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IOM Recommendation 5: Community Links

by Michelle Troseth

I alone cannot change the world, but I can cast a stone across the waters to create many ripples. – Mother Teresa

The 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, addresses the need to broaden the definition of communities. “The typical definition of a community is a group located in a particular geographic area. However, communities that promote continuous learning and improvement in healthcare go beyond geographic boundaries to include groups linked through culture, occupation, conditions based on a common workplace, prognosis, stage in the care process, intensity of care needed and more.” (7-14).

The most unique healthcare community I have ever been engaged with is the CPM International Consortium. More than 25 years ago, the CPM Resource Center recognized that uniting like-minded organizations to make the healthcare transformation journey together was not only a smart solution, but also a less risky one. We recognized that one healthcare organization cannot change the world, but together we could collectively learn and impact the creation of an integrated health care system and the health of a global community. That’s why the CPM International Consortium was created; a voluntary community made up of hundreds of our client hospitals, health systems, and educational institutions.

The CPM International Consortium Model gathers a group of organizations that unite around a common vision for sustainable healthcare transformation through the use of a common culture and professional practice framework. The CPM Consortium community has the opportunity to participate in collective thought leadership, implementation science and clinical scholarship.

An example of this is a recent study published that was conducted to better understand the relationship between self-efficacy and EBP Implementation in clinical environments that have undergone efforts to increase EBP utilization. In the study, Does self-efficacy influence the application of evidence-based practice: A survey and structural equation model , the researchers’ analyzed data by a 2011 survey of clinicians working within a national sample of hospitals that are actively participating in the CPM Consortium to guide the implementation of EBP into the work worlds of clinicians. (2013, Abrahamson, K., Arling, A., & Gillette, J.)

Another example of tapping lessons from this unique learning community that has implemented a common framework with replicable interventions and sustainable outcomes is described in Lessons from the Field: The Essential Elements of Point-of-Care Transformation. (2011, Wesorick & Doebbeling) Medical Care 49 (12), S49-S58.

Community sharing can decrease “re-inventing the wheel” and move us much faster to sustainable improved health of a broad community.

Recommendation 5: Community Links

Promote community-clinical partnerships and services aimed at managing and improving health at the community level. Care delivery and community-based organizations and agencies should partner with each other to develop cooperative strategies for the design, implementation, and accountability of services aimed at improving individual and population health.

Strategies for progress toward this goal:

Health care delivery organizations and clinicians should partner with community-based organizations and public health agencies to leverage and coordinate prevention, health promotion, and community-based interventions to improve health outcomes, including strategies related to the assessment and use of web-based tools.
Public and private payers should incorporate population health improvement into their health care payment and contracting policies and accountability measures.
Health economists, health service researchers, professional specialty societies, and measure development organizations should continue to improve measures that can readily be applied to assess performance on both individual and population health

What does community mean to you?

What are ways your organization is constantly improving transformation strategies, tools and resources?

Cheers,

Posted in: CPM Consortium, Evidence-Based Practice, IOM Recommendations, Uncategorized 0 comments

IOM Recommendation 3: Clinical Decision Support

by Michelle Troseth

“You mean this actually exists today?”

That was the surprise response from a nurse at the TIGER (Technology Informatics Guiding Education Reform) Summit in 2006 after seeing how the CPM interdisciplinary evidence-based clinical practice guidelines were integrated into the clinical workflow of an EHR vendor system.

“I applaud you for embedding evidence-based practice into the clinician’s workflow.”

This is the comment that I received, just last week, from a physician & chief quality officer looking for a feasible way to sustain and optimize the health information technology system that they had spent so much time and resources in building. Regrettably, these two statements occurred 6 years apart and, the idea that embedding evidence-based practice inside an EHR is still a novelty should make us all sit down and really think. The fact that he, like many other leaders in his position, is trying to find a way to sustain the kinds of “unique” EHR systems that are common in our large hospital systems today is an indictment of our collective efforts to build a healthcare system that is sustainable and scalable. The fact is, the effort to support systems like these is extremely challenging, especially absent another huge commitment of funds and intellectual energy.

In order to achieve a transparent, seamless, and knowledgeable health care system, that is exponentially expandable, we must learn to think in a different way.

I celebrate the progress that has been made toward this goal over the years but remain frustrated at how long it is taking to adopt and enhance evidence-based and meaningful clinical decision support to the point of care. The 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, addresses how much of a challenge it is, in the face of our current technological progress, for clinical research and clinical decision support to keep pace with the introduction of these new procedures, treatments, and care delivery models. Add to that the further challenge of getting the information into the hands of the clinicians where it can be used starts to glimpse of the size of the challenge. Put simply, building health information systems without an integrated clinical infrastructure is akin to putting bicycle tires on a race car.

In light of this, let’s take a look at the next recommendation from the IOM.

Recommendation 3: Clinical Decision Support

Accelerate integration of the best clinical knowledge into care decisions. Decision support tools and knowledge management systems should be routine features of health care delivery to ensure that decisions made by clinicians and patients are informed by current best evidence.

