The vision of a safe, efficient and cost-effective healthcare system supported by information technology was outlined in a recent Institute of Medicine report, The Learning Health System Series: The Digital Infrastructure.

According to the report, the primary intent of the meetings which informed it was to identify and explore strategic opportunities for accelerating the evolution of a digital infrastructure -- described as "the (healthcare) system's nerve center, its circulation system, or the engine" -- that will support and drive continuous improvement.

The report identified several rules to guide healthcare which are intended to bring more, and more appropriate, information to bear for both clinicians and patients at the point of care.

The goal is to bring about the "emergence of a digital infrastructure that allows data collected during activities in various settings -- clinical, research, and public health -- to be integrated, analyzed, and broadly applied ('collect once, use for multiple purposes') to inform and improve clinical care decisions, promote patient education and self-management, design public health strategies, and support research and knowledge development efforts in a timely manner."

The report heavily endorsed both the incorporation of population health data into the clinical decision-making process and, "the direct involvement and support of patient and population roles in the generation of knowledge through the incorporation of user-generated data; understanding the benefits of information use in patient care and population health improvement; and improving patient access to health information to allow for a more active role in care decisions."

In terms of recommendations, the report supported taking an "ultra-large-scale systems (ULS) approach" to developing a digital infrastructure.

"ULS refers to the existence of a virtual system that has bearing on a social purpose -- e.g. improving health and healthcare -- and in which a few key elements, such as interchange representation, may be standardized, but whose many participants have diverse and even conflicting goals, so adaptability is key. Institutions retain flexibility for innovation in their choices, and evolutionary functional change can be shaped by architectural precepts, incentives, and compliance assessment, but not by centralized control."

The report went on: "ULS functionality is therefore facilitated by protocols that allow maximum practical flexibility for participants. Incorporating decentralization of data, development, and operational authority and control, this approach fosters local innovation, personalization, and emergent behaviors. Participants felt that this approach was well suited to the complex adaptive characteristics of the health system, and that it could serve as an anchoring framework for approaching both the social and technical components of the overall infrastructure."

On a more granular level, the report said stakeholders should endorse, "the principle of parsimony and minimizing centralization that might constitute a barrier to entry: specify only the minimal set of standards or requirements necessary for key functional utility, and push the maximum amount of control to the periphery."

In setting the stage for its recommendations, the report seemed to specifically note that Health Information Technology for Economic and Clinical Health (HITECH) was a much-needed step in the evolution of a digital healthcare system. "...The diversity and limited compatibility of the products, and the lack of economic incentives to their use has, to date, restrained the broader uptake, application, and functional utility of digital capacity across the system."

The report was the result of three meetings held in the summer and fall of 2010, bringing together researchers, computer scientists, privacy experts, clinicians, healthcare administrators, health IT professionals, representatives of patient advocacy groups, healthcare policymakers, and other stakeholders.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at aguerra@healthsystemCIO.com.

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