Health IT Policy Committee: Mostashari urges workflow changes for better outcomes
“Five percent of the problem is people and 95 percent of the problem is systems,” said Farzad Mostashari, MD, ScM, national coordinator of health IT, in opening remarks at the Health IT Policy Committee on May 7.
Mostashari said that while progress has been made moving healthcare into the digital realm, “we are about five percent on the way from changing workflow and redesigning care to take advantage of those technologies.”
He discussed efforts with six clinics affiliated with the Beacon Challenge to achieve a rapid improvement in measures related to LDL cholesterol in diabetes patients. “As people know, diabetes greatly increases the risk of heart attack and stroke,” he said.
Mostashari said the best providers achieve an 85 to 95 percent rate control among patients with diabetes and heart disease, with 40 to 45 percent of patients with diabetes achieving good LDL control. To move the dial further on the challenging proposition of controlling LDL in diabetes patients, providers must identify where the system is failing, not where people are failing, he said.
“The approach we are taking is to ask the simple question, if there are 1,000 patients with diabetes who come in, and 400 are receiving treatment, where are we losing the other 600? Application of data is the answer,” Mostashari said.
He discussed difficulties in patient engagement in a recent case where a clinic sent out letters to 700 patients who have not had a recent LDL test. About 50 of them showed up in response to the letter with many leaving without getting a prescription.
The answer, Mostashari said, is automation and a new workflow. He recommended LDL tests before a physician visit, so the lab test results are on hand for the encounter. “It’s a new concept of population health management that lowers the center of gravity.”
While process redesign could yield some positive results, the next step is how to scale this “hard fought knowledge of what works and how to make it work,” Mostashari said. “How can we do this not just in 3,000 hospitals, but in 180,000 practices? How do we get it to spread?”