Minimum Necessary or Optional?
One of the things that continues to excite me about the world of healthcare informatics is the opportunity to reduce the cost of care while providing better care and overall better outcomes. Often people think in terms of zero sum game where reducing the cost of care always reduces care and outcomes. But the promise of technology is that it can make us more efficient; a man can dig a hole faster with a shovel with more precise dimensions than with his bare hands.
Much attention has been paid of late to re-admission rates for hospitals. Hospitals stays are expensive and if a patient is sufficiently recovered from whatever put them there to begin with, they are usually eager to get home to continue to recover in a more familiar environment. Both parties – the hospital and the patient – often want the stay to end as soon as possible.
But if the patient is released too early, it is always bad news. At best, they must be re-admitted – often through the emergency room process. Worse, they could relapse and not make it back to the hospital at all. Outcomes for patients who are released too early are both worse and more expensive than if they had stayed in the hospital instead of being released.
Certainly, trusting our doctors is a first step, but they are often very busy and under the same pressures to release a patient discussed above. There are simply too many variables to be perfect at this when practicing medicine. While experience gives the doctor his most potent weapon she can only draw from the experience available to them. Patterns do exist, however, that are indicators of good situations to use additional caution when deciding to release. No one doctor could ever amass enough experience to recognize them all though.
Today, there are powerful analytic tools available that can take massive amounts of data and sift through looking for patterns that simply would not or could not be seen otherwise. Rather than take a sample scenario and examine the data to see if that scenario is more likely to result in a readmission, these tools are capable of comparing millions or billions of situations to each other at the same time. The result is finding co-morbidities or patterns of care that no one could have ever thought to test out on their own.
These types of comparisons were computational fairy tales just a few years ago but can be done today because of advancements in parallel processing. The bad news is no matter how good the tools are, they are only as good as the data they have to examine in the first place. . . What if no one can get the data?
Minimum Necessary is the process that is defined in the HIPAA regulations: When using or disclosing protected health information or when requesting protected health information from another covered entity, a covered entity must make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure or request.
Next: Part 2: A False Choice. . .
Part 3: Shouldn’t This Be Easier By Now?