Health IT Holds Key To Better Care Integration

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Although a new report on improving and accelerating the coordination of care does not explicitly say so, a former head of Kaiser Permanente who helped draft the paper believes that it is nearly impossible to achieve the goals of care integration in the absence of well-designed IT systems.

"IT is a substantial enabler," Dr. David M. Lawrence, retired chairman and CEO of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, told InformationWeek Healthcare. "You almost cannot do complex medical care without that kind of connectivity."

Lawrence, who led the Kaiser Permanente organization from 1991 to 2002, was on the committee that wrote the newly released Order from Chaos: Accelerating Care Integration, from the Lucian Leape Institute at the National Patient Safety Foundation.

According to the report, which was funded in part by pharmaceutical and medical device manufacturer Hospira, the average patient with a single chronic illness will be cared for by six to nine physicians, at multiple sites, over a prolonged period of time.

The report also notes that the Institute of Medicine reports on patient safety, To Err Is Human (1999) and Crossing the Quality Chasm (2001), said lack of care integration is a major factor in preventable medical errors.

"Most failures of coordination occur during care transitions, when there is a failure to transfer key pieces of information during handover and to ensure the completion of essential tasks of care," the Lucian Leape Institute report stated. "Examples include failure to transfer the results of medical tests and even the medical record as a whole, specialists receiving little or no information from referring primary care providers, and inadequate or missing discharge summaries."

Unfortunately, according to Lawrence, there has been "little attention" paid to how important a technology infrastructure is to care integration.

Lawrence explained that connectivity is finding a way of assembling vast amounts of data in real time. Healthcare has "fallen far behind" other industries in terms of collecting, synthesizing, and processing large quantities of information. "What you now have is too much data for the typical doctor to sift through," Lawrence explained to InformationWeek Healthcare.

"It's the really complex stuff where this becomes particularly critical," Lawrence added. "The more complex the issue, the more minds you need." Computers can and should serve as those minds.

Lawrence said the advances in medical technology since World War II have served to "deepen the intelligence required to practice medicine." However, data from medical devices and diagnostic testing still ends up in silos more often than not. In the context of reform-minded innovations like the patient-centered medical home, silos only make the task more complicated, he said.

"The medical home doesn't synthesize complex intelligence," Lawrence explained. Providing visibility into all the silos of information in real time needs to be central in coordinating care between multiple providers and even non-clinical settings.

Organizations unwilling to invest in the technology to provide this type of integration and coordination typically blame the cost. "It's less expensive to do it than not to do it," Lawrence said. He acknowledged that it can be difficult for cash-strapped community hospitals, rural facilities, and those providing safety-net care to invest in IT and process redesign. However, the former Kaiser CEO said, "It is morally proper to do this."

IT also will help break down barriers to greater patient engagement in their own care, including the significant cultural barrier of physicians traditionally being the final authority on healthcare decisions.

"The care delivery system is struggling to escape the straitjacket of physician autonomy and economic independence, a payment system that reinforces fragmentation and independent decision making, and a regulatory framework that places legal responsibility on the individual professional without corresponding accountability of the team or the system within which that professional works," the report says.

Or, as Lawrence put it, "The culture is still docs not talking to each other with this ping-pong approach to referrals."

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)