Earlier this year, the American Recovery and Reinvestment Act (ARRA) authorized $1.1 billion for healthcare comparative effectiveness research (CER), which is expected to guide a growing number of treatment protocols moving forward.
While debate continues regarding the shape and scope of a national CER initiative, a successful program will require the aggregation of comprehensive patient and outcome information and, more important, extensive analysis and interpretation of this data. Information technology requirements and realities, therefore, must be at the forefront of the CER discussion.
Several factors will be critical to creating the IT infrastructure required for an effective and efficient national CER initiative. The ability to gather timely, accurate and comprehensive patient, clinical, claims and outcome data in an electronic format is the first consideration.
On this front, providers and the nation as a whole have yet to fully embrace the digitalization of healthcare information and the adoption of electronic medical records. The Obama administration and Congress acknowledged the need for progress on this front by earmarking more than $17 billion in the ARRA to promote investment in EMRs.
Standards and interoperability are also fundamental to sharing and comparing healthcare data that comes in many disparate formats and from many different sources. “Improving Medical Decisions through Comparative Effectiveness Research: Cancer as a Case Study,” a recent report published by Friends of Cancer Research, underscores the importance of linking data from public and private entities to build on existing data collection and research capabilities as a fundamental requirement for an effective CER initiative.
Today, the majority of clinical as well as claims data is locked in systems that cannot communicate, prohibiting the aggregation and analysis of critical information that could help to improve care and drive down costs. To support CER initiatives, we require further progress around standardizing clinical and claims data and, in the interim, should look to leverage innovative solutions that enable the interoperability of disparate data to support detailed analysis.
The ability to find meaning in volumes of aggregated data is at the very core of a CER initiative. Powerful analytics capabilities, therefore, must be front and center in a national CER program, providing researchers with the tools they require to identify patterns and determine the relative effectiveness of treatments. These tools must provide insight into the overall effectiveness of a treatment and, even more critical, enable understanding of the intricate differences in how specific populations and individuals respond to various regimens.
In rolling out a national CER program, we also must address IT infrastructure scalability and complexity issues along with requisite cost considerations. As important is the ability to share real-time information and enable collaboration across “virtual” organizations (as research teams may include members from multiple organizations).
Grid computing and/or cloud computing can be suited to addressing these considerations. Security concerns, however, must be paramount in the creation and management of these networks, as well as every layer of the technology and application stack. In the absence of an unwavering commitment to security, patient privacy and the reputation of the national CER initiative are at risk. Equal attention should be paid to physical and data access controls, including the need for effective identity management and provisioning as information is shared across virtual organizations.
Much uncertainty remains as we continue our national discussion about the best options for improving access to healthcare – while controlling costs and ensuring quality care – and the role that CER initiatives should play in this process. It is clear even now, however, that IT will play a critical role in realizing these national goals and, therefore, must be an important part of the discussion.
Neil deCrescenzo is senior vice president and general manager for Health Sciences at the Oracle Corp. He is responsible for managing Oracle’s solution groups, strategic planning, product development, sales, service and support for the industry solutions sold in the healthcare and life sciences markets worldwide.
