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ASH 2016

ASH Symposium on Quality Addresses Health IT Challenges for the Provider and the Patient

Surabhi Dangi-Garimella, PhD
The Special Symposium on Quality at the 58th American Society of Hematology Annual Meeting & Exposition, looked at how health information technology can be utilized to improve healthcare quality, enhance patient-provider shared decision-making, and facilitate efforts in quality research.
Blayney, who has in the past presided over the American Society of Clinical Oncology, serves on the CancerLinQ Physician Advisory Committee. CancerLinQ is a big data platform that aggregates EHR data for quality benchmarking and also to aid clinical decisions.2 He addressed the challenges faced by providers in the clinic with using health IT platforms.

“Poor usability, mismanagement, and misidentification can all lead to HIT problems,” Blayney said. “It’s important to note that user interfaces need to be improved and people need to be trained as well.” However, he emphasized that there needs to be an intuitive nature to using these interfaces, similar to using a mobile device, which is more user-friendly and intuitive in nature.

Blayney explained that while electronic data capture shifts the data entry burden, it does not reduce the number of steps involved in assimilating all of that data. “At Stanford, we have taken advantage of the data warehouse to develop curated analytic data sets. So the solution is to create access to data warehousing, use a curation engine, and create a documenting warehouse that can all help the process.” He acknowledged, however, that all of this does not come cheap and needs significant monetary and personnel investment.

It’s widely accepted, however, that without measurement there is no improvement. Blayney provided an example of a breast cancer staging compliance report that was sent to oncologists individually and then to the entire groups, to improve physician adherence to the staging module. “By inserting a curation engine, we were able to add cancer stage as a measurable field,” he said.

A team of experts at Stanford is also working on natural language processing to electronically extract data from clinical records.3 “Capturing unplanned hospitalizations and emergency department visits as part of an episode of care, which might be happening outside of Stanford’s network, is often difficult to capture.” But the team developed a system to gather this information from EHRs, “Although a significant amount of curating was need, including for ambiguous terms like ER, PR, and other acronyms,” Blayney told the audience. “It is important to reduce data mismanagement and to aggregate data across networks and nationally, and provide feedback to the physicians involved,” he added.
Finally, to speak about how health IT can enhance the patient experience was Howell, who is a health services researcher.

Patient engagement, she said, is about taking actions that help manage their health to gain benefit from healthcare. “It needs an active collaboration between patients and providers to design, manage, and achieve positive health outcomes,” Howell added.

Studies have shown that actively engaging patients in their own care does improve outcomes, it encourages them to use more preventive services, and they also experience better transitions between silos of care.

Historically, meaningful use emphasized increased EHR use; however, the current belief is that empowering patients and improving their engagement with providers is more important for meaningful use. Howell said that patients want to engage in technology to help improve their lives—such as appointment reminders, refills etc. But do patients have the tools or equipment to care for themselves?

Health IT can be used to support and empower patients via,
  1. Education tools and by providing them access to their data
  2. Data and information exchange among providers
  3. Data and information exchange between providers and patients on symptom management and virtual treatments
  4. Data and information exchange between providers and health systems
Howell told the audience that while health trackers/mHealth can help with early preventive intervention and help create a proactive model of care, issues such as data capture and health privacy remain.

The bottom line, though, is to think of the patient as a whole. “Quality of life and patient experience is as important as the toxicities and adverse events that are documented,” Howell said, adding that she is a firm believer in the potential of patient-reported outcomes measures.

  1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.
  2. Miller R. CancerLinQ—ASCO’s rapid learning system to improve quality and personalize insights. Am J Manag Care. 2016;22(SP8):SP308-SP310.
  3. Obtaining clinical data for research. Stanford website. Accessed December 4, 2016.

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