Is Population Health Management Latest Health IT Fad?
Several thought leaders are pushing the PHM approach to healthcare, but we need more sophisticated EHRs and clinical analytics systems to make it a reality.
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In my 30 years as a journalist and science writer, I've seen countless "healthcare revolutions" come and go. So I can't help but wonder if the new push to reform patient care using population health management (PHM) is another of those "revolutions."
So exactly what is PHM? Experts define it in various ways. According to Mathematica, a policy research group, PHM aims to
''improve population health by attacking 'the upstream causes of so much of our ill health,' including poor nutrition, physical inactivity, and substance abuse. One medical dictionary defines it as, "The coordination of care delivery across a population to improve clinical and financial outcomes, through disease, case, and demand management."
Those are noble aims but identifying the upstream causes of poor health and improving care coordination are tall orders for our fragmented healthcare system. What's needed are sophisticated IT tools and a willingness on the part of clinicians to embrace them to turn patient population management into a long-term tactic.
On the IT front, a recent report from the Institute for Health Technology Transformation sees several roadblocks to fully realized PHM. The report cites a variety of technology tools needed to keep populations healthy and minimize the need for expensive interventions such as emergency department visits and hospitalizations.
Those tools include electronic health records, telehealth platforms, electronic registries, data management software, and analytics systems. Providers can use EHRs and automation tools in particular to identify and stratify patients who need special attention or care; identify care gaps; measure outcomes; and encourage patients to assume more responsibility for their health, the report says.
However the tools healthcare providers currently use don't have the ability to store, manage, and distribute comprehensive, timely, and relevant information to the degree needed for PHM, the report concludes.
EHRs, for example, often don't contain the data about the care that patients have received outside an organization, and they aren't designed for interoperability. Likewise, many EHRs don't generate the real-time alerts for preventive and chronic care, and don't generate quality and population reporting.
Similarly, many clinical analytics tools currently in use are quite primitive, reporting a few basic facts and figures about a patient panel. The next generation of BI tools will have to be predictive and prescriptive to make PHM a reality.
On the clinician side, there are other thorny issues to contend with. Physicians have been trained to provide individual care, not population care, and while PHM proponents might counter that population care is simply individual care multiplied by X, it's more complicated than that.
Many of the interventions needed to improve the health of a large population fall more into the realm of education and public safety than they do into medical practice. Getting diabetics to exercise more or eat a heart-healthy diet, for instance, isn't what doctors do best. That's traditionally been handled by nurse educators and public health agencies, often with the help of public service campaigns or classroom instruction.
Similarly, many doctors object to having clinical practice guidelines imposed upon them, even when those guidelines have been proven to improve the health of large patient populations. Physicians argue that what works on a population as a whole doesn't always work on individual patients. And from a statistical point of view, that makes sense.
A clinical trial that shows a drug lowers serum cholesterol in 1,000 patients doesn't prove that it will be effective--or safe--when administered to an individual patient who didn't share the lifestyle, gender, eating habits, and genetic predisposition of the 1,000 patients in the clinical trial.
The bottom line: Unless our IT systems get a major upgrade and clinician concerns are addressed, patient health management may become another one of those fanciful "solutions" that fade into the sunset.
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