When Dr. Farzad Mostashari, the national coordinator for health information technology, addresses more than 4,700 healthcare professionals at the Allscripts Client Experience in Nashville on Monday morning, Aug. 29, he’s likely to discuss one of the most exciting developments in healthcare today – and perhaps surprisingly, it won’t be the meaningful use of electronic health records. 

Dr. Mostashari recently commented, “I think something bigger is afoot here than just the incentive payments. The wind is at our backs in a very important way. We are approaching the virtuous cycle, where what providers need to do to succeed in the new era of healthcare financing requires better information”.
His focus will be on the coming movement beyond the adoption and utilization of Electronic Health Records to what many see as the next stage of healthcare – what he refers to above as the ‘virtuous cycle.’  In other words, the conversation will shift from incentives and implementation to information that will have the capacity to change all of our assumptions about healthcare today.

He’s on to something really big.  To me, however, it’s more than information. In fact, more information by itself is not the answer.  In fact, it can be a bad thing.  We are rapidly moving from not enough information to information overload. 

So if it’s not information, what do our physicians and caregivers really need? Our answer is a concept we call ‘insights to outcomes’ or i₂O.  i₂O describes exactly why we are spending all of our time, effort and money to promote adoption and meaningful use of Electronic Health Records --- to deliver real, actionable insights to physicians and caregivers at the point of care, typically when they are facing the patient . . . insights that drive better clinical and financial outcomes.  Just as H₂O is essential to life, we believe i₂O is essential to healthcare.  After all, we are all learning that healthcare is, at its core, an information business.

Consider the Internet.  As of 2008, according to Google, there were over 1 trillion unique URLs on the web.  After that, people stopped counting.  Can you imagine trying to access all those terabytes of information without a search engine?

While healthcare IT will drive exponential increases in the amount of available information, to be useful it will need to radically simplified and presented in an intuitive way that providers can leverage to truly improve patient care, at the right point in the care process. 

After all, our physicians and caregivers don’t actually need more information --- they want truly valuable insights.  And EHR adoption is not an end; it’s a means to an end which is better outcomes for patients.  And that shift in thinking couldn’t come at a better time.
               
The End of the Beginning

In healthcare today there is an incredible level of chatter about some really important issues and opportunities: value-based care, accountable care organizations (ACOs), provider consolidation, meaningful use, ICD-10, IT adoption, health information exchanges (HIEs), and medical homes, to name just a few. And then there is the increasingly accepted assertion that medical payments in the future will be less. In many quarters, the assumption is that the future is not bright and that this is the beginning of the end.

At Allscripts, our view is different. We believe that information, in the form of insights, will enable a new age in healthcare and that we are – to paraphrase the famous Winston Churchill quote – not at the beginning of the end but rather at the “end of the beginning” of this new age. That’s what Dr. Mostashari is saying. In other words, quality will be the new currency.

While many have embraced the value-based concept, behind closed doors they will all acknowledge that 1) they don’t exactly know what that model would look like and 2) that it is a pretty scary proposition – as how they get paid would change.

The major players in healthcare are accepting and, in some cases, embracing the eventual move to a value-based model. Some view it as having the potential to launch a new era in healthcare and others see this as the end of healthcare as we know it. It may be both. 

The promise of improving quality, after all, is what brought us to healthcare in the first place. The question now is not if but when and how the value-based system can be made to work for everyone. Regardless of your view of the merits of the approach, every stakeholder has concluded one thing: that healthcare IT will be central to answering these questions.

Driven by the HiTECH incentives, lower reimbursements, competition, new payment models, and government action, the adoption of healthcare IT has rapidly accelerated with significant progress on the first three steps of the information evolution in healthcare – applications, connectivity and information.

Let’s take these three stages one at a time.

1. The value of healthcare IT begins with not just with the adoption, but the utilization of an application. While we’ve had electronic health record technology for years, for the first time their adoption is becoming commonplace and their use is increasing, especially among the hard-to-convince group of independent physicians in smaller practices.  However, by itself, its value is limited.  Not unlike the computer, when it was first introduced, electronic health Records are today still largely for data logging and retrieval without much feedback or insight provided.
2. But, as with a computer, a smartphone or an ATM, the value of the application increases exponentially as it is connected to others – what many refer to as the network effect.  That connection in healthcare has been accelerating recently, not only because of the introduction of standards but also due to the willingness of some vendors to open their platforms.  Today you can find examples all across the US of providers, large and small, connecting disparate systems from a variety of vendors.
3. As those connections become more commonplace, we can then access information that has the possibility to address the problems we have been chasing: medical errors, redundant tests, miscommunication, etc.  But information by itself is as limited as the Internet without a search engine.  That information needs to be organized and made intelligent so that it can actually affect how care is delivered.