Strategies for progress toward this goal:

Clinicians and healthcare organizations should adopt tools that deliver reliable, current clinical knowledge to the point of care, and organizations should facilitate the development, accessibility, and use of evidence-based and harmonized clinical practice guidelines
Health professional education programs should teach new methods for accessing, managing, and applying evidence; engaging in lifelong learning; understanding human behavior and social science; and delivering safe care in an interdisciplinary environment

The IOM’s emphasis on “accelerated integration” must not be overlooked! Without this element being central to the plan, we will surely fail in our efforts. This need for a simple framework was foreseen by my colleague and mentor Bonnie Wesorick over thirty years ago. Ever since then, it has been my personal mission and the shared mission of Elsevier CPM Resource Center to make this a reality. For any of us interested in realizing the dream of a having a truly integrated, sustainable, and scalable healthcare system, we would be wise to avail ourselves of this visionary leader. Just as the IOM Report calls for “accelerated integration” of clinical knowledge, Wesorick has called for “exponential growth” of a practice platform as recently addressed in this national webcast.

Additionally, our “new ways of thinking” must also extend to the interdisciplinary team charged with the care of our patients and we must start at the beginning of the education process. This allows all of our care providers to learn to work on the same platform of care, have a clear understanding of the scope of each other’s practice, and to develop and use shared knowledge to improve outcomes, identify and refine new processes that work, and to develop efficiencies that allow our systems not only to survive, but to thrive. One first step in this direction has been the establishment of the Bonnie Wesorick Center for Healthcare Transformation at Grand Valley State University’s Kirkhof School of Nursing in Grand Rapids, Michigan. By affiliation with Grand Valley State University, the Elsevier Resource Center will be engaged as an innovative incubator in the new HRSA Grant for a National Coordinating Center for Interprofessional Education and Collaborative Practice granted to University of Minnesota.

At the end of the day, we must realize that the designs of the past will simply not serve the needs of the future of healthcare. To continue to pursue them will ultimately lead to our failure in our reach for a truly sustainable healthcare system.

So, no matter whether you are a clinician, healthcare vendor, politician, or patient, we all have a stake in or own health where the future brings us. Each of us also has a voice. I for one will be continuing to boldly raise mine. I hope that you will join me!

What do you think is needed to “accelerate integration” of best clinical knowledge into care decisions?

What is your vision for interprofessional health education?

Cheers,

Posted in: Clinical Decision Support, Clinical Informatics, CPM General, Evidence-Based Practice, Interdisciplinary Practice, Interprofessional Education, IOM Recommendations, Practice, Quality, TIGER Updates 1 comment

IOM Recommendation 2: The Data Utility

by Michelle Troseth

THERE IS POWER IN PATTERN RECOGNITION OVER MULTIPLE DATA POINTS. The number one complaint I hear from clinicians and healthcare delivery organizations about electronic health records is the difficulty of getting real time clinical data from the system for clinical decisions in a readily meaningful way (okay, it may be a toss-up between that and usability of the system!).

Now there’s a call to take “access to clinical data” and “clinical research data” a step further, pushing pretty much every stakeholder to think about and then take action on new strategies to turn readily available clinical data into valuable information to improve patient care. This recommendation calls for polarity thinking – “and & both” thinking: accessing published research to support evidence-based care and accessing real time clinical data that can inform care.

For many years, I cared for critically ill patients and clinical questions always came up as the team and I strived to deliver “best care.” Thinking back on the time when everything was paper, it certainly makes me appreciate the significance of electronic health records and the growing digital infrastructure today.

In 1986, I began working at a CPM Consortium hospital and many of my clinical questions were answered by evidence-based guidelines that we used, and then documented to, at the point of care. That was so wonderful – evidence kept me focused on the most important clinical data and helped me assess, monitor, detect and prevent potential problems the patient was at risk for, due to their diagnosis.

Today, with the benefit of technology, these same guidelines bring the information to clinicians even faster because it is embedded in the computerized clinical workflow. And, it continues to get better and better.

But as technology and the digital infrastructure grow, there is still a need to gain real time clinical insights from the clinical data that is being recorded, documented and stored. Hence, the second recommendation from the 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, deals with data utility.

Recommendation 2: The Data Utility

Streamline and revise research regulation to improve care, promote the capture of clinical data, and generate knowledge. Regulatory agencies should clarify and improve regulations governing the collection and use of clinical data to ensure patient privacy but also the seamless use of clinical data for better care coordination and management, improved care, and knowledge enhancement.

A strategy for progress toward this goal is:

Patient and consumer groups, clinicians, professional specialties, health care delivery organizations, voluntary organizations, researchers, and grant-makers should develop strategies and outreach to improve understanding of the benefits and importance of accelerating the use of clinical data to improve care and health outcomes.

One of my favorite stories in the IOM Report is in Box 4-2 Gleaning Real-Time Insights from Clinical Data, based on the work of Frankovich, Longhurst & Sutherland (2011). It is a case study about a 13-year-old girl with systemic lupus erythematosus (SLE) and, due to lack of peer-review literature or expert opinion for her clinical situation, the team turned to EHR recorded data in their organization and made a clinical decision with a positive outcome. It illustrates the power of pattern recognition over multiple data points…in this case, clinical data points.

Because clinical data is now so much more accessible, we need to find a way to free it, tap it, and improve patient care while protecting the individual privacy of each patient. Surely we can figure this out!

Frankovich, J., Longhurst, C.A., & Suttherlund, S.M. (2011). Evidence-based medicine in the EMR era. New England Journal of Medicine. 365 (19): 1758-1759.

What clinical questions would you ask if you could tap real-time clinical data from your electronic health record?

What strategies can you think of to improve understanding of the benefits of accelerating the use of clinical data to improve care and health outcomes?

Cheers,