To this point, the discussion has centered on more efficient and less costly ways to provide care at the existing level of quality and the technology used in the studies. With this general understanding of the technology the discussion can move to how this system should improve care in a number of ways. An indirect affect may be that care may improve as a benefit of more efficient use of physician time. Figure 4 demonstrates the potential halo effect (area 3) associated with unburdening physicians from more routine care. If a substantial percentage of overall clinic visits and patient interactions can be safely managed elsewhere, the MD will have more time to devote to the individual patient who requires their skill level. An extended patient encounter benefits both the accuracy of the assessment as well as patient satisfaction.




Integrated Best-Practices Care Delivery:

Application of scientifically vetted best practice standards can improve care. Adoption, distribution, ongoing analysis, and process improvement of these standards remain problematic under the current system. The advanced medical analytical software being used in this trial is designed to eliminate these barriers in a number of ways.


Consistency:

The easiest way to rapidly improve quality is to remove unnecessary variance in practice and institute a standardized approach to care for common conditions. The enhanced team concept includes this approach because the software is able to guide its users though a consistent process based upon best published data.


Missed or delayed diagnosis:

It has long been known that timely and accurate diagnosis or decision to treat results in the highest quality and the lowest cost. The diagnostic engine provides a fund of knowledge and frame of reference equivalent to many physician lifetimes of experience. It never forgets, never tires, is never distracted and is extremely consistent in its performance. Advanced studies of missed or delayed diagnosis demonstrate that data critical to making the diagnosis is almost always present but either not pursued or there is no recognition of an important pattern. By providing relevant prompting based upon a far larger fund of knowledge than any one person is likely to possess, matched with advanced pattern recognition, the Lifecom system is designed to reduce missed or delayed diagnosis.


Problem-based Learning and Improvement (PBLI):

Knowledge retention is greatest the shorter the time frame between encountering a problem in real life and engaging learning exercises germane to this experience. PBLI (Practice-Based Learning and Improvement) and CPL -(Continuous Physician Learning) are intended to improve patient safety through the application of continuous quality improvement processes to the establishment, maintenance measurement and growth of clinical competence through ongoing education. As such, PBLI is applicable to the full range of clinical decision environments including initial bedside diagnostics, chronic disease management, and patient triage to name a few. PBLI tenants include 1) identification of knowledge gaps 2) directed learning, 3) incorporation of knowledge, and 4) assessment of improvement. Challenges to PBLI include adoption, compliance, recognition of knowledge gaps, creation and distribution of knowledge content, impact assessment and relevance to a specific