You cannot track outcomes, or any quality improvement for that matter, if you cannot measure it.  Measurement requires standards for comparison.  Standards require structure.  Too much of existing electronic records do not provide for structured data.  Patient records, documentation and reporting need to be captured in a structured, preferably relational, database.  It all starts with standards and the capture of structured data.  Other industries learned this decades ago.

“Meaningful use”, “value”, “outcomes” – all powerful concepts to be sure and unfortunately, all subjective terms with varied definitions depending on the audience.  Talk to a physician about outcomes or value and the definition is likely to be far different than that provided by the average health consumer.  However, the point of view that any definition of meaningful use must include deference to the consumer is quite profound.  One could project that the only reason the collective health system, in fact health “care” itself exists, is to provide care for the health consumer.  It seems as though the future of health care must get back to the roots of the consumer.  How do we transition from a world of passive consumer participation in managing their health, to an active one?  A foundation for that transition must be information - accurate, timely, highly reliable and personalized information.  Further, that information must be available whenever and wherever the consumer needs it to ensure optimal care – be it a chronic, acute or preventive application.   This “information foundation” is the basis of the transformation of virtually every other aspect of our day to day lives, where information technology has had an impact.  If the automation of information in health care is to have true benefit, this focus is essential.  Value through the lens of the consumer is solving problems – making life easier.  Is there anything that automating personal health information may accomplish to that end?  The issue may be that from a consumer point of view the bar in health care is so low that the industry is trying too hard.  People have been “aging” since the beginning of time.  Yet to a large degree, each person experiences it as if it has never occurred before.  Can health IT, provide some relief?   Potentially help an individual “risk assess” themselves – understand of all the potential health conditions that may challenge them – which ones to pay particular attention to?  Frame proactive steps they can take to mitigate risks.  Present therapeutic alternatives to them for their conditions, allowing them to have a more informed and productive discussion with their care provider.   The foundation is information – highly personalized information.  By engaging consumers in the process, we leverage a certain market dynamic that increasingly and naturally seeks greater efficiency, services and solutions.