Information Technology Reference
In-Depth Information
complete information about the patient's condition, medical history, services
provided in other settings, or medications prescribed by other clinicians.” [
8
]
The practice of medicine is largely comprised of collecting data, analyzing that
data, making decisions based on it, conveying those decisions to other members of a
care team and the patient, following what happens, and adjusting according. Any
effective coordination of care depends on making a patient's data available when and
where it is needed. In essence, we have a “health data logistics problem”. That is
what the national effort to deploy health informatics is primarily aimed at solving.
This is very analogous to problems other industries have identified and solved
using contemporary information technology. For example, Wal-Mart famously
scans every item sold in its stores and transmits the information, as sales occur, to
databases at its Arkansas headquarters where it is virtually instantaneously avail-
able for analysis and action. If snow shovels are fast sellers in Minnesota, Wal-Mart
makes sure more are on the way. If swim suits are languishing in Florida, it slows
their resupply. Wal-Mart can only do this because it has a standard electronic record
of every sales transaction and a network in place to seamlessly and quickly move
that digital information from where it is generated to where it is needed.
Countless manufacturers have similar systems in place to manage a global sup-
ply chain and logistics network feeding components to their plants. This is the sort
of technology that makes “just in time” possible. Today most automobile manufac-
turers rely on suppliers to deliver entire and often even customized subassemblies as
they are needed for installation in a particular car. Their computer systems are inte-
grated with those of the companies that supply them so the entire process can be
orchestrated efficiently without error or delay.
Paper records are hard to share. The original can physically exist in only one
place. They can be copied and faxed but this is slow, time consuming and relatively
error prone. The results may not be very legible. The information contained in them
is rarely standardized except where required for billing.
Yet, in many respects, managing chronic disease is a “data logistics problem”
comparable to those we just described. More effective management of these increas-
ingly common problems will depend to a large degree on creating the same data
liquidity that drives all current global logistics and supply chains. Of great, or per-
haps even equal, importance is the need to substantially improve care processes
based on this wider access to more timely and accurate data.
Consider a seemingly simple issue: when should a chronic disease patient next be
seen by their physician? The traditional approach is somewhat arbitrary but is hope-
fully guided by experience and intuition. The next appointment is scheduled in three
months, six months or a year. If Wal-Mart used this approach of stocking their inven-
tory on a fixed schedule unneeded swim suits might arrive at Florida stores even
though the shelves are overflowing. Potential sales of snow shovels in Minnesota
might be lost as customers go elsewhere because the inventory is exhausted.
Perhaps Mr. Smith, a diabetic patient who just saw his physician, will do fine. He
will follow the prescribed diet and take his medications in the proper amount and at
the proper time. If so, he won't need to be seen in six months, as scheduled, but, in
most clinics, the physician will see him anyway, congratulate him on his success
and schedule the next visit after another six months.
