Are Health Information Silos on a Path to Extinction?

There are many reasons for making collaborative, patient-centered care work better, and organizations are beginning to talk about them. For chronic conditions, a multi-disciplinary team can provide more comprehensive care than a single clinician. New technologies, including Datuit’s, are making it easier to communicate, collaborate and share information among team members and with patients and caregivers. Patients and clinicians alike are starting to realize that more information from more sources can help them improve health and avoid the consequences of poor communication.

It’s happening at the Cleveland Clinic. In her new book, The Silo Effect: The Peril of Expertise and the Promise of Breaking Down Barriers, Gillian Tett tells the story of Cleveland Clinic’s transformation under the leadership of Toby Cosgrove. Dr. Cosgrove asked what would happen if he “defined medicine as patients, not doctors, experienced it?” [1] As a result, Cleveland Clinic has re-examined how they defined their professions, making it easier for the disciplines to more effectively work together. [2] They created multidisciplinary institutes to address issues the way patients experience them rather than in the way each discipline was trained. [3] Now, physicians, surgeons, other clinicians and support staff work together to solve their patients’ problems. In addition, all employees are trained with their teams about customer experience.

Cleveland Clinic is attempting to measure the impact of these changes. Although it’s difficult to determine the impact, patient satisfaction measures have improved and costs appear to be lower. Dr. Cosgrove attributes the cost savings in part to changes in incentives – there was no longer “incentives to prescribe overlapping treatments.” [4] The specialists and other clinicians in the institutes work together to offer alternatives to patients, and data is gathered about the effectiveness of the various options, allowing even more accurate statistics for predicting outcomes.

It’s happening in other parts of the world. Patients with Parkinson’s disease (PD) have greater loss of quality of life than with other chronic conditions. The Dutch addressed this by asking PD patients about the services they were receiving and found significant dissatisfaction. Patients asked for more interdisciplinary therapies, such as physiotherapy and speech therapy, and also that the therapists have greater expertise providing care for PD. In response, the ParkinsonNet was developed to deliver high quality, evidence-based, multidisciplinary care to patients with PD. The ParkinsonNet allows patients to connect to expert PD clinicians, including therapists, neurologists, nursing home physicians, psychologists, pharmacists, social workers, dietitians, and others as well. It also features an information technology platform that facilitates communication among the various clinicians and between clinicians and patients. A personal e-health record is supported where patients can contribute information. [5]

After analyzing the model in several studies, they concluded that:

  • The ParkinsonNet network resulted in more PD patients received care from experienced, trained clinicians and treatment guidelines were followed more often;
  • PD patients treated within ParkinsonNet had 55% fewer fractures than those who were not;
  • PD patients treated within ParkinsonNet needed less rehabilitation care; and
  • Stwo of the studies demonstrated substantially lower cost of care for PD patients with ParkinsonNet.
  • As a result, the model is being adopted in Germany and in the U.S. at Kaiser Permanente, and it is now a model of care other diseases, starting with COPD. [6]

    Collaboration and communication among multiple disciplines are additional benefits of using a network such as ParkinsonNet. In addition to better communication among clinicians, patients and their caregivers, clinicians’ skills improve because they can imitate those with the best outcomes. This has been shown to result in more consistently better results. [7]

    Back in the U.S., a new vision for Health IT. The recently released Federal Health IT Strategic Plan 2015-2020 sets forth a vision where health information is available when and where it’s needed. For the Triple Aim to be realized, The Office of the National Coordinator for Health Information Technology (ONC) will leverage information and technology to facilitate health IT innovation and use for multiple purposes. [8] With greater experience with health IT, there’s a growing recognition that healthcare system data alone is insufficient for patients and clinicians to meaningfully interact to improve health outcomes. For example, if a prescription is written for a medication, the patient will not necessarily fill it or take the medication as directed, but the prescriber doesn’t know why. What factors influence the patient’s actions? Is it not understanding the impact on a health goal? Financial difficulty? Lack of transportation to a pharmacy? Physical concerns, such as ability to swallow a pill? What kind of patient feedback do prescribers need, and how can that feedback be most efficiently delivered and utilized? [9] ONC proposes a “person-centered vision is vital to improving health and health care” because patients’ motivations and actions are such a huge factor in their health outcomes. [10]

    The first goal of the Strategic Plan is to “Advance Person-Centered and Self-Managed Health” with objectives to empower patients and families and foster partnerships among patients, providers and communities. [11] Reaching that goal could go a long way toward breaking down the silos that are so often blamed for poor communication, inefficient care and patient dissatisfaction. Datuit is working to close the gap among patients, providers and products and services in the community that have been so difficult to bring together – with its SafeIX® Platform that enables data aggregation from multiple sources and with its Care Plan Manager that allows a care team to collaborate with a patient and family members about ongoing care.

    [1] G Tett, The Silo Effect: The Peril of Expertise and the Promise of Breaking Down Barriers (New York, NY: Simon and Schuster, 2015), p. 196. [2] Ibid., p. 205. [3] Ibid., pp. 208-9. Starting with the Neurological Institute and moving on to 27 others, including the Digestive Disease Institute and the Head and Neck Institute. [4] Ibid., p. 214. [5] BR Bloem & M Munneke. Revolutionising management of chronic disease: the ParkinsonNet approach. BMJ 348:g1838 (March 19, 2014). Accessed at [6] L Rompen, et al. Net results: A novel model of healthcare delivery in Parkinson’s. On the Move 12:29-32 (July 2015). Accessed at [7] M Wensing, et al. Connectedness of healthcare professionals involved in the treatment of patients with Parkinson’s disease: a social network study. Implementation Science 6(67):1-9 (2011). Accessed at [8] ONC, Federal Health IT Strategic Plan 2015-2010 (2015). Accessed at [9] Ibid., p. 12. [10] Ibid., p. 13. “A person-centered health system enables individuals to access wellness and health care services and information, enabled by user-centered technology that reflects their needs, values, choices, and supports both self-care and meaningful interactions with their care providers with seamless transitions between these activities.” [11] Ibid., pp. 34-5.