“It’s systems that let ordinary people do extraordinary things,” national coordinator for health IT Farzad Mostashari, MD said during a HIT Policy Committee meeting talk that vice chair Paul Tang described immediately afterward as “inspiring and challenging.”

The challenge: transform healthcare to harness the IT either in place today or currently being implemented. And the inspiration: demonstrable improvements in cost and care quality that make patients healthier, for instance, helping diabetics avoid heart attacks or strokes by better managing high blood pressure and LDL levels.

“We’re about halfway through the process of computerizing and digitizing America’s hospitals and doctor’s offices,” Mostashari said in the May 7 meeting, “and we’re about 5 percent of the way through changing workflows and redesigning care to take advantage of those technologies.”

[Commentary: EHR dissatisfaction — a technology or people problem?]

Explaining that his favorite part of the work week is a meeting with half a dozen providers involved in the Beacon Community project, Mostashari spotlighted the aforementioned example about an initiative to engage diabetic patients in the effort to monitor and control LDL.

“That one issue, helping people with diabetes not have strokes and heart attacks by addressing their lipid control has opened up a wonderful window into the skills that we’re going to need to develop,” he continued.

With that, Mostashari shared three suggestions for transforming the healthcare system to take advantage of this IT infrastructure.

1. More effectively engage patients. A starting point is those who are lost-to-follow-up but need to come back, say, those diabetics with high LDL and high blood pressure. “We can‘t just wait for them to show up,” Mostashari said. Indeed, one of the clinics sent letters to those 700 patients and drew about 50 to a weekend clinic. Another clinic, employing the same tactic, garnered a 25 percent success rate. “I’m sure if we did what marketers have been doing for more than a decade now — altering the message, figuring out how to couch it — we could iteratively drive up higher and higher the ability to re-engage patients who have been lost,” he said, adding that healthcare entities have to use tools to measure how well they engage patients.
2. Redesign processes and workflows. Continuing the diabetic clinic example, Mostashari added that providers should, when they reach out to those people, explain that they need to come back for an LDL test or, better yet, have them get the test done before they attend the doctor visit so patient and physician can review the results together, in the same room. “Let’s automate this as much as possible so we’re not relying on the physician making a decision in an 8-minute office visit that ‘gosh, this person needs an LDL test,’” he continued — because in one clinic that brought patients back, many left without a lab slip or prescription. “So that’s a new workflow, that’s a new concept of population health management, of lowering the center of gravity,” he said. “The other is the idea: do we really need to individualize every decision? That is, I think, the most interesting cultural shift.”
3. Use protocol-based defaults. Part of such automation is tapping into available knowledge for care choices, such as a patient who has been trying to reduce LDL and blood pressure with diet and exercise for more than a year but has not succeeded. “Let’s have a protocol that says in these cases the default should be go right to the statin. You can always change it and, in fact, Brent James [MD, chief quality officer at Intermountain Healthcare] said ‘providers must customize the defaults to the individual person.’ But at least there’s a default there. You automate it as much as possible.”

The tools are there today and the federal government is increasingly gearing the payment systems to reward Mostashari’s triptych of suggestions. But he admitted that there is a concern that many practices and providers lack the know-how to strategically take advantage of either the tools or payment systems.

[Q&A: On health data 'we can't dream big enough']

Mostashari explained that 5 percent of the problem in healthcare today is people  — and 95 percent of the problem is systems-related. Indeed, scaling this hard-fought knowledge, practice-by-practice and not just among the large, already IT-savvy health networks, is the hard part. 

“How do we get that to spread? That’s going to be probably the most interesting challenge for the next few years,” Mostashari said. “It’s going to mean new roles for the entire care team, including the patient — Onward!”
 

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Listen to the entire HIT Policy Committee meeting from May 7 on HHS' site