needs to be defined by intelligence and communication that foster well being by managing all the steps needed to take someone through a complete care episode to a state of wellness and equilibrium. We can't achieve this desired state without tight interconnections and picture-perfect hand-offs across the continuum of care. Such an effort begins with the understanding that every data point, every blood draw from a diabetic, needs to be linked and communicated with every stakeholder across the healthcare community-and in a way that actually matters to each stakeholder.

The bottom line is that the technologies needed to better manage patient information exist. We need to use these technologies to shape and use our data to make actionable insights that improve outcomes and lower costs for each individual.

When we achieve this goal, we'll no longer have an excess of data and one-off technologies that often widen the gap in healthcare communications. Instead, we'll have a bridge to enable a smarter system that offers better care, better value, and better health. We'll have a world of Watsons.

Keith J. Figlioli is senior vice president of healthcare informatics, Premier healthcare alliance, Charlotte, N.C. (


Publication Date: Thursday, September 01, 2011

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