Better Information, Better Clinical Decisions
Optimum utilization management is best driven through evidence-based medicine which is fed by vast and readily-accessible patient data
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated
When you stop and think about the available tools and resources for clinicians today, it is somewhat mind boggling. The clinical resources and study data, ready access to health records, vast networks of physicians from general through specialty and so many other resources are available. For a clinician, these resources are augmented with a more sophisticated patient population who also has access to much broader medical and healthcare databases than any time in history.
A concern though is the capability to aggregate these disparate sources of information together at the time they are needed so better clinical decisions can be made. The use in a practice of EMR (electronic medical or health records) has been the buzz for several years, and highlighted throughout the recent healthcare reform debate. In the ARRA bill [1], $36B was allocated to healthcare IT and EMR with an aggressive reimbursement schedule based on the timeliness and speed of adoption and implementation into the practice or facility. Subsequently, they have been implemented in many practices and healthcare facilities. The challenge continues though in the transfer of this information between unrelated facilities or practices and the integration into decision support aids.
The goal of the EMR is to collect, centralize, standardize and act as a repository for patient healthcare information for use by all of the stakeholders within the system so efficiencies can be achieved throughout the healthcare process. By efficiency, I mean speed of acquisition, accuracy of information and ready transmission to the clinical decision maker. As EMR tools are implemented on a grand scale, within and across health plans, a huge quantity of data will be collected and ultimately available. As you know though, more is not necessarily better. In the context of EMR, the benefit of more data is actualized in the ready access and format so the required information is available in an on-demand mode. (Please note that I do not use data and information interchangeably since data without formatting and ready access is just a collection of numbers or facts. Information is the processing of data and hence formatted for immediate and direct use as required for our decision making). Challenges arise though, assuming you agree with the ‘collect, centralize, standardize and distribution’ nature of an effective EMR, in the cross-organizational sharing of information that may not be readily accessible or formatted similarly.
That said, it is still my belief that the more and better information we can get, the more effective we can be in practicing medicine – effective in both improving outcomes and reducing costs. Utilization Management, by definition, optimizes the triage, diagnosis and treatment of patients utilizing evidence-based information. So important is evidence-based medicine (EBM), the Healthcare Reform Bill (HR 3590) referenced it several dozen times both as a treatment and preventive modality. The thought process allows the optimal leverage of countless data points correlating treatment with outcomes, and via algorithm, assisting the clinician through the best-case scenario in a decision-support role.
Interestingly, it has been clearly observed in multiple hospital studies which show that some of the best clinical outcomes can be seen at facilities that actually have lower costs. It seems that the availability of more information certainly lays the groundwork for better outcomes. Case in point – Pennsylvania. The Pennsylvania Health Care Cost Containment Council (PHC4) continues to track key healthcare metrics as they have for over 20 years. They publish these statistics annually. Some are pretty impressive. For instance, over the last 5 years, although their readmission rate has stayed roughly constant (down from 19.1% to hover around 18.7%), the length of stay (LOS) statistics are quite impressive. In 1994, the statewide average LOS was 6.63 days. From their FY09 report, it had decreased to 5.23%, showing a steady decrease over the previous 16 years.
Details are endless for different ailments and conditions. The more information that is available to clinicians, the better the decisions they will be able to make. These would include stent implants for cardiovascular disease, overuse of CT scans, over-prescribing of antibiotics for viruses they cannot cure, back pain diagnosis (or non diagnosis) from multiple MRI scans to name a few. This is not to say that information alone should drive the physicians’ decisions. Information can support and guide their decisions as well as justify their diagnosis and treatment. In the end, the physician is responsible and accountable for the patient’s care and outcome. Information will allow the physician to be the best caregiver they can be. I believe that better information makes for better outcomes.
What do you think?
Thanks for reading and I welcome your comments. Since we are expanding the focus, I would also welcome your thoughts on topics that would interest you. Please contact me directly at healthexecforum@healthintegrated.com or you can comment directly in the blog.
Best Regards,
Jay I. Pomerantz, MD
Notes:
Download: PWC Report on Stimulus Package
[1] American Recovery and Reinvestment Act of 2009
