September 20, 2011 – HSPH Expert Outlines Key Ways to Improve Health Care Delivery
Of the many problems facing health care in the United States, critics say one of the biggest is that patient care isn’t well coordinated. It’s easy, for example, for medical records to get lost in the shuffle among primary care physicians, specialists, hospitals, and rehabilitation facilities.
According to David Bates, it’s essential that coordination be improved. And a key factor is to boost the use of technology.
Bates, an internationally renowned expert in using information technology to improve clinical decision-making, patient safety, quality of care, and cost-effectiveness, spoke Sept. 7, 2011 at the Harvard School of Public Health’s (HSPH) Herbert Sherman Memorial Lecture. Sherman, a former HSPH lecturer, was particularly interested in health care information technology, quality of care, operations research, and technology assessment.
Bates is Chief of the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, a professor of medicine at Harvard Medical School, and a professor of health policy and management at HSPH, where he co-directs the Program in Clinical Effectiveness.
A patient with a “medical home,” Bates explained, is someone whose care is integrated and comprehensive, led by a team of physicians. The idea is that all of the health care professionals involved with a particular patient would communicate on a regular basis, have easy access to the patient’s medical records, and use technology in a number of ways to improve that patient’s care. Patients would have ready access to care when they need it. They’d also routinely give feedback to physicians and participate more fully with decision-making about their care. The hoped-for outcome, said Bates, is that health care quality and efficiency would increase.
Bates noted that both the Bush and the Obama administrations have supported the increased use of technology to improve health care. In fact, part of the economic stimulus bill Obama signed into law in 2009 included legislation aimed at stimulating the adoption of electronic health records and other health care technology.
Key aspects in creating a well-functioning medical home include:
• Clinical decision support systems—software that can draw on patient data and medical knowledge to help guide physician decisions
• Registries—databases that contain extensive information about patients and diseases that can help clinicians find crucial information as well as coordinate care with other providers
• Personal health records—electronic health records that patients can manage themselves
There are roadblocks preventing quick implementation of technology-related improvements in health care, Bates conceded. For instance, convincing physicians to make use of clinical decision support systems may be difficult. Some physicians who have access to such systems don’t even turn them on.
And, among patients who have the ability to establish personal health records, there are early indications of a “digital divide”: a study published earlier this year in the Archives of Internal Medicine,for which Bates was senior author, found that African Americans, Hispanics, and low-income patients are less likely to make use of such records. However, Bates and his colleagues also found that aggressive marketing can increase the number of users.
Efforts to increase the use of technology—on all fronts, and by both clinicians and patients—must continue, Bates said. “If we are going to be successful in [providing] integrated care, we have to use information technology successfully,” he said.
photo: Aubrey LaMedica
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