The healthcare communities around the world are under significant pressures due to well documented challenges (i.e., aging populations and decreasing wellness; poor patient safety results; increasing patient/consumer expectations; spiraling healthcare costs; and poor integration of care. HIT for healthcare information sharing (e.g., HIE, EHR, PHR, EMR) is still an empty promise.
In our entry for ‘Semantic Interoperability’ Robert Stegwee asks the question “if semantic interoperability is equally important to the healthcare professional, why is it still unknown territory to the majority?”.
Similarly, how do we account for individual expectations for the use of information technology to facilitate better care for individuals? They are getting older. They are becoming more likely to suffer from a long term chronic condition. They are educated consumers with expectations of getting what they want/need whenever they desire. They have been using technology in every other part of their life and see HIT as a reasonable approach.
How will care communities deal with these expectations and demands? There are many transformational ideas and programs underway including:
• Payment for results
• Proactive care services (see example Telehealth & Telecare entry by Jason Crellin)
• Restructuring of reimbursement models
• Increasing transparency of care costs and quality of care
• Introduction of competition into national care services
• And of course, national/regional HIE, EHR, PHR, EMR implementation programs
We see that these pressures and forms of response are appearing in virtually every nation, region, and care community, demanding specific responses suited to individual needs and expectations of the players. There is a clear need to balance the expectations and the complex value network that spans these players (i.e., hospitals, general practices, clinics, diagnostic service providers, payers, government, pharmacies, volunteer organizations, and patients). There are many examples, but consider the perverse incentives that exist when attempting to implement a proactive care service or share patient information through HIT. How do we get everyone to participate? How do we realign the value proposition incorporated into the reimbursement models?
Our experience indicates that healthcare transformation will require new levels of collaboration. The collaboration needs to actively engage all parties at the same time. The collaborative process needs to be sustained beyond the onetime instances. Collaboration needs to be supported by strong communications, agreed standards, and shared views of the community’s health economy (the value network).
That’s how we approach this global challenge. What are you seeing in your care community? Is collaboration working? Are the “players” working together with new levels of connectedness and cooperation? What are the key incentives that have made this happen? We welcome your contributions, be they positive or more skeptical.