Andrea Fiumicelli: Better Coordination, Better Health

It’s a complicated picture, but two factors seem clear: The activities of medical practitioners, no matter how effective they may be in isolation, are often not well coordinated; and medical interventions are often underpinned by surprisingly little evidence. Our health, it would seem, is an area where healthcare technology can make a significant contribution.

Most of us will have experienced the frustration of dealing with multiple clinicians, each an expert in his or her field but each with only a partial picture of the situation. In some ways it is an inevitable reflection of the multiple specialties that make up medical care, but it is also a reflection that healthcare systems have not yet embraced systems that speed data flow through their organizations.

Coordinated care makes a difference

Research from across the world suggests that “coordinated care,” by which we mean actively managing the relationships among multiple care providers, can both improve health outcomes and decrease costs. By establishing well-understood care pathways and protocols, a coordinated care system can make a real difference for patients.

The role of technology is clear: information flow, process management, administrative scheduling and record keeping. The technology provider’s requirement is to deliver robust integrated systems that embrace multiple, independent care providers. As we move farther into the 21st century, it will be the way systems work together that will drive improvement as much as the individual systems themselves.

A key feature of successful coordinated care systems is the adoption of “evidence-based” medical practices. Clearly, adopting approaches that have been demonstrated to be effective seems like a good idea. It is surprising then that Eric Topol, M.D., in his influential book, The Creative Destruction of Medicine, claims that “A large proportion of tests and prescriptions used frequently in medicine have little or no supportive evidence of utility.” He quotes The Institute of Medicine as a source supporting the claim.

This is not the place to comment on the culture and practice of medicine. One thing is clear, though: The rising use of technology in medicine means more electronically held patient data. It is a scary thought that online retailers already have better systems for understanding the motivations and habits of their customers than healthcare systems have for their patients.

Analytical techniques produce evidence

Applying analytical techniques to patient data will undoubtedly yield a rich source of evidence about populations as a whole, as well as insights that can transform the treatment of an individual patient. We are already seeing analytics help healthcare payers improve their businesses. The real health benefits will come when we use it to improve the provision of care — as, for instance, with the CareVeillance solution described elsewhere in this issue.

Take a look at any care setting and you will see technology in use. Medical records and lab results are held electronically; in many cases, appointment booking and scheduling are computer-based; and of course a wide range of medical devices are measuring vital signs. In some hospitals, such as Cabrini in Melbourne, Australia, clinicians routinely carry iPads that give them immediate access to patient data.

The next step is to coordinate all of that technology across all of those care settings, and to harvest the data we are already collecting. The foundation is effective next-generation technology solutions; the result will be better health outcomes.

Andrea Fiumicelli is vice president and general manager of CSC's Healthcare Group.