National Coordinator for HIT (ONC) in the strategic plan published in July 2004 called for four national goals. In order to describe the business requirements, it is important to identify with the four overarching national goals and how the business requirements fit into that framework.

Informing the Clinical Practices

This involves making sure that clinical practices are provided with timely, accurate and actionable information to enable them to provide improved health care to the patients. While this serves to improve the efficiency of the care providers, moving them away from the mundane tasks of collecting and managing patient information, this also serves to reduce the number and types of inadvertent errors during treatment.

From an IT perspective, this translates to the implementation of certified EMRs in the clinical practice. From a RHIO and HIE perspective, the goal would be to make sure this EMR is well fed with relevant information.

Interconnecting Physicians

This goal ensures that medical information revolves around the patient rather than be tied to silos of information maintained around hospitals and physician practices. Interconnecting the physicians also enables patient information to be portable to a high degree between care providers.

• According to some observations, in 1 out of 7 visits, some important piece of information (including laboratory results, letters, reports, history etc) was missing while the patient was in the office.*
• It has been reported that in 60% of the cases where clinical information was missing resulted in delays or redundant medical services, thus decreasing efficiency and increasing costs. *
• Also, in 44% of such cases, the well being of the patient was likely to be affected. *

* Smith PC, Araya-Guerra R, Bublitz C, et al.

All of the above point to the crucial nature of the risks of not interconnecting physicians and enabling information flow betweens them.

Personalizing Care

Traditionally, diagnosis, treatment and related information have been locked away in medical information records maintained at the care provider’s facilities. Patients typically had limited access to information pertaining to their own care, inhibiting them from being able to make informed decisions about the choices they need to make regarding their own wellness. A system that provides personalized care and access to health and wellness information would thus bring in more transparency and control and empower the individual patient.

Such information will also enable the healthcare system to provide more individualized care for the patients by providing them with custom screening and health advice based on key indicators. For example, reminding patients to perform routine examinations based on personal factors that are established risk factors will go a long way towards improving the care provided to the population. Personalized care does also take the form of recommending care solutions to patients based on their personal circumstances such as their genetic predisposition to a particular disease. Immunization reminders, chronic disease care etc also can benefit if we can personalize care to the circumstances of patients.

Improving Population Health

The American Heritage Dictionary defines “public health” as “The science and practice of protecting and improving the health of a community, as by preventative medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.”

Achieving all of the above is possible only if the public health agencies can receive adequate information on success or failure of each of the treatment regimens delivered to patients. This information is required to complete the feedback loop with the agencies. For this, data collected by physicians and hospitals must be provided back to agencies such as CDC, FDA, state and local public health agencies.

Initiatives such as DOQ-IT (Doctors Office Quality – Information Technology) and PHI (Public Health Initiative) in California strive to further the quality of healthcare delivered to the public as a whole.

Healthcare information collected and maintained in various nodes through out the care providers premises contain valuable trends and indicators that, once collected and analyzed correctly, could be leveraged to provide valuable insights into public health. Among the various scenarios enabled by such an analysis would include indicators into bio terrorism threats, outbreak monitoring and quality and adverse event tracking for new drug releases.