Editor’s note: For more on connected health, see Health Affairs‘ newly published February thematic issue on the subject. The issue was discussed at a Washington DC briefing this morning, keynoted by the new National Coordinator for Health Information Technology, Karen DeSalvo. The Office of the National Coordinator and West Health Institute are cosponsoring a conference tomorrow on developing an interoperable health care system.
There is a war going on in our healthcare system, where according to a recent analysis, the annual losses are worse than any other war in our nation’s history, including the Civil War, World War II and our War on Terror. It is an undeclared “war on error” within our healthcare delivery system. It is the most deadly war we have ever waged, with errors and resultant harm in hospitals contributing to the death of nearly 1,000 people each day in the U.S., potentially more than 400,000 a year.
As with any other war, there is an enormous economic burden. The U.S. spent approximately $2.8 trillion on health care in 2012, with about 30 percent of total health care expenditures attributed to hospital services. That’s just over $800 billion annually, making America’s war on error not only the deadliest, but also the most expensive.
Until now, this war has often been waged in hospitals, where small, poorly outfitted groups of combatants have used simple, unconventional means like prompts for hand washing, autographing surgical sites and implementing ‘no interruption zone’ for medicine preparation – with limited success. But now, new technologies like integrated sensor networks, fully integrated electronic medical records (EMRs), clinical-decision support systems and algorithm-based care, all embedded in smart and learning systems, may finally provide the tools needed to win the war.
A war on two fronts
Transformed with these and other tools of connected health, the war can be seen as taking place in two separate settings, the home and hospital. On the home front, connected health technologies can enable objective measurement, motivation of healthy behaviors, predictive analytics to improve patient adherence, passive monitoring of critical biomarkers, and delivery and management of the frequent but subtle “course-corrective” interventions to help avoid hospitalizations, potentially outflanking the opponent of hospital-induced errors. In this way, causalities could be prevented by helping keep the chronically ill out of harm’s way.
When hospital stays are unavoidable, these same technologies can be used to ensure that in-hospital communication between and among providers, EMRs, and related medical devices is seamless and that care is timely, smart, and safe. We must assure that the wide array of individuals and devices that all play important roles in patient care do so in a connected, coordinated, and continuous fashion.
Cracking the code of interoperability
Arguably the most fundamental requirement for enabling this connected, coordinated, continuously improving model of healthcare delivery is functional interoperability, the ability for health information to be seamlessly shared among medical devices and enterprise health systems, which recent analysis suggests to be a more than $30 billion a year opportunity to improve healthcare and lower costs through helping avoid errors like adverse events, reducing redundant testing and lowering clinician time spent manually entering information.
Healthcare requires the code-breaking of interoperability to unleash the free flow of all relevant information and communication from siloed devices and systems. Individual healthcare providers and vendors of medical devices and EMRs have not yet fully aligned on this very important issue, and the full weight of regulatory oversight has not yet been brought to bear. Given the latest casualty reports from medical errors, and medical interoperability’s potential to lower these mistakes, can we wait any longer? In this, America’s most deadly and costly war, can we afford to lose?