Measure/Analyze what? - Financial or Clinical?

Cost goes in one direction and benefit goes in another direction.

Healthcare is not like a transaction system where you get a service for a consideration. Healthcare is unique because the cost of healthcare is borne by either the Govt in commonwealth healthcare system or the Insurance companies in private healthcare system, whereas the benefits go to the patient.

Someone can say that the benefits to the patient can be measured, but the improvement in patient safety is not really measurable. If you are going on the correct side of the road then you don’t know all the hazardous events that could have happened to you if you were on the wrong side of the road. So if you don’t know something, then you can’t measure it.

Therefore benefits of healthcare cannot be always measured in financial terms. What makes more sense is measuring the parameters in clinical terms e.g. disease trends at population levels, outcomes based on past evidence and disease progression in each patient. Utilization of resources as compared to baseline also helps.

Most business consultants’ don’t understand this simple logic in healthcare. In summary, Healthcare doesn’t have the service for a consideration financial model.

I know most people will not agree to my note above, until lots of projects fail. I will also wait for someone to educate me otherwise.

Federated vs. CDR Integration Approach

What is better system for integrating different Healthcare applications spread across different locations e.g. Regional or Provincial level EHR? -

1. Federated model - where data is pulled on demand
2. Central Data Repository - where all data from source systems is pooled upfront
   

This Q has troubled my mind for a long time and I am unable to find a consensus on the best approach. But after having discussed this matter extensively I felt I should post summary of all views in the blog for a wider audience.

Most Commonwealth countries are adopting the Federated model to build their HIE and EHRS. Standards such as HL7 and DICOM make it relatively simple to implement a more flexible Federated model. However how would you do Evidence based medicine 'closing the loop' and Epidemiology data analytics in Federated model? Isn't Central Data repository required for the data analytics.

Whereas Central repositories tend to be fairly brittle. Converting the source data to standard format to store in CDR is a challenge. Also, relatively small changes on the part of any of your data sources can result in all kinds of difficulties. But it is much easier to get a single, consolidated view of patient information with a CDR method.

Some people feel that we need at least some metadata or a clinical subset to be stored in a CDR fashion. That's the only way to do data analysis for outcomes measurement. A "hybrid" model is most promising i.e. Store key clinical indicators and pull other details as needed.

In summary, all depends upon what you want to achieve. Federated is the best if you want the patient data to move along with the patient in the healthcare value chain. However you will need CDR if you want to close the loop and do epidemiology analysis, evidence-based medicine or disease progression trend charting for patients.

HCIT plus HC-Mgmt Education Model

With coming of paper-less film-less Digital Hospitals, the Healthcare industry is facing a severe shortage of skills in Healthcare Informatics and on the other side Academia is producing Healthcare Management candidates who need to go to a finishing school to be employable.

Medical education lacks management and IT curriculum. Whereas doctors are increasingly expected to manage digital hospitals, electronic medical records, digital diagnostic images and analyze public health data in electronic form. Isn’t it a paradox?

The shortage is compounded by the HCIT outsourcing from north-America and Europe, where export of services and onsite staff augmentation is growing and needs lot of HCMgmt + HCIT resources.

Govt, Industry and Academia need to come together in building a consortium for enabling a Healthcare-IT R&D university in India. Well developed Healthcare-IT curriculum can be taken from North-American universities and modified for Indian Healthcare. Also IAMI and HIMSS should be involved in accrediting these courses.