Don’t Forget the Human Factor in Realizing the Full Potential of Health IT to Improve Healthcare for Americans

As I discussed in my most recent blog post, a report, published in December 2010 to examine how health IT could improve the quality of healthcare and reduce its cost, considers whether existing federal health IT efforts are optimized for these goals. The report was prepared by the President’s Council of Advisors on Science and Technology (PCAST), which is an advisory group of the nation’s leading scientists and engineers, appointed by the President to augment the science and technology advice otherwise available to him.

The Council has stated that an intended benefit of increasing use of health IT includes the following:

Ensuring real-time access to information;
Improving workflow and decreasing administrative requirements for clinicians; and
Increasing consumer confidence in care delivery.

Council members also emphasized that connecting the business and clinical sides of healthcare through technology will have a positive impact on the efficiency and quality of healthcare delivery.

The report concluded that “…it is crucial that the Federal Government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records while strictly ensuring patient privacy.”

These are all worthy goals, and it is important to note clinical and informatics experts are currently working at many levels and in many organizations to advance the use of information technology and systems to achieve them. Yes – this process requires that humans understand the workflow and have expertise in addressing the management, communication and representation of health information. And, yes – this process impacts patients who need confidence that their care delivery is being managed by intelligent human beings who not only care about their needs, but have the knowledge and experience to make the right clinical decisions.

So, let’s not limit these recommendations to a data-element-focused, technical approach. Patients are not made up of individual bits of healthcare data, tagged with privacy and security specifications, ready to be processed by search engines and presented for view in a variety of ways. Patients present to their healthcare providers in the full context of their physical, mental and emotional state, bundled with their family history, past and current medications and treatments. It is necessary and important to consider patient data in this full context, and to acknowledge that it is clinicians who are experienced in dealing with complex problems and specific human needs.

I will end this blog post with a simple example taught to me by my mentor, Ida Androwich RN, PhD, FAAN. As background, let me provide a few key definitions from Graves and Corcoran.

Data are discrete entities that are described objectively without interpretation.
Information is data that are interpreted, organized or structured.
Knowledge is information that is synthesized so that relationships are identified and formalized.[1]

Applying these definitions to this discussion, a vital sign for an individual at a single moment – heart rate, respiration, temperature or blood pressure – is an example of data. A chronological set of vital signs, placed into context and used for longitudinal comparison is considered information.

For example, if a patient’s blood pressure and heart rate are dropping and the respirations are increasing, they are likely in some type of cardiac or respiratory distress. When we apply the knowledge and experience of the caregiver to the context of the patient, we will get the human intervention that is necessary for optimal patient care.

Clearly, a common exchange language and the related technical approaches and specifications are necessary to manage and secure the volume of data that reside in health records, be they paper or electronic. But, as noted by the ANA Nursing Informatics Scope and Practice, “….as data are transformed into information and information into knowledge, each level increases in complexity and requires greater application of human intellect.”[2]

If the PCAST’s recommendations focus solely on the uniform exchange of metadata tagged data elements, without fully recognizing the importance of information and knowledge, patients and clinicians will be prevented from achieving optimal health outcomes.

Let’s make sure, as we move forward with innovative technologies and digital interventions, we don’t forget what is most important – the human factor.

[1] Graves J.R. & S. Corcoran (1989). The study of nursing informatics. Image 21(40), 227-331.

[2] American Nurses Association (2008). Nursing Informatics: Scope and Standards of Practice

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4 Responses to Don’t Forget the Human Factor in Realizing the Full Potential of Health IT to Improve Healthcare for Americans

Cheryl D. Parker, RN, PhD says:

January 14, 2011 at 8:58 am

Joyce, excellent insights that are critical to our use of healthcare IT. It’s not about the technology, it about the patient and all that goes with each one. The technology is only a tool…that must be used correctly not as a replacement for clinical assessment. Thanks, Cheryl

Joyce Sensmeier says:

January 14, 2011 at 12:27 pm

Thanks for your comments, Cheryl. One opportunity for sharing this patient/clinician-focused perspective with others is the ONC request for comments on the PCAST report due on January 17th which HIMSS will certainly do. Another is to monitor and participate in the ONC Standards and Interoperability (S&I) Framework initiatives to ensure that this perspective is represented. An invitation has recently been sent to HIMSS, its members and other stakeholders to participate. The S&I Initiative focuses on “..a single challenge with a set of value-creating goals and outcomes that will enhance efficiency, quality and effectiveness of the delivery of healthcare, through the development of content, technical specifications and reusable tools and services.” Three initiatives are currently being launched, each of which has a clinical component:
Transitions of Care
Lab Interface Improvement
CDA Consolidation Project
Those interested can get more information on the S&I Framework Wiki at(http://wiki.siframework.org). The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and it will be important to make sure that the patient and clinician perspectives are represented in this work.

Hank Mayers says:

January 15, 2011 at 1:48 pm

Hi Joyce,

I agree with your comments, especially the reminder as to how data becomes information, and how information is packaged and analyzed to become knowledge.

I do not claim to be an expert in technical matters when they get down to these levels, but it seems to me that PCAST is simply asking everyone to eventually adopt a way of labeling and processing data so it is easily identified, and in some cases, better controlled. The technologies they refer to would enable a more precise understanding of the data, so that it is more readily interpretable by EHR technologies and user-practitioners. Seems to me that PCAST is recommending that data become more straightforward, regardless of the technology of the source, so that it can be electronically presented as the meaningful information that practitioners desire to improve the appropriateness and effectiveness of their treatments for their patients. As I ponder the likely exponential increase in data complexity required to reach the stage of “personalized medicine” that is being foretold, it seems to me that working for more precision in describing health care data is becoming imperative.

Frankly, one of the inferences from the PCAST report that puzzles me is that one must choose between the data fundamental of documents and tagged data. Again, I am no expert here, but I cannot see why they cannot operate side-by-side. After all, there is no apparent reason why standardized electronic documents cannot also be accumulated packages of tagged data.

Having said all the above, I want to make it very clear that I do NOT espouse some kind of disruptive shift in the standards reached after so great an effort by so many over the last 4-5 years. We have a base for interoperability. Now is the time to get going, not greater preparatory deliberations.

As I see it, the focus on PCAST’s recommendations should now be the matter of incremental implementation and non-disruptive timing. In that way, we can prepare a roadmap that is understandable to vendors, customers, payers, and other stakeholders in the creation of the electronic nervous system of a modern healthcare system.

I’d appreciate your thoughts on this.

Thanks

Hank Mayers

Joyce Sensmeier says:

January 15, 2011 at 3:05 pm

Thanks, Hank. I completely agree with your assessment. I, too, welcome the use of innovation and technologies that, as you say, would enable a more precise understanding of the data, so that it is more readily interpretable by EHR technologies and user-practitioners. And that access to data could become more straightforward, regardless of the technology of the source. But, too often the context of the patient is not fully considered in these discussions, and my intent was to raise that voice more loudly. I also agree with your concerns about taking too disruptive of an approach. The sweet spot would be to build on the foundational standards work that has been accomplished and find a way to simplify and accelerate its adoption. Those providers that testified at the HIT Standards Committee implementation hearings last week were calling for interoperability NOW. We don’t have time to start the process over again.