"We're going to need tools, all kinds of new tools," said David Nash, MD. "We need comparative data. We're going to need the analytics behind it."
Nash, the founding dean of Thomas Jefferson University's School of Population Health in Philadelphia, was speaking about the new world wherein doctors, hospitals and public health departments more aggressively and effectively treat patient populations.
Indeed, population health is "so central to where the world is going to go,” Nash said at the annual Allscripts Client Experience users’ meeting. "It's the outcome we care about.”
Unfortunately, however, in a fee-for-service world clinicians are forced to care more about the volume of patients they see and procedures they can perform than they do about either those outcomes and the health of populations.
And it doesn't help that patient attitudes also are skewed: "I'm going to take my Lipitor on my way to McDonald's, and you're going to pay for the Lipitor," Nash said of the current mindset.
The movement toward value-based payment is a "complete cultural change," he said. "This is bringing a whole new science of population health."
And that is where the IT world comes in.
Nash, a practicing internist, is most interested in patient registries. "The registry is what gives me closure of the feedback loop," he said.
He wants feedback on whether patients take care of themselves in their daily lives, since most health practices happen outside of hospitals and clinics. Actual care delivery, Nash said, comprises only about 15 percent of the story. Yet, 88 percent of health-related spending in the U.S. goes to medical services, with just 4 percent to healthy behaviors, according to a 2013 report on obesity from the Trust for America's Health and the Robert Wood Johnson Foundation.
[See also: On the intersection of artificial intelligence and bioinformatics.]
"It's not about what goes on in the hospital. Health is wrapped up into everything that we're all about," Nash said. "Outside of the box of the hospital, that's really where the action is."
To change the culture and cross the quality chasm — a phrase coined by the Institute of Medicine in 2001 — clinicians need to: practice based on evidence; reduce "unexplained clinical variation"; end their "slavish adherence to professional autonomy;" continuously measure and close the feedback loop; and engage patients across the entire care continuum, Nash explained.
“What do we need? Total public transparency," he said.
And an attitude shift on the issue of professional autonomy that often drives physicians to ignore data from outside sources and disregard safety alerts from EHRs.
"Get over yourself, doctor," Nash said in an interview with Government Health IT sister site Healthcare IT News.
In his vision for the future, Nash would like to come into the office and see exactly how he is doing in key clinical areas such as preventive care, counseling on smoking cessation and flu vaccinations. Without a registry, he has no way of knowing.
The core of medical education has always been one patient and one problem at a time, but that is not how care should work.
"It's not about the seven magic minutes they're going to have with me maybe two times a year," Nash said.
Related articles:
Payers bringing telehealth to critical mass
