Harvard Business Review
Michael Porter and Thomas Lee
This is an excerpt of the paper: “The Strategy That Will Fix Health Care“, published in 2013, focused on the topic above.
The Value Agenda Detailed
- IPUs — Organize into Integrated Practice Units (IPUs)
- OUTCOMES & COSTS — Measure Outcomes and Costs for Every Patient
- BUNDLED PAYMENTS — Move to Bundled Payments for Care Cycles
- INTEGRATED CARE — -Integrate Care Delivery Systems
- GEOGRAPHY — Expand Geographic Reach
- IT PLATFORM — Build an Enabling Information Technology Platform
6: Build an Enabling Information Technology Platform
The preceding five components of the value agenda are powerfully enabled by a sixth: a supporting information technology platform. Historically, health care IT systems have been siloed by department, location, type of service, and type of data (for instance, images). Often IT systems complicate rather than support integrated, multidisciplinary care. That’s because IT is just a tool; automating broken service-delivery processes only gets you more-efficient broken processes. But the right kind of IT system can help the parts of an IPU work with one another, enable measurement and new reimbursement approaches, and tie the parts of a well-structured delivery system together.
A value-enhancing IT platform has six essential elements:
- It is centered on patients.
- It uses common data definitions.
- It encompasses all types of patient data.
- The medical record is accessible to all parties involved in care.
- The system includes templates and expert systems for each medical condition.
- The system architecture makes it easy to extract information.
It is centered on patients.
The system follows patients across services, sites, and time for the full cycle of care, including hospitalization, outpatient visits, testing, physical therapy, and other interventions. Data are aggregated around patients, not departments, units, or locations.
It uses common data definitions.
Terminology and data fields related to diagnoses, lab values, treatments, and other aspects of care are standardized so that everyone is speaking the same language, enabling data to be understood, exchanged, and queried across the whole system.
It encompasses all types of patient data.
Physician notes, images, chemotherapy orders, lab tests, and other data are stored in a single place so that everyone participating in a patient’s care has a comprehensive view.
The medical record is accessible to all parties involved in care.
That includes referring physicians and patients themselves. A simple “stress test” question to gauge the accessibility of the data in an IT system is: Can visiting nurses see physicians’ notes, and vice versa? The answer today at almost all delivery systems is “no.” As different types of clinicians become true team members-working together in IPUs, for example-sharing information needs to become routine. The right kind of medical record also should mean that patients have to provide only one set of patient information, and that they have a centralized way to schedule appointments, refill prescriptions, and communicate with clinicians. And it should make it easy to survey patients about certain types of information relevant to their care, such as their functional status and their pain levels.
The system includes templates and expert systems for each medical condition.
Templates make it easier and more efficient for the IPU teams to enter and find data, execute procedures, use standard order sets, and measure outcomes and costs. Expert systems help clinicians identify needed steps (for example, follow-up for an abnormal test) and possible risks (drug interactions that may be overlooked if data are simply recorded in free text, for example).
The system architecture makes it easy to extract information.
In value-enhancing systems, the data needed to measure outcomes, track patient-centered costs, and control for patient risk factors can be readily extracted using natural language processing. Such systems also give patients the ability to report outcomes on their care, not only after their care is completed but also during care, to enable better clinical decisions. Even in today’s most advanced systems, the critical capability to create and extract such data remains poorly developed. As a result, the cost of measuring outcomes and costs is unnecessarily increased.
The Cleveland Clinic is a provider that has made its electronic record an important enabler of its strategy to put “Patients First” by pursuing virtually all these aims. It is now moving toward giving patients full access to clinician notes-another way to improve care for patients.
About the authors
Michael E. Porter, is the Bishop Lawrence University Professor at Harvard University. He is based at Harvard Business School.
Thomas H. Lee, is the chief medical officer at Press Ganey and the former network president of Partners HealthCare
A version of this article appeared in the October 2013 issue of Harvard Business Review.
Originally published at https://hbr.org on October 1, 2013.