Creating a better future requires understanding why things are the way they are, having a vision of a better tomorrow, and having a strategy for realizing that vision. When it comes to something as complex as healthcare, making sense of all this is no easy task. This wiki, therefore, focuses on presenting the main issues in a clear and organized manner to stimulate productive dialogue about ways to solve the healthcare crisis.

First, we define a main problem: Healthcare expenditures in America continue to escalate out of control as quality (safety, effectiveness, timeliness, and availability) suffers. Fiscal strategies have not only failed to curb costs, but may have actually lowered overall care quality in the process. Cost control tactics have failed to improve healthcare cost-effectiveness largely because they didn’t focus on making better use of scientific research and knowledge. This has had, and continues to have, devastating consequences.

Second, we examine proposed solutions: Debates now focus on what models should replace the failed financial strategies of the past. New models being discussed tend to focus on increasing consumer co-payments and deductibles while demanding consumers make complex healthcare choices without adequate knowledge, and rewarding providers financially for attaining performance goals that may not improve outcomes or control costs.

These models may be useful, but will only succeed if they address a fundamental problem: Healthcare stakeholders[1] must (a) know the specific treatments and prevention[2] methods best for each patient and how to deliver that them efficiently and effectively, and (b) use that knowledge in a way that continually improves care quality.

Unfortunately, healthcare stakeholders don’t have this essential knowledge primarily because there has been a lack of widespread collaboration and consistent use of clinical information systems to help healthcare providers and their patients make better decisions based on the scientific evidence. It’s ironic that those who deliver healthcare are drowning in oceans of information, while operating in a knowledge gap; and those who pay for and receive the care don’t have the knowledge they need to make informed decisions about the value of that care.

Often, the necessary clinical information simply doesn’t exist. But even when good information is available to support healthcare decisions, it often isn’t being used to improve care quality because the unaided human mind, no matter how competent, simply cannot focus on all the necessary details nor possess all the knowledge needed for continually making the best clinical decisions. Specialization and traditional information technology do not solve this problem.

Third, we propose a uniquely comprehensive approach to solving our country’s healthcare problems. Unlike other models focused primarily on economic strategies, ours is based on the wisdom that sustainable gains in care quality require a focused commitment on building and using scientific knowledge within a collaborative healthcare community to improve outcomes and lower costs. This model recommends implementing patient-centered care in a supportive healthcare environment enabling stakeholders to improve the health and well-being all people by:
  • Collaborating to develop and use evolving knowledgebases (i.e., information storehouses) of evidence-based practice guidelines[3] and clinical pathways[4] lessons learned, and educational materials enabling more personalized treatment tailored to the specific condition and needs of each person
  • Collaborating to develop and use evolving software tools to collect, share, analyze and discuss comprehensive healthcare data and models for reporting knowledge-building information and helping handle catastrophic events
  • Using knowledge services to help them establish collaborative learning networks that enable new knowledge to emerge, develop, and evolve as people share and discuss their experiences and ideas, and develop evolving practice guidelines and educational materials.

Next = The Current Situation


Footnotes and References
[1] Healthcare stakeholders include:
  • Providers, including RHIOs (Regional Health Information Organizations), primary care physicians, specialists, hospitals, clinics, ambulatory centers, nursing homes, home health agencies, public health agencies, etc.
  • Researchers, including academicians, health scientists, research organizations, knowledge management specialists, etc.
  • Payers, i.e., health insurers (health plans) and privately funded health plans
  • Purchasers (Funders), including employers and organizations providing healthcare coverage, the self-insured, and insurance exchanges
  • Consumers, i.e., patients and their families; the public
  • Pharmacies, Laboratories, Medical equipment manufacturers, Suppliers
[2] Preventive care is “comprehensive care emphasizing priorities for prevention, early detection and early treatment of conditions, generally including routine physical examination, immunization, and well personal care.” From http://www.plexisweb.com/glossary/words/p4.html
[3] Evidence-based practice guidelines (aka clinical guidelines or practice guidelines) are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. These can simply be broad statements or be very detailed based on literature review as well as expert opinion. Typically, clinical guidelines reflect more than local consensus regarding appropriate diagnosis and treatment of a condition. Clinical guidelines also can be developed to describe the indications for procedures and the process of care. … Clinical Algorithms are clinical guidelines prepared in a flow chart format, typically describing the process and decisions involved in addressing a specific condition. Alternate diagnostic and treatment approaches are described based upon decision points regarding information or judgments made about the patient.” From the American Academy of Physical Medicine and Rehabilitation at http://www.aapmr.org/hpl/pracguide/terms.htm). See the National Guideline Clearinghouse at http://www.guideline.gov/ for examples of practice guidelines.
[4] Clinical Pathways (or Critical Pathways) “document essential steps in the diagnosis and treatment of a condition or procedure for individual patients. They document a standard pattern of care to be followed for each patient. Often specific information on timing of each intervention is specified, with provision for recording variances and their reasons so that analysis can be performed to modify the pattern of care in order to avoid variances in the future. These are predominantly management tools and are based on clinical information developed in other guidelines or parameters. They are specific to the institution using them.” From the American Academy of Physical Medicine and Rehabilitation at http://www.aapmr.org/hpl/pracguide/terms.htm

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