Tuesday, May 26, 2009

Grand Rounds: More than good stories found

One of the things I like best about Grand Rounds is that I find inspiration to help bring my hodge-podge of loose thoughts and impressions together.

Healthcare reformers and activists have begun to focus on the $20 billion American Recovery and Reinvestment funds that--God-willing-and-the-creek-don't-rise--will make IT in healthcare "meaningful." The National Committee on Vital and Health Statistics' Report of Hearing on "Meaningful Use" of Health Information Technology captures multi-stakeholder concerns well. It's a worthwhile read about the realities we face in harnessing strong IT solutions to transform healthcare efficiency and outcomes.

I jumped at the chance to talk about meaningful use last week, both here and over at On Your Meds, the Medscape medication safety blog I write. Although I'm techy by nature, it doesn't take a specialist to see that the current state of IT often makes front line clinical people tie the horse to the Edsel's bumper to advance a care goal. (If you missed Gina's story a few weeks back, it's worth a read to sample just a few of the unintended consequences front line clinicians face when e-systems fail to communicate.) So I posted call-to-action pieces about meaningful use, advocating for IT outputs that would make patient data central and help get front line clinicians out of the manure.

Then I started reading what cutting edge e-patient advocates and health 2.0 innovators were saying about what "meaningful use" might really mean. E-patient Dave's remarkable story is one that has drawn attention to health IT's intention-outcome mismatch. The power of high-end patient involvement left me feeling that my "make it work for those on the line" approach was like suggesting we replace "Mr. Ed" with "Rachel Alexandra" on the bumper.

But today at Grand Rounds, I stumbled across the story of a man, and his family, movingly told through the fresh eyes of a soon-to-be nurse in Brain Death, Part 3. The patient and family in the story, especially when contrasted with e-patient Dave, show the vast continuum of abilities and circumstances of people in our care.

We most certainly need to get the horses off of the bumpers. But we also need to be certain that we advocate for models of care--which are ultimately what IT solutions support--that allow all kinds of horses to make it around the track.


Tom said...

Great post, Barbara. I think the new administration is on the right track with declaring "meangful use" as critical to any measure of success with HIT, EMRs, CPOE, whatever. It could take some time to develop solid measures of meangful use, but I think it's absolutely necessary.

We need to be sure that the tremendous investments in time and resources, and the large-scale disruptions can create in large scale HIT implementations are delivering on its promises - not to IT vendors, or to political pistol-notches, but to measurable improvements in the safety, quality, patient-centered-ness,efficacy and equity of care.

e-Patient Dave said...

Very well written, thoughtful, sensitive.

So much of the trouble we're in, medically and financially, seems to arise from simply taking our eye off the supposed beneficiary: the patient. And as you suggest, that doesn't mean one type of patient, it means EVERYONE, all the different types, with nobody left out.

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