Brief description of current state of healthcare delivery system and benefits of widespread implementation of information technology

1. Noelani Fox
University of Texas
HIT Institute
How Health Information Technology can Improve
Community Health Outcomes
The Current State of Affairs
An increasing amount of political and popular attentionis being focused on the state of
our national health care system. OrdinaryAmericans are realizing what politicians,
medical experts, and public health authorities have known for a long time: our health
care system is poorly designed to keep our population healthy. The organization of our
health care delivery system today is the result of unplanned construction, and the time
has come to apply intentional reforms and systemic changes that can positively affect
health outcomes. Although we provide top quality medical schools and ground breaking
research, have access to the most effective medical equipment and technology, and
have some of the most skilled specialists in the world, the overall health of our
population compares unfavorably to many other countries with fewer resources. In
order to impact our out-of-control health care costs, elevated chronic disease
prevalence, and declining wellness metrics, we must focus on the fundamental changes
to our health care delivery system that can generate improved community health
outcomes.
A national health care delivery system is anintricatecomposite of many attributes.
Types of providers and care settings, payments structures, quality oversight and
reporting, government policies, and patient attitudes all contribute to the form and
functionality of health care. From the standpoint of a wellness based approach, each of
these areas is deficient in America today. Our focus is on tertiary instead of primary
care, our performance on adverse medical events is very discouraging,and we do not
actively support preventive care, have public policies or coordination of care that
encourage health. Finally, as citizens, we are not encouraged to be proactive in our
own care, and live lifestyles that are hazardous to our health.
There is no easy fix for the multitude of dysfunctional components of American health
care. Recent policies in Washington are beginning to address fundamental failings;
providing increased access to the healthcare system for those to whom care is currently
unavailable, developing measures to improve quality of care, and recognizing the need
for better management of information, both patient specific and up-to-date evidence-
based information. The medical profession is an information intensive industry. A
physician cannot possibly keep current with all the new research, diagnoses, guidelines

2. and best practices that are constantly evolving. Without automated communication, he
cannot know all the details of care a patient is receiving from an array of specialists.
Being that we live in the information age, it is high time we brought medicine out of the
dark ages of paper charts, information silos, and 17 year delays in getting research
findings to the front lines of care.
The United States is experiencing a crisis in chronic illness, and the tertiary focus on
acute care does not support management of these conditions. There are two major
contributors to this predicament. Modern medicine has eliminated most of the acute
illnesses that kept life expectancy low for thousands of years. We have an aging
population, and elderly people are more likely to develop multiple diseases that require
management. Modern efficiencies and commercial interests have also contributed to
our declining health, in that low nutrient convenience foods have replaced whole foods,
very little physical effort is required to work, transport, and care for ourselves, and our
environment is polluted and, often, a contributor to ill health. People are developing
chronic conditions at progressively earlier ages.
In 2007, heart disease, cancer and stroke were the top three causes of death, followed
by lower respiratory diseases and accidents. The Institute of Medicine has estimated
that nearly 100,000 accidental deaths are attributable to medical errors.Prescription
errors and adverse medical events are increasing causes of emergency room visits.
Inadequate management of chronic diseases and iatrogenic injuries are having a huge
impact on our mortality and morbidity statistics, and our national health.
Health Information Technology
There are many ways health information technology can contribute to our healthcare
delivery system. Chronic disease management, improved patient safety, care
coordination, and public health are four main categories of benefits to be directly
derived from widespread use of integrated health information. Immediate results can be
obtained through better chronic disease management and decreased injuries. Long
term benefits can be derived from the genesis of patient centered medical homes,
where care is accomplished through partnership between the patient, all of her
providers, and family, facilitated by information technology. Additionally, de-identified
aggregate information extracted from nationwide databases can contribute to the body
of knowledge and to the management of public health crises and national health.
Patient registries and clinical decision support are functions that have the potential to
significantly augment population health management. Computerized systems can track
and alert providers to the need for vaccinations, preventive screenings, and lifestyle
education and counseling. Once a patient is identified as having a specific condition,his
needs for monitoring and treatment can be automatically linked to current evidence
based care guidelines. On-screen alerts and regular reports can be valuable tools to
help the provider ensure that he is providing high quality care.

3. Electronic prescription management is a measure that is widely acknowledged as
having the potential to prevent adverse events. Electronic medical records have the
capability to check for possible drug interactions at the time of initial prescription;
electronic transmission of the prescription order eliminates concerns of illegibilityand
other translational errors; and, interoperable systems can ensure complete and
accurate information on all medications prescribed to an individual.
Coordination of care across settings is crucial to improving quality and decreasing
duplicated or unnecessary services. Communication with the patient is essential, as is
collective informationamong primary care providers, specialists, hospitals, nursing
homes and home health agencies, ancillary services, and community resources. Health
information exchanges can support partnerships between providers, patients and their
families in the patient centered medical home, and ensure that patients get care when
and where they need it. Open communication and shared information can inform
everyone involved of their roles and responsibilities in the care of the patient, and
increase accountability.
Health and wellness are not solely in the domain of health practitioners. Patients must
be encouraged to take responsibility for their own role in determining their health.
Patient education through counseling, support groups, handouts and internet based
information can empower patients to make choices that prevent potential disease, or to
self-manage disease once it has presented. Providers can be encouraged to provide
preventive and educational measures if the ease of access and distribution is
automated, and if they can be properly compensated through documentation of these
efforts. Additionally, patient adherence to treatment plans can be encouraged through
computerized home monitoring of vital measurements such as glucose levels or blood
pressure and electronic monitoring of prescription bottles, which can also feed data
directly into an EHR and inform the provider. Finally, improved communication between
the patient and provider can be enhanced through patient portals and other electronic
communication technology.
Public policy is being written to support the extensive changes necessary for the
renovation of our healthcare delivery system. A significant component is the investment
in widespread electronic health record implementation and information technology
infrastructure. Complete, accurate,structured, patient-centered information from
multiple sources can be intelligently filtered through up-to-the-minute guidelines
contained in clinical decision support engines to support best practices of quality care.
Patients can be given the appropriate kind and intensity of support to self-manage their
disease under the care of a fully informed physician. Aggregate information from many
sources can provide regional and national planners and policy makers with the
necessary data to inform enhanced preventive measures and public health policies.
Community health outcomes can be positively impacted at the personal level, provider
panel level, and national health level through the widespread adoption of health
information technology.

4. Acknowledgement
Thank you to Dr. Vince Fonseca, Director of Medical Informatics at Intellica Corporation, for his
advice and insight.
References
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e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice,
Schade, CP, et al, Journal of the American Medical Informatics Association, Volume 13, Issue
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