Summary
Health care is complex, and the goals of improved quality and safety and a better, more valuable customer experience will be difficult to achieve even in the best of circumstances. However, the current health information technology infrastructure in the U.S. makes it practically impossible to achieve the three aims the authors discussed, especially in their "virtually integrated" organization model that necessarily needs to rely on information technology to bridge disparate legacy information and diagnostic technologies. Movement to true interoperability, in which the various actors in the health care arena can access necessary information when needed, is required to allow health care to achieve the three aims.
Analysis
The key to achieving the three aims discussed lies in leveraging a health information technology infrastructure that is not yet in place. Akin to the national highway system that emancipated travelers and commerce and allowed individuals and businesses to travel the last mile, we need a system of information interoperability that promotes true continuity of care, safety and value. Health care has been hampered by an information technology environment retarded by historical under-funding and a competitive view of patient information that pitted one health care provider against the next, treating the information as a secret asset that couldn't be shared, regardless of the benefits that would accrue to patients.
Interestingly enough, the authors use the Geisinger Health System as an example, which is telling in ways they did not explore. Geisinger is clearly a leader in delivering clinical excellence to the residents of Central and Northeastern Pennsylvania Possibly more importantly, Geisinger has taken a leadership role in ensuring the interoperability of health information through it driving involvement in KeyHIE, one of the few early examples of a sustainable health information exchange - one that links disparate providers and their information systems and diagnostic results to each other. KeyHIE provides health information across 31 counties in Pennsylvania, covering more than 50 hospitals and other health care provider facilities. This allows information to follow the patient across the service area (and potentially beyond) - for example a patient presenting at an emergency department in which she'd never been seen will benefit from the emergency department's access to key health information, such as her drug allergies, her medical history and problem list, and possibly recent test results in another HIE member's facility. In absence of the HIE, this information would have to be "discovered" some other much less efficient and more costly way. This is the kind of health information ecosystem that has to replicated throughout our health economy. Health care needs this "eInfoSystem" to achieve its real promise.
