Andrew Litt, M.D.

IT and the promise of patient-centered collaborative care

August 28, 2013 6:00 AM EDT

Imagine that you are 55 years old, a former smoker with Type 2 diabetes. Today, you are seeing your primary care physician about a sore throat and a very itchy rash on your lower leg.

Now we depart from current reality. Your primary care physician looks at your medical record on her EMR system, logging on to the cloud-based application that stores your record. She reviews the daily blood glucose and blood pressure readings and your body weight, all uploaded from your Wi-Fi-equipped home monitors. She sees from your online diet and exercise diary that you’ve been getting regular exercise and following your dietitian’s recommendations.

She sees that your cardiologist has discontinued the meds for blood pressure and cholesterol control, which resolved as the result of your recent 25-pound weight loss. She also sees that the nurse practitioner who works with your endocrinologist has set up automatic text-message medication reminders and has coached you via weekly videoconferences. She reviews your colonoscopy report, including the image of the small polyp that the gastroenterologist removed.

The sore throat is just a virus, and your doctor recommends getting plenty of fluids and rest. That rash? It looks like poison ivy. You tell your doctor that you’ve been walking more, and other than the current virus, you are feeling remarkably well, and you are more productive at work and happier at home. Your doctor sends an e-prescription for a topical hydrocortisone cream to your local pharmacy for the rash and recommends a poison-ivy-free walking trail.

After recording your visit in the EMR, she logs off. All your other doctors will be able to see the notes from today’s visit when they review your electronic chart.

Yes, I know that’s a fantasy scenario at this point, but it fits the model of patient-centered care, facilitated by a free flow of information, that was envisioned by the Institute of Medicine in its 2001 report Crossing the Quality Chasm. And parts of that vision are now in routine use. The rest inches closer to reality every day as healthcare transformation accelerates, driven by the rapid pace of technological development. A study published by the Annals of Family Medicine in January 2013 predicts that 80 percent of family medicine physicians will have adopted EMRs by the end of this year.

The economics of this transformation make sense, as evidenced by the increase in Accountable Care Organizations and other outcomes-based reimbursement models. The success of these models will be facilitated by better access to information and by sophisticated analytic tools to identify chronically ill patients who can benefit from intensive, proactive care. In our fantasy scenario, the healthcare system will save several hundred thousand dollars by not doing cardiology procedures, dialysis treatments, amputation surgeries and eye procedures to deal with the complications of poorly controlled blood glucose levels. Or on cancer treatments for that polyp that might have become an invasive tumor. Compared to those big-ticket items, office visits, text messages, videoconference coaching and the necessary information technology are minor expenditures.

We still face big challenges as we transform healthcare into that collaborative, patient-centered continuum that we envision. On the technological front, interoperability is still elusive. But we’re making progress; clinical application vendors have agreed to collaborate on interoperability standards. Once we solve that problem, cloud technology will make possible a central electronic record-keeping system that can be accessed as needed by authorized healthcare providers and patients.

The bigger challenges lie in non-technical areas. Clinical operations and workflows, and many clinicians themselves, must reorient toward a patient-centered, collaborative approach. For solo practitioners used to working in silos, and health systems that have spent decades competing with each other, the new model might not be an easy change.

Public and private payers, too, have some work to do. Financial incentives have to align with outcomes goals, because if you don’t pay providers for preventive care and collaboration, you won’t get much of either.

Healthcare IT leaders must become strategic partners, focused on aligning technology with long-term clinical and business goals. When we meet as a community in Washington, DC, during National Health IT Week, Sept. 16-20, we’ll explore how technology and analytic tools can accelerate the needed changes. I’ll be there participating in the 12th Annual HIMSS Policy Summit, the Childhood Cancer Summit, and an interactive forum exploring the future of personalized medicine sponsored by the Bipartisan Policy Center.

We are so close now that we can see that new world coming. It’s time to keep our eyes on the prize, which is better health for our patients and lower costs for us all.