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This detailed White Paper on the state of healthcare services in the US and potential solutions for the problems identified is published on the WWW in wiki format. Comments (and collaboration) from users are encouraged. The White Paper supports much wider use of information technologies in healthcare and describes and promotes the Wellness-Plus Solution™, a model and commercial technology the authors claim is capable of supporting significant improvements in the quality of healthcare provision in the USA. To quote from the White Paper: "True quality improvement requires an integrated clinical information system with Diagnostic Aids, Electronic Health Record (EHR), Computer Physician Order Entry (CPOE), Computerized Practice Guidelines & Clinical Pathways, Plan-of-Care Execution and Coordination, Biosurveillance & First Responder Assistance, Knowledge Management, and Business Intelligence tools, all with advanced decision support and information-sharing capabilities."

"This wiki examines financial policies, clinical practices and health information technologies, as well as the causes and consequences of low-quality care. ... Our strategy changes healthcare policies and practices by focusing on health maintenance, care quality improvement, and the use of new information technologies."

Executive Summary

"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 the problem: Healthcare expenditures in America continue to escalate out of control as quality (safety, effectiveness, efficiency, affordability, 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 focus on increasing consumer co-payments and demanding consumers make complex healthcare choices without adequate knowledge, or else they focus on setting arbitrary and difficult to measure “quality” goals providers must accomplish for financial rewards. These models may be useful, but will only succeed if they address a fundamental problem: Healthcare stakeholders must (a) know the specific treatments and prevention 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 void; 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 unique and sensible model to solve our country’s healthcare problems. Unlike other models, 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 which healthcare stakeholders continually improve the health and well-being all people by:

• "Collaborating to develop and use evolving knowledge bases (i.e., information storehouses) of evidence-based practice guidelines and clinical pathways 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."

Stephen E. Beller
National Health Data Systems, Inc.
130 Hastings Ave.
Croton On Hudson, NY 10520
USA

T: (914) 271-5434 ext. 2
E: sbellernhds.com

   Understanding and Curing the Healthcare Crisis ...    National Health Data Systems, Inc.