As a result, first vendors and then the federal government, through the meaningful use program, have defined what they want in healthcare IT systems--while providers, the ones actually paying for the systems, haven't had a say. It's time for that to change.
Define the Software Capabilities You Need
The CURE Project began as an "academic exercise" for the Agency for Healthcare Research and Quality that examined information models in the patient-centered medical home (PCMH), one of the cost-saving initiatives included in healthcare reform. Brown and Waldren had to define that information model, as there was no standard approach, and soon discerned that the model was missing nearly everywhere else, too.
Traditionally, healthcare IT systems have been designed in an iterative manner that focused on business process automation--namely, billing and documentation--and not care delivery. Now that government incentives encourage improved care, through the adoption of the PCMH and the accountable care organization, there are financial reasons to improve clinical applications, Waldren notes.
For this to happen, the industry needs to define the capabilities it needs, the software functionality that will make it happen and the common, open technical specifications--not the "insular and problematic and very proprietary" ones Brown says EHR vendors have used for so long--which can deliver these features.
"If we don't specify what we need to do as these new types of [healthcare] delivery models, or existing delivery models, we can't expect to get a usable, interoperable IT system to support them," Waldren says.
The CURE Project is taking a grassroots approach to defining these capabilities and functionality; its parent company, New Health Networks, will license the output via Creative Commons, and once that work is finished the CURE Project will turn the work over to an entity the community deems best suited to manage and oversee the specifications.
A grassroots approach is necessary because those definitions need to be specific. For example, Waldren points out, healthcare leaders say they want "population management" capabilities, but that's far too vague to build specs around.
The community needs to decide what patient care quality measures need to appear in a dashboard, what evidence can be brought in to change an individual patient's care plan and, on a broader level, what data will be used to determine which patients are at the highest risk of, say, developing diabetes. If that doesn't happen, he says, the emerging EHR backlash will only worsen.
EHR Interop Struggles of VA, DOD Point to Management Woes
Few scenarios better illustrates the difficulty of interoperability, and the source of that backlash, than the 15-year effort of the Veterans Affairs and Defense departments to get their EHR systems to talk to each other.
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