In her remarks Molly Coye, formerly from the Public Health Institute (now the University of California, Los Angeles), identifies what she sees as three areas of opportunity for HIT innovation. Citing the need to improve the current state of clinical decision support she suggests areas where innovation could help meet this goal: how to recognize and deal with incorrect or missing data, integration of a single patient’s data from multiple sources, and how to turn data into clinical guidance. Dr. Coye cites the need for research to be integrated into care processes and for evidence generated to be fed back in a continuous, seamless process that supports informed, shared decision making. Lastly, she points to the movement of healthcare delivery to integrated models—such as accountable care organizations—which increase the need for remote data collection, diagnosis, consultation, and treatment. Dr. Coye concludes by stressing that many of these challenges are social rather than technical in nature, and therefore successful approaches will need to take into account the complex character of these systems.

The growing prevalence of personal information ecologies provides the context for the remarks made by the Institute of the Future’s Michael Liebhold. He notes that these ecologies are composed of digital artifacts not only related to health and fitness, but also to social activities, media use, and even civic life. Mr. Liebhold observes that citizens are ready and willing to collect and share their health information and, with the encouragement of industry and employers, to become more actively involved in their own health. However, effectively integrating information from all of these sources in a meaningful way presents a formidable challenge. Technologies such as those that underlie the semantic web hold much promise, but still face challenges, especially in the areas of privacy and security. Looking to the future, Mr. Leibhold notes the need for methods to curate web-based health information, for interoperable health app stores, and for the development of a web of linked, open healthcare information and knowledge interoperability.

CONCEPTUALIzING A U.S. POPULATION HEALTH RECORD

Daniel J. Friedman, Ph.D.
Population and Public Health Information Services

This paper presents a concept for a U.S. population health record (PopHR), an idea initially presented in a recent article coauthored with Gib Parrish (Friedman and Parrish, 2010). Before presenting the concept of a PopHR, it is necessary to define population health. Our definition is the level and distribution of disease, functional status, and well-being of a population. This definition focuses on (a) functional status and well-being as well as disease; and (b) the level and distribution of each, allowing for knowledge of disparities and equity.



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