"Are we there yet?"
Every parent is familiar with that refrain. No doubt, every health system executive can be forgiven for asking the same question about the long-promised benefits of healthcare information technology. Despite investments of time and resources, data and information technology have struggled to become fully integrated into the workflow of care delivery and administration.
However, we are nearing our destination at last. Actionable content and content-as-a-service (CaaS) are two strategies that will have significant impacts on decision making, care coordination, administrative efficiency and outcomes.
Bringing Knowledge, Information into Clinical Workflows
For much of the history of medical practice, we have relied on the technology of the printed word to collect and share information. However, clinical knowledge is out of date as soon as it is bound in a textbook or printed in a medical journal. Today, content delivered electronically may be more convenient to use than printed content, but it is still not always available when and where it is needed, nor is it the most current information.
In the corporate world, many organizations have now adopted e-learning tools and shared learning environments to train employees with current information that is relevant to specific tasks. In the healthcare industry, new state-of-the-art technologies are enabling just-in-time delivery of appropriate content into provider workflows, such as when a physician is prescribing, ordering, scheduling or otherwise making decisions about patient care.
This shift will impact all aspects of care delivery. Picture a physician using the very best clinical content to make both evidence-based and cost-effective decisions during the course of providing treatment. Imagine the same content being made available to nurses, physician assistants, clinics and insurance plans, tailored to their specific level of understanding and information need. Most importantly, this kind of information sharing is key to a deeper partnership between the care provider and the patient, which leads to better care decisions. The end result is higher quality care that is more accessible, collaborative and affordable.
There are two broad categories of content:
1. Clinical content, which starts in the medical literature and is used in current practice standards
2. Person-specific data, which is specific to an individual and his or her clinical care
For content to become fully "actionable," it needs to satisfy three criteria:
Quality: Is the content based on the best, most current clinical evidence? Is the content as comprehensive and accurate as possible? Many factors go into a determination of quality, and various market solutions exist to support providers as well as payers in sorting through the volumes of available information.
Context: Is the content tailored to the patient and his or her unique environment? For content to recognize context, it must be translated into clear, consistent and reproducible rules logic. Those rules make content more intelligent by tying disparate pieces of information together. The right evidence-based treatment, for example, gets linked to other critical questions, such as whether that treatment is actually covered, where it should be provided, how much it costs, and what impact it can be expected to have on outcomes.
Accessibility: Is the content delivered when and where it is needed to best support decision making? CaaS is a new technology model that overcomes historical barriers to bring rules-based information to any point of care.
With CaaS, rules are housed in one secured, centralized repository - in "the cloud" - and delivered via technologies based on Web services, so that they can be deployed seamlessly to deliver up-to-date, actionable content into any healthcare workflow for simultaneous use by any stakeholder. This impacts care in three specific ways:
Centrally maintained content: Cloud-based content is always current and locally accessed. It is easier to organize and connect to other forms of content, easier to update and maintain based on the latest evidence, and easier to share, distribute and configure based on the preferences of the user. The cloud also makes it easier to develop new models to charge or pay for that content.
A common language for stakeholders: Without CaaS, content must be hard-coded into software. This compounds the challenges of staying up to date and integrated; various stakeholders will have different versions because of operational, financial and technological barriers to upgrading.
CaaS allows a broad group of clinicians and other healthcare personnel to access the most current, relevant and evidence-based content to enable their care decisions. It also allows various health systems to configure rules to meet their own needs while still enabling them to subscribe to a common core of content shared within healthcare. In addition, the sharing of rules between payers and providers brings administrative efficiency and a common language to the assessment of medical care, while ensuring the right channels for delivery.
Optimized intelligence: CaaS should not be unidirectional; in other words, content should travel from the cloud to the stakeholder and back again. This two-way flow enables us to continuously optimize and develop content, making it more intelligent, useful and current and overall a better integration tool. For instance, if the choices providers make in care lead to better outcomes, then a new mechanism for determining best practices becomes possible.
This set of performance data can be used as we move from reimbursement models based on volume to those based on value by providing scorecards that can be up to date and relevant to the payer and provider relationship. Such information will help us to accommodate accountable care organizations, quality of care assessments, and bundled and episode-based payment models. It can also begin to reveal the impacts of care decisions, complementing the very long randomized controlled trial processes in place today.
The elusive goal of healthcare information technology has always been to support more efficient, accurate and consistent decision making to enable better care delivery.
CaaS makes it possible for us to pull our disparate health system of multiple providers, payes, and patients into a cohesive ecosystem. As that content circulates among the stakeholders and feeds back into the system, it becomes truly intelligent, enhancing our understanding of what is taking place, what is best practice, and what is the right way forward. This is a game-changing step for achieving better quality, more cost-efficient care outcomes.
Dr. Mitus, Matt Zubiller and Laura Coughlin are members of the Decision Management team at Newton, Mass.-based McKesson Health Solutions.