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IOM report: Meaningful use just the start of health IT revolution

Earlier this month at a New England health IT conference, former U.S. health IT coordinator Dr. David Blumenthal said that he is reasonably confident the HITECH Act’s push for EHR adoption would be successful, and we’d see that happen. The part about nationwide health information exchange (HIE) happening? Confident, yes. By 2015? Probably not.

The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care — of which Blumenthal is a member — issued a comprehensive report on the state of health IT in the United States, and what it’s going to take to build it out like Blumenthal’s Office of the National Coordinator of Health IT (ONC) envisioned it.

Not surprisingly, the IOM offers a stack of recommendations for the health care sector — industry followers know that these reports often inspire action in both the public and private sectors. Here are some of them:

  • Build a shared learning environment. HIT provides an opportunity to change the current environment in which health decisions are made to one of shared input and active participation from patients, caregivers and the population at large.
  • Engage health and health care, population and patient. To improve health outcomes for the nation, thinking must extend beyond clinical encounters, and even beyond the individual patient, to the population as a whole.
  • Leverage existing programs and policies. Recent policies and legislation — such as meaningful use — have laid a foundation for this work. The resulting investments and progress can be leveraged toward long term system goals.
  • Embed services and research in a continuous learning loop. A digital infrastructure that supports both the generation and use of knowledge cannot be effective unless it is integrated seamlessly within the processes from which it draws and is meant to support: care delivery, research, quality improvement and population health monitoring.
  • Emphasize decentralization and specifications parsimony. Essentially, let health care providers and the vendor ecosystem that serves it tailoring to specific needs, local innovation and evolvability.
  • Provide continuous evaluation and improvement. A “learning system” is one that assesses its own performance against a set of goals and uses the results of that evaluation to change future behaviors. Workshop participants articulated the importance that all components of a digital infrastructure must themselves function as learning systems themselves.

Meaningful use, the report authors found, can “provide starting points, incentives, and guidance, while retaining the flexibility necessary to accommodate breakthrough capacities,” …it could end up being “a transformative effort that moves health care [toward]  … comparability and consistency in health information.”

The report also identified what the roundtable considered the “key opportunities” in the next two stages of meaningful use regulations for building the interoperable national health IT network. What does the IOM think will make this thing go? Semantic interoperability and the capacity for health information exchange.

Remember, the IOM isn’t a regulatory body, it has no real authority. But, a lot of what it says is the DNA for future regulations — and that is why electronic health record vendors are quaking in their boots waiting for the IOM’s pronouncements on EHR safety due out later this year. Keep an eye on how this report is cited and quoted in the next few months, up to a year. It seems like kind of a big deal.

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