The impact of health information technology on collaborative chronic care management.

BACKGROUND: Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. OBJECTIVE: To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. SUMMARY: Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. CONCLUSIONS: Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

Transforming the future of health together: The Learning Health Systems Consensus Action Plan.

The Learning Health Community is an emergent global multistakeholder grassroots incipient movement bonded together by a set of consensus Core Values Underlying a National-Scale Person-Centered Continuous Learning Health System developed at the 2012 Learning Health System (LHS) Summit. The Learning Health Community's Second LHS Summit was convened on December 8 to 9, 2016 building upon LHS efforts taking shape in order to achieve consensus on actions that, if taken, will advance LHSs and the LHS vision from what remain appealing concepts to a working reality for improving the health of individuals and populations globally. An iterative half-year collaborative revision process following the Second LHS Summit led to the development of the Learning Health Systems Consensus Action Plan.

Health information exchange policy and evaluation.

Concerns about the quality, safety, and cost of healthcare have driven the nation to increase its focus on this issue. A number of states are moving forward-in parallel with federal efforts-to develop and adopt policies for improving health and healthcare through health information technology and electronic health information exchange. Based on the eHealth Initiative's experience providing technical assistance to more than 20 states, and its work related to its coalition of more than 250 state, regional and community-based health information exchange initiatives and organizations, the most difficult challenges facing these initiatives and organizations today is that related to assessing the value of services that emerge from the health information exchange to various stakeholders groups such as providers, payers, and employers, and converting those value assessments to business plans that promote and assure sustainability for these initiatives. The combination of increased federal and state focus and funding and the pace at which regional and community-based health information networks are developing, along with the identification of value and sustainability as some of the most difficult challenges experienced by these efforts, all point to the significant need for evaluation. The most critical evaluation questions focus on the impact of health information technology and health information exchange on quality, safety, efficiency, the value of such efforts for various stakeholders, and assessment of how grant programs can be designed to support positive impact, value, and a sustainable business model, so that efforts continue when the grant funds are fully expended.

The United Hospital Fund meeting on evaluating health information exchange.

Health information exchange (HIE) projects are sweeping the nation, with hopes that they will lead to high quality, efficient care, yet the literature on their measured benefits remains sparse. To the degree that the field adopts a common set of evaluation strategies, duplicate work can be reduced and meta-analysis will be easier. The United Hospital Fund sponsored a meeting to address HIE evaluation. HIE projects are diverse with many kinds of effects. Assessment of the operation of the HIE infrastructure and of usage should be done for all projects. The immediate business case must be demonstrated for the stakeholders. Rigorous evaluation of the effect on quality may only need to be done for a handful of projects, with simpler process studies elsewhere. Unintended consequences should be monitored. A comprehensive study of return on investment requires an assessment of all effects. Program evaluation across several projects may help set future policy.

The potential of HIEs as infomediaries.

For more than 40 years, various health services researchers have noted the many distortions in the American healthcare economy that produce massive information assymetries and almost near opacity in the medical services delivery market. This paper comments on the potential of health information exchanges (HIE) to address many of these deeply embedded structural issues. Although hundreds of HIEs are emerging across the nation and the value of moving to a fully interoperable digital healthcare system has been widely recognized, the economic sustainability of HIEs remains a vexing matter While most of these organizations rely on a transaction- or production efficiency-based model, the authors conclude this model has economic limits and their future viability may rest upon HIEs becoming public utility infomediaries. As infomediaries that create value-not just in new exchange efficiencies but by establishing new system-wide feedback loops-HIEs may yield entirely new levels of value to many types of markets interested in better managing their portfolios of risk.

Results From the Bipartisan Policy Center's CEO Council Physical Activity Challenge to American Business.

OBJECTIVE: The aim of this study was to describe findings from a survey of employees at 10 businesses participating in the "Building Better Health: Physical Activity Challenge," an effort led by the Bipartisan Policy Center's CEO Council on Health and Innovation. METHODS: Employers provided employees with pedometers as part of an 8-week Physical Activity Challenge (Challenge). Employees were then asked to complete a survey about their awareness of, participation in, and satisfaction with the Challenge. RESULTS: One hundred three thousand three hundred eighty-three employees participated in the Challenge, averaging 6886 steps per day per participant. Of the 3820 respondents to an employee survey sent to all workers, 62% reported enrolling in the program, and of those, the majority reported positive impacts on health (76%), fitness (73%), and lifestyle (70%). CONCLUSION: A brief, workplace-based physical activity challenge can achieve positive self-reported health impacts when supported by senior management of the company.

Communities' readiness for health information exchange: the National Landscape in 2004.

BACKGROUND: The Secretary of Health and Human Services recently released a report calling for the nation to create a national health information network (NHIN) that would interconnect Regional Health Information Organizations (RHIOs). These RHIOs, which others have called Local or Regional Health Information Infrastructures (LHII), would in turn interconnect local as well as national health information resources. Little data exist about the activities taking place in communities to create LHIIs. APPROACH: The authors analyzed data that communities submitted in response to a request for capabilities issued by the Foundation for eHealth as part of their Connecting Communities for Better Health program using descriptive statistics and subjective evaluation. IMPRESSION: The authors analyzed data from 134 responses from communities in 42 states and the District of Columbia. Communities are enthusiastic about moving forward with health information exchange to create LHIIs to improve the efficiency, quality, and safety of care. They have identified significant local sources of investment and plan to use some clinical data standards but not as broadly as was expected. The communities have not yet developed the specific technical approaches or the sustainable business models that will be required. Many communities are interested in creating an LHII and are developing the leadership commitment needed to translate that interest into an operational reality. Clinical information standards can be incorporated into a community's plans as often as they need to be. Communities have to overcome funding issues, develop deeper understanding of the technical and organizational issues, and aggressively share their learning to succeed within their community and to help other communities succeed.

A novel Transformation Model© for personalized medicine laboratory systems.

The role of health system laboratories is critical to the appropriate clinical integration of personalized medicine. We conducted semistructured interviews with experts and opinion leaders representing laboratory medicine, health policy and the diagnostics industry, to examine what is known about the real-world effectiveness of health laboratories as organizations. We describe and encourage the wider use of an evidence-based, novel Transformation Model© to prepare for the future and set goals for a better health system. A collaborative approach appropriately integrates the efficiency and high-quality expertise of the health laboratory system with the transformative vision of the personalized medicine community.