Outcomes and informatics

Archives of Pathology & Laboratory Medicine, Nov 1997 by Connelly, Donald P, Aller, Raymond D

* Objective.-To provide an overview of the potential contribution that informatics can make for pathologists who become involved in outcomes assessment and management.

Data Sources.-Contemporary scientific articles centered on pathologists and the assessment of outcomes, the definitions of outcomes assessment and management, and related methodologic issues, especially those pertaining to information technology and outcomes, and a summary of eight independent group process sessions involving volunteer pathologists and a group facilitator discussing issues related to informatics and outcomes as structured by a clinical scenario with focusing questions.

Study Selection.-Articles reviewed were drawn primarily from the literature published since 1985 and found through Medline key word searches of titles and abstracts; likely articles were then selected for subsequent detailed

review on the basis of the abstract's contents. Group process data were drawn from summaries of each of the eight groups as prepared by the facilitator from notes taken during the session by a designated scribe.

Conclusions.-It is crucial for pathologists to participate in clinical outcomes studies. Informatics can serve as a tool kit for performing outcomes studies relevant to pathology (eg, collect data or analyze data), or it can be seen as a malleable component of health care processes that can be modified to achieve improved outcomes. Pathologists see many potential avenues for using informatics to leverage the impact that the pathologist and laboratory can have on clinical outcomes. Focusing on some specific informatics learning objectives can help the pathologist become a leader in outcomes studies.

(Arch Pathol Lab Med. 1997;121:1176-1182)

HEALTH CARE IS CHANGING FASTER THAN INFORMATION TECHNOLOGY

Health care has been undergoing dramatic changes in the last decade, and there is no sign of impending stabilization. Dramatic and fundamental shifts in how health care is financed and delivered have changed what health care is and what it is expected to be. Even before today's health care transformation began, successful application of information technology (IT) to the problems of health care was problematic and lagged behind the needs by several years. This lag had many causes, including the inherent complexity of health care, limited capability of IT, and limited investment in IT by health care organizations. For many years, large computer companies with limited understanding of information processes in health care sold software packages focused on a small segment of the health care information process (eg, Medicare billing) as "total hospital information systems." Not surprisingly, today's rapidly changing health care scene has only accentuated the weaknesses of yesterday's incomplete and often ill-conceived IT solutions. The gap between need and IT solutions is growing broader and at a faster rate than ever before. Some of the most fundamental changes that health care is undergoing and corresponding barriers to progress that have been inherited from earlier IT systems are summarized in Table 1.

WISHFUL WAITING OR PLANNED PROGRESS?

Of course, hope springs eternal within the souls of information technologists. They point to solutions that are on the horizon for each of these issues (see Table 2).

At least one health care management consultant predicts that managed care needs and IT capability will converge near the start of the next millennium.1 Managed care will have moved toward larger and more complex integrated delivery systems, for which IT will serve as the integrating glue by distributing and managing information throughout what probably is a geographically farflung enterprise. Information integration with the outside world may be accomplished by learning from the mistakes of recent attempts to create community health care information networks? Computer-based patient records will be at least a partial reality, and state-of-the-art information technologies will deliver what managed care organizations need, doing it affordably, flexibly, and reliably. The knowledge underlying effective outcomes management will have grown and so will have supportive technologies, such as longitudinal repositories of population data, structured clinical data, active decision support to clinicians, and mechanisms that improve the execution of practice guidelines.

So what do we do in the meantime while technology plays "catch up" in terms of the needs of outcomes measurement and management? We cannot simply wait for the promise of technology to come, certainly not as it pertains to the work of pathology. With some sense of urgency, laboratory workers and pathologists must document the value they bring everyday to health care.ss It is increasingly important that pathologists participate in interdisciplinary teams seeking to measure outcomes.6 Health care has not waited for IT in the past, and it will not stand still now. Neither will it wait for pathology to build its case. While we cannot do everything with respect to outcomes measurement, we must do something.