Monday, December 16, 2013

EHRS + Clinical Prediction Rules = Better Outcomes + Reduced Costs?

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Today's guest post comes from ePharma's event chair Paul Ivans, President, Evolution Road Consulting. This year marks his 10th year as ePharma event chair.  ePharma Summit takes place this February 10-12, 2014 in New York City.  Want to join Paul?  As a reader of this blog when you register to join us and mention code XP1906BLOG, you're eligible to save up to $100 off the current event rates!*

EHRS + Clinical Prediction Rules = Better Outcomes + Reduced Costs?

As we discussed at the ePharma Summit earlier this year, the US Healthcare System is facing dramatic, tectonic-plate level changes driving us toward the horizon of a very new and different “Healthcare Future”. And the hope for all of us, is that it will be a much better future than the broken, misaligned, costly and marginally effective system we face today.

Source: Image 1                                                                                                                                              Source: Image 2

Of course, the road so far has not been particularly smooth (and you thought you had a tight deadline building that website for your brand, huh). But if we pull back and look at the foundational changes happening in the system, there are tremendous signals of hope that the new healthcare future will drive significantly better patient health outcomes at dramatically lower costs.

A key driver of this optimistic outlook is the intersection of two rapidly growing trends: the rapid adoption of EHRs and the maturing of clinical algorithms that leverage actual patient data from EHRs to provide probabilistic guidance to healthcare providers in real time.

We have all seen the data on the dramatic adoption of EHRs in the US, primarily driven by the current incentives and upcoming penalties related to meaningful use. All good. Yet under the surface is a massive opportunity for EHR data to be leveraged in the clinical setting to improve patient outcomes, yes improve outcomes. The data on you and me in EHRs will include (over time) all our symptoms, lab results, diagnoses, treatments, and how we’ve responded to treatment pathways. The real power of the EHRs will be in leveraging that data in real-time as input to clinical prediction algorithms that will help the provider diagnose you more accurately the first time, with fewer trial and error cycles, fewer lab tests, and fewer office visits…all based on the detailed data and nuances found in your clinical data.

Over the last few months, the results of a series of randomized clinical studies have been published, indicating that while this type of approach is still “early”, it has demonstrated improved outcomes and reduced costs across conditions such as streptococcal pharyngitis and pneumonia (by Mount Sinai's Division of General Internal Medicine as published in JAMA Internal Medicine, September 2013).

Source: Image 3
Additionally, other clinical researchers are adding another fascinating layer to the mix – genomics. For example, the Inova Translational Medicine Institute is partnering with data analytics company GNS Healthcare to build predictive models based on EHR and genomic data to predict infants at risk of preterm live birth. According to Inova and GNS, “these models will characterize the complex relationships among many variables in order to identify the associations and underlying causal mechanisms of preterm birth and will allow for personalized prediction of preterm birth risk and gestational length. This, in turn, will help prioritize the testing of potential new diagnostic and treatment plans for at-risk patients" (source: Fierce EMR, August 2013)

So while we are still in the very early stages of our healthcare system’s transformation to the new healthcare future, there are many strong and positive indicators of hope that, as an industry, we can dramatically improve patient outcomes and reduce costs, at the same time.

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