The Launch of i₂O

While there is more work to do in each of the stages outlined above, all of them are essentially building blocks for what comes next.  And this is where the excitement is just beginning to build.

The next stage of healthcare, now being unleashed at many organizations across the country, is what I call "insights to outcomes," or i₂O.  The concept is that  insights (i), even small ones, have the potential to yield massive changes in outcomes (O). 

There is a wonderful statement about technology that captures where we are today – The First Law of Technology says we invariably overestimate the short-term impact of new technologies while underestimating their longer-term effects.  Fortunately in healthcare, the long-term just became much shorter – the time is truly now.

Insights that truly improve the delivery of care are the payoff for all the effort and expense of acquiring, implementing, utilizing, connecting and optimizing electronic health records.

i₂O is the place where population health, disease management, real-time clinical trials, syndromic surveillance, and comparative effectiveness become a reality and part of what I believe will become the new operating system of healthcare. 

The future is not only about big data sets, but also about small, real-time insights delivered to physicians and other caregivers at the point of care that will make a real and measureable difference in the lives of individual patients.

In fact, we are already starting to see examples of this progression:

• Blessing Hospital in Quincy, Ill. reduced transcription-related medication errors by 95 percent
• Orlando Health in Orlando, Fla. cut the relative risk of mortality from sepsis by 25 percent
• Summa Health System in Akron, Ohio cut 31-day readmissions for stroke by 36 percent through better compliance with evidence-based treatment
• University Hospital in San Antonio, Texas lifted compliance with diabetic medication therapy by 74 percent, and diabetic eye exams by 50 percent
• Jefferson Regional Medical Center in Pine Bluff, Ark. reduced 30-day readmissions by 26 percent for the top 50 surgical DRGs
• Kaleida Health in Buffalo, N.Y. realized a 9-percent increase in cash collections, a $1.45 million increase in point-of-service cash collections, and a 32-percent drop in days in accounts receivable
• Sharp Community Medical Group in San Diego, Calif. saved an estimated annual $1.9 million related to EHR from reduced expenses on medical charts, transcriptions and billing/data entry
• UMass Memorial in Worcester, Mass. has already enrolled more than 1,000 patients in a program that enables patients to upload their blood glucose meters from home or from within UMass Memorial outpatient offices – and to have that data instantly added to the patient’s medical record to  improve long-term diabetes management and enable better collaboration.

After making significant progress in the application, connection and information stages, these exceptional organizations are proving the potential of i₂O to become the norm.  And, the beauty of information technology is that it doesn’t discriminate by size of organization, location, or any other demographic. Once we have it, we can deliver the life-saving insights across the country, to inner city clinics, to rural hospitals, and to solo physician practices and ... anywhere in the world and change the world of healthcare as we know it.

The amazing thing about working in healthcare is that everyone is here for the same reason. We all want to ensure that our family, friends, neighbors and communities receive the best possible care. In order to deliver on that promise, we have to address both the quality and cost challenge – you can’t do one without the other. 

Since we’ve tried everything else, we now need to use the one tool that has allowed us to prosper in every other industry: information technology. Driven by the insights that providers will receive using advanced, interoperable systems, the disconnected healthcare system of the past will quickly become a relic, and an outcomes-based model will emerge. 

My hope is that the idea of i₂O is not just a concept, but a rallying cry that will encourage more organizations to take action. Ultimately, we have no other choice; government, private payers and the realities of our economy have made the status quo in healthcare unsustainable.

The only meaningful question now is not about meaningful use, but what will we do to make all of this effort meaningful for patients. Clearly just collecting more data, if we don’t use it to improve care, is meaningless. 

By focusing on a common vision of i₂O, we can ensure that we move from problems to possibilities ... and from insights to outcomes. We aren’t there yet but we’re getting close … and we’re gaining speed.

Glen Tullman is chief executive officer of Allscripts (www.allscripts.com).  His keynote address at the Allscripts Client Experience, including an appearance by Dr. Mostashari, will be streamed live on the Internet at www.allscripts.com/ace2011 beginning at 8 am Central/9 am Eastern on Monday, Aug. 29.