Problems in healthcare Modern healthcare delivery faces multiple challenges, including delayed translation of new knowledge into clinical practice, unwarranted variability in healthcare delivery at the patient and population level, lack of optimization of value, cost, and quality, a need for improved patient and provider experience, and the need for payment reform. Delayed translation of new knowledge to clinical practice is caused in part by the ongoing knowledge explosion in medicine. This continues apace and it is extraordinarily difficult for general internists to keep up with everything in internal medicine or primary care. Sub-specialists have a narrower but deeper domain and so face their own challenges. Suffice to say, the rate of discovery, publication, and learning results in a delayed translation of new evidence into practice for all clinicians. Some have estimated that it takes up to 17 years for a new notable and clinically valid innovation to be generally adopted and applied in healthcare (Balas and Boren 2000). Unwarranted variability in healthcare delivery is another thorny problem. Clinicians today will always try to practice at the top of their license all the time. But it is really difficult to have exactly the right knowledge available for the right decision in the right place and at the right time in all settings. And when that current knowledge is not available, the result is unwarranted variability where the patient may not experience the care that they should. There may also be a lack of personalized care that is tailored to each unique patient.
Research has shown that evidence-based medicine is only applied in clinical practice about 54% of the time (McGlynn EA et al) .
Only when we can leverage the best evidence in the right context will we be able to reduce unwarranted variation in care. There is also a lack of optimization of value, cost, and quality and a need for improved patient and provider experience – the Quadruple Aim. There are multiple causes of these problems but one fundamental problem underlying many of them is that the clinician does not always have access to the best evidence for each and every decision that they need to make. And, sometimes they do not have the ability to apply that evidence at the point of care in the patient’s particular context and setting. Lastly, there is the issue of payment reform. Many payers are interested in reforming the ways in which providers are paid for services. They want to incentivize providers to do more of the right things that they should be doing, and less of the wrong things that they should be avoiding. This requires knowing first of all, what is the right thing and what is the wrong thing to do clinically. Having that knowledge available and applied at the point of care in real-time should optimize physician behavior and decision-making in a way that will benefit payers, providers, and patients. Many of the challenges relate to optimizing the clinical encounter in all the settings where it might occur and also overcoming current problems with clinical decision support.
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