A View of Health Information Exchange: Towards a Digital Health Community

Introduction

For more than a decade now the potential role of Information Technology within the context of changes in healthcare systems has been discussed and some progress has also been made. Some important trends with respect to these changes in healthcare systems are shown in Figure 1, “Trends in healthcare”. The top-level drivers behind these trends are: to improve the quality of the healthcare system, reduce the increase in costs and cope with a shortage of professional staff. These trends are influenced by the increase in chronic diseases across all ages and the aging society, due to longer life expectation.

Figure 1.

Trends in healthcare

Healthcare institutes working at the front line of the changes in the healthcare domain are starting to adopt an approach called the ‘care cycle approach’, as defined in the book “Redefining Healthcare” (Porter, 2006). The author states: “Care Cycles are the best way to transform Healthcare from a zero-sum game to a patient-value driven industry”. Related to the use of information technology in healthcare delivery, the following is mentioned:

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  The information should be collected and stored around the patient. All information should be tied to the individual throughout his life.

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  Electronic patient records, including images and lab results, are essential: they allow for better integration across care givers and different care locations.

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  Organizational improvements can only succeed when clinical, administrative and financial information is brought together, otherwise optimization to achieve patient value is not possible.

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  All data should be sharable, and seamless integration of systems is needed. This puts a high emphasis on interoperability, data standards and security standards.

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  The aggregation of information should be based on the medical condition and the process definitions should be based on the specific medical condition so as to give optimal support to care givers.

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  Stepwise implementation is important in order to build up confidence by the users. However, the steps should be carefully planned and dependencies between successive steps should be identified and taken into account.

With respect to care cycles one should be aware that during a person’s life a care cycle relates to the evolution of a disease within a patient and in the case of chronic diseases might contain cycles in treatment. The essence is that the complete care process is focused on the patient and his or her specific disease, first in a single disease context, but this might evolve into multiple disease contexts during a patient’s life and for the elderly they may quite often also occur in parallel. This is in contrast with most approaches to date, which are organized around a clinical treatment plan for a single disease, through which the patient is navigated.

To support a patient-centric care approach, access to complete and up-to-date information is needed; and using health information technology across several care givers, inside and outside the hospital, is essential to enable adequate support across all activities within the care cycle: preventing, diagnosing, treating and monitoring chronic diseases. Besides the care cycle approach there is also the change in a patient from an object of care to a subject within the care process and ultimately to a partner in the process with his own responsibilities. This also means that the main goal for healthcare providers is re-defined to ‘deliver superior patient value’, as presented in the book “Redefining Healthcare” (Porter, 2006).