Even as healthcare organizations struggle first to embrace and ultimately achieve interoperability of patient data, they need to start thinking about what do with the information once they’re able to move it around securely. That means learning how to develop longitudinal coordinated care plans, according to a new report from Boston-based Chilmark Research.
“While the technology and concept are immature, Chilmark Research believes strongly that care plans are an important next stage of realizing the potential of health IT to provide a more cohesive, inclusive experience for patients who have put their wellbeing in the hands of the healthcare system,” said the report, authored by Chilmark analyst Matt Guldin.
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“[E]ven as medicine has produced innovations like the Human Genome Project and minimally invasive surgery, it has not found a way to reliably share the full story of a patient’s care or coordinate healthcare professionals around a shared set of goals and assumptions for a patient. This is where care plans come in,” the report explains.
For now, data remains siloed. “They’re still focused on getting information out of hospitals,” Guldin said.
The healthcare industry is at least eight years away from “achieving an idealized version of the coordinated care plan,” according to Chilmark. Health IT vendors are about 2-3 years away from having large-scale products for creating and managing longitudinal care plans.
The long time horizon means now is a pretty good time to start thinking about what that idealized care plan might look like, Guldin said.
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Chilmark came up with eight “core” elements for a care plan:
- Patient demographics;
- Members of the care team;
- Any care management programs the patient is in;
- Active problem list;
- Active medication list;
- Goals, including those for self-management;
- All health interventions and their current status;
- Risk factors for the patient.
But there are other elements that might be included, many of which will be specific to clinical situations — allergies, test results — administrative factors or the individual patient. “There’s a lot of variability,” Guldin said. This creates the risk of care plans getting very long in a hurry.
“I don’t think that these care plans can be 8, 10, 12, 15 pages long,” Guldin said.
“The key is coming up with the right data sets and figuring out [data] transport issues.”
Image: Chilmark Research
