Among the six steps foreseen by the Digital Agenda for a value-based healthcare, there is a technological platform able to support the patients care cycle and provide with information on results, therapeutic adherence and costs. Let’s examine them.
The value-based healthcare (VBHC) foresees the identification of homogeneous patient groups on which models of taking charge are settled, based on specific care paths (Population Health Management). At the base of this process there are the ability to profile patients and to assign them the correct clinic risk class. In addition to the actual analysis based on pathology certifications, diagnosis codes and medicine consumption – where they are present – it is possible to realise rule-engine based systems, for implementing complex algorithms able to consider and valuate other types of information, even with semantic analysis. In profiling patients under multi-drug therapy also the pharmacologic risk should be considered.
The VBHC recommends a central focus on important results for patients. For this reason, first it is necessary to define a reference clinic model for the pathologies treated in the care path, in which clinic conditions, events and results are defined and correlated. In other words, it is necessary to define a plan to consider and survey the patient condition, fix the goals, define actions in special events, valuate the reached results (the actual approach sees the care path as a simple list of activities got from a standard list coming from history or protocols). This means a clinic logic inside the care management system to really help operators, not only to remember the tasks,
The VBHC requires a strong integration of cares. From an IT point of view, two approaches are now followed, sometimes together: the development of ad-hoc platform to manage clinical pathways, for primary cares doctors, specialists and care manager; the information sharing through the EHR and specific documents (Patient Summary).
The first one presents the problem that professionals – especially GPs, some specialists as diabetic specialists –are very reluctant to use other software platforms than their base application. Routine apart, there is the problem to fragment information on several systems and often repeat some activities, as the prescription, on two different applications.
The second approach – in theory more coherent with the interoperability paradigm – presents a limit: the system in use not always possess all the necessary information; this question is amplified if we think at a deeper clinic logic than the actual one used by the GPs EMR. At last, the problem to where allocate a series of processes which require a dedicated database, a function not imputable to EHR.
Moreover, the VBHC foresees to measure results and costs, evaluate the clinic correctness of carried interventions and the adherence to patients’ therapy. These goals can be reached by adopting a Clinical Decision Support System (CDSS), both for the clinical practice (ex-ante) and for the analysis and valuation (ex-post). Using this system you can get a more complete analysis than the actual one, especially comparing what foreseen by reference clinical pathways (standard) and what really occurred. An advanced CDSS is able to valuate doctors’ activity in reference to medical evidences, protocols and guidelines. It can also signalling and measure those risks that doctors’ decisions or non-decisions have caused, such as the lack of special checks, interactions risks or adverse effects.
I’ll try to treat these themes in next articles.