Comments on: IT: Notes From A Parallel Universe http://healthaffairs.org/blog/2007/01/26/it-notes-from-a-parallel-universe/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: annecarroll http://healthaffairs.org/blog/2007/01/26/it-notes-from-a-parallel-universe/comment-page-1/#comment-734 annecarroll Thu, 01 Feb 2007 19:25:02 +0000 http://healthaffairs.org/blog/2007/01/26/it-notes-from-a-parallel-universe/#comment-734 To give a different perspective on Chheda's comment: planning and standards must come from top-down, while a bottom-up approach may be appropriate for implementation, support, and diffusing the use of IT and health information throughout the individual practice sector. Both of these activities must be done simultaneously. Relying only on a bottom-up approach will not address the barriers to adoption that physician practices have identified: cost, lack of familiarity with information technology, fear of the need for constant upgrades, lack of capacity to evaluate new technologies, confusion arising from the need to know and use different systems at different hospitals where they have privileges. Another urgent reason for top-down planning and standards is the need for public health agencies at the state and local levels to carry out their responsibility for health status surveillance at the community level. Greater penetration of syndromic surveillance capacity is required to detect non-routine situations such as emergent diseases, exposures to environmental pathogens, etc., as well as to evaluate the outcomes and impacts of public health interventions in the community. The current patchwork system of required reporting of a limited subset of diseases and observations is underused, confusing, provides little actionable knowledge, and reveals the inefficiency and ineffectiveness that is the outcome of one-way systems development. Developing these kinds of capabilities depends on top-down standards and planning by federal, state, and local public health acitvities with the provider communities as well as bottom-up support in their implementation and capacity development to remove the barriers to their adoption. Finally, top-down planning and standards developed independently from the way health care is delivered enable future development of technology that builds the capacity of providers and supports new learning from medical and health care data. If individual practices or HMO's went away tomorrow, or if different kinds of data must be collected or different knowledge about outcomes must be analyzed, or if a provider decides to use a new technology, the top-down plan and standards provide a roadmap for how to get to a new destination. For an analogy, we frequently point to the 2x4 board as a standard for the construction industry: it is flexible enough to be used in many different kinds and styles of buildings, it does not restrict future designs or uses of buildings; yet it is also beneficial for planning a project, for budgeting, and for understanding how a project will be engineered and implemented. To give a different perspective on Chheda’s comment: planning and standards must come from top-down, while a bottom-up approach may be appropriate for implementation, support, and diffusing the use of IT and health information throughout the individual practice sector. Both of these activities must be done simultaneously. Relying only on a bottom-up approach will not address the barriers to adoption that physician practices have identified: cost, lack of familiarity with information technology, fear of the need for constant upgrades, lack of capacity to evaluate new technologies, confusion arising from the need to know and use different systems at different hospitals where they have privileges.

Another urgent reason for top-down planning and standards is the need for public health agencies at the state and local levels to carry out their responsibility for health status surveillance at the community level. Greater penetration of syndromic surveillance capacity is required to detect non-routine situations such as emergent diseases, exposures to environmental pathogens, etc., as well as to evaluate the outcomes and impacts of public health interventions in the community. The current patchwork system of required reporting of a limited subset of diseases and observations is underused, confusing, provides little actionable knowledge, and reveals the inefficiency and ineffectiveness that is the outcome of one-way systems development. Developing these kinds of capabilities depends on top-down standards and planning by federal, state, and local public health acitvities with the provider communities as well as bottom-up support in their implementation and capacity development to remove the barriers to their adoption.

Finally, top-down planning and standards developed independently from the way health care is delivered enable future development of technology that builds the capacity of providers and supports new learning from medical and health care data. If individual practices or HMO’s went away tomorrow, or if different kinds of data must be collected or different knowledge about outcomes must be analyzed, or if a provider decides to use a new technology, the top-down plan and standards provide a roadmap for how to get to a new destination. For an analogy, we frequently point to the 2×4 board as a standard for the construction industry: it is flexible enough to be used in many different kinds and styles of buildings, it does not restrict future designs or uses of buildings; yet it is also beneficial for planning a project, for budgeting, and for understanding how a project will be engineered and implemented.

]]> By: Nainil Chheda http://healthaffairs.org/blog/2007/01/26/it-notes-from-a-parallel-universe/comment-page-1/#comment-725 Nainil Chheda Thu, 01 Feb 2007 05:24:46 +0000 http://healthaffairs.org/blog/2007/01/26/it-notes-from-a-parallel-universe/#comment-725 It has been argued by variety of industry leaders that even thought there are many such nationwide systems trying to interact with each other and exchange relevant patient data, the truth still remains true that if there is not enough penetration of the EHR industry amongst the physician practices the system will fail. There needs to be a bottom-up approach and not a top-down approach. The top-down approach leads to the creation of various nationwide systems and standards first and then looks for the availability of electronic health record amongst the physicians. However the bottom-up approach first creates a need for the electronic health records amongst the physicians; and then joins them together to form nationwide architectures. Even though there is a good possibility of the rapid learning systems evolving quickly, the base questions are still left unanswered: - “What are the risks involved in creating a central repository of patient relevant information?”, “Who owns the patient data?” and “What are the barriers to the growth of these rapid learning systems”. It has been argued by variety of industry leaders that even thought there are many such nationwide systems trying to interact with each other and exchange relevant patient data, the truth still remains true that if there is not enough penetration of the EHR industry amongst the physician practices the system will fail.

There needs to be a bottom-up approach and not a top-down approach. The top-down approach leads to the creation of various nationwide systems and standards first and then looks for the availability of electronic health record amongst the physicians. However the bottom-up approach first creates a need for the electronic health records amongst the physicians; and then joins them together to form nationwide architectures.

Even though there is a good possibility of the rapid learning systems evolving quickly, the base questions are still left unanswered: – “What are the risks involved in creating a central repository of patient relevant information?”, “Who owns the patient data?” and “What are the barriers to the growth of these rapid learning systems”.

]]>