The patient’s medical record data should be available to all care providers to achieve the goals of integration. In addition to furthering care coordination, data registries across patients can be effectively used to “learn” from prior experiences of similar patients enhancing IPU care protocols and point of care decision support (e.g. patient safety alerting) systems since all patients in the IPU share a common context. Since the IPU scope includes improved value across the entire care continuum, the patient medical record is accessible to all parties involved in care including support clinicians (e.g. therapists, home nurses, pharmacists, patients and families) for enhancing outcomes. Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions.
Since the IPU is focused on a specific domain, context-specific templates make it easier and more efficient for the IPU teams to enter and find data, execute procedures, and use standard order sets, and measure outcomes and costs. Artificial intelligence systems (rules, machine learning, natural language processing) can help clinicians identify needed steps (for example, follow-up for an abnormal test) and possible risks (e.g. emerging infections that may be overlooked if data are simply recorded in free text, for example). Since the IPU is designed to deliver improved value/enhanced outcomes, the data needed to measure outcomes, track patient-centered costs, and monitor/control for patient risk factors can be readily extracted and put into patient context using structured terminologies and natural language processing. Such systems also give patients the ability to report outcomes on their care, not only after their care is completed but also during care (e.g. using telemonitoring devices) , to enable better ongoing clinical decisions.
Even in today’s most advanced systems, the critical capability to create, extract and share such data remains poorly developed. Semantic interoperability remains an elusive goal in today’s fragmented health IT environment relying on “standards” to achieve computable information exchanges . As a result, the value of IT in fragmented care coordination is diminished and measuring outcomes and costs across providers is unnecessarily increased. A common IPU-based IT platform organically enables effective collaboration and coordination within IPU teams, while also making the extraction, comparison, and reporting of outcomes and cost data easier.
Thus, the IPU-based healthcare system components can be viewed as a well-engineered, integrated and adaptive set of people, processes and products, “supercharged with domain-focused informatics”, and organized to encompass all services or activities that jointly determine success in meeting a set of patient needs, to efficiently and effectively deliver improved health outcomes to meet the highly diverse care (preventive/routine, emergent, acute, chronic, and palliative) needs and expectations of patients with specified conditions.
Transformational agendas such as creating IPUs will require sustained leadership/commitment to adoption of the goal of patient-centered value through formation of high performance learning teams and associated processes/facilities dedicated to continuous measurable improvement in outcomes that really matter to patients. Current organizational reputations that are based on perception and adherence to processes and not actual outcomes will fade. Maintaining current cost structures in the face of demands for measurable value will be untenable….a new, significantly more effective and efficient delivery model is needed…..the IPU model may not be perfect and will involve tradeoffs such as reducing scope/refocusing of organizational services, or dealing with physical location inconveniences for example, but the potential for such “patient-centered horizontal integration” models, particularly if they enable the unleashing of the enormous power of “continuously learning” expert teams and digital data sciences in improved care resulting in improved outcomes, is true disruptive innovation in achievement of the vision of global leadership in value-based care.