Mostashari: 3 tactics to redesign care and reap HIT

“Inspiring and challenging” is how Paul Tang, Vice Chair of the HIT Policy Committee described the systems to redesign care and reap HIT during a Policy Committee meeting.

Farzad Mostashari, MD, national coordinator for health IT said “It’s systems that let ordinary people do extraordinary things.”

This discussion was addressing the challenge to transform healthcare to harness IT either in place today or IT that is currently being implemented.

The inspiration is driven by the need to make massive improvements in the cost and quality of care that helps improve patient health.

For example, helping diabetics avoid strokes or heart attacks by managing blood pressure and LDL levels better.

“We’re about halfway through the process of computerizing and digitizing America’s hospitals and doctor’s offices,” Mostashari said in the May 7 meeting, “and we’re about 5 percent of the way through changing workflows and redesigning care to take advantage of those technologies.”

“That one issue, helping people with diabetes not have strokes and heart attacks by addressing their lipid control has opened up a wonderful window into the skills that we’re going to need to develop,” he continued.

On those thoughts, Mostashari shared three ideas for transforming the healthcare system to take advantage of the IT infrastructure:

  • Engage patients more effectively. This includes following up with patients and not just waiting for them to show up on their own. “I’m sure if we did what marketers have been doing for more than a decade now — altering the message, figuring out how to couch it — we could iteratively drive up higher and higher the ability to re-engage patients who have been lost,” he said.
  • Redesign processes and workflows.“Let’s automate this as much as possible so we’re not relying on the physician making a decision in an 8-minute office visit that ‘gosh, this person needs an LDL test,’” he continued. This can be done with more efficient processes and workflows.
  • Use protocol based defaults. “Let’s have a protocol that says in these cases the default should be go right to the statin. You can always change it and, in fact, Brent James [MD, chief quality officer at Intermountain Healthcare] said ‘providers must customize the defaults to the individual person.’ But at least there’s a default there. You automate it as much as possible.”

In some cases the tools needed to make this a success are there but Mostashari has admitted that many practices and providers simply just lack the know-how to take advantage and use the tools and payment systems. Mostashari explained that 5 percent of the problem in healthcare today is people  — and 95 percent of the problem is systems-related.

“How do we get that to spread? That’s going to be probably the most interesting challenge for the next few years,” Mostashari said. “It’s going to mean new roles for the entire care team, including the patient — Onward!”

 

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