In my last blog post, I described the virtues of Meaningful Use. The short version is that Meaningful Use established economic incentives that drove adoption of Electronic Health Records and made the creation of a lingua franca of health discussions both necessary and possible. The three foundational components that were initiated or advanced by Meaningful Use incentives are the following:
- Vocabulary Standards
- Document Content Standards
- Data Transport Standards
While it would be possible to endlessly debate how completely and how well these have been addressed, I refuse to back down from the premise that rapid advances in these areas have established an infrastructure that allows us to push into new and more substantive and rewarding use of individual and population health data.
Several additional components of an information collection and distribution infrastructure have sprung up based on the ones described above. Important ones that I want to talk about are Personal Health Records, Health Information Exchanges, electronic prescribing (eRx) networks, and Data Registries. For now I am simply going to describe what they are. I will later probe further into their strengths and weaknesses.
Personal Health Records
My view of Personal Health Records is that a PHR is an EHR from a patient’s perspective. Think of it as the shoebox, manilla folder, or file drawer where we collect our current paper records. Imagine that all important records, receipts, pictures, videos, and other files relating to your care were stored in one place. Assuming they have been catalogued, tagged, and organized appropriately, this collection of information would be invaluable to anyone attempting to optimize your health. That is what I want and expect of a PHR platform. Patient-centric. Comprehensive. Accessible.
Health Information Exchanges
Key to providing access to the PHR information described above is a network of networks which can handle the health information exchange transactions in a way that assures delivery, manages authorization and notice, protects privacy, and does so efficiently and reliably. That is the essence of health information exchange.
Electronic prescribing networks are perhaps the best example of how important health data can be managed in a distributed but secure fashion. The rate of penetration of electronic prescribing has been phenomenal. I believe the reason to be the huge amount of money that prescribing represents, and also the importance of prescribing to our approach to health care. Leveraging a deep, rich vocabulary (RxNorm) and based on a combined commercial / public network infrastructure, we now have an exceptionally rich data set regarding the use of pharmaceuticals to treat patients.
Similar in many ways to the eRx network, rich repositories of data relating to a wide range of populations of patients have been established in Registries. These registries have begun to capture and organize information relating to patients who share some common demographic and/or health and disease attributes. A group to be studied is selected, then data collected about that population. These registries support the search for more effective therapy or successful strategies for reducing or eliminating the burden of a disease or health risk. I view registries as “case reports” of what will become a broad strategy of health and wellness optimization based on Precision Medicine - an extensive understanding of individual characteristics that will allow us to tailor disease prevention and treatment to the individual.
Taken as a collective, these technologies and capabilities have pushed the use and utility of health information to the brink of broad impact on Triple Aim goals - better care, a better care experience, and lower cost. But there are key pieces of information infrastructure still missing. Check in next week as I share my thoughts on where we must go next if health information technology is to live up to its promise of promoting better individual and population health.
featured photo from healthaffairs.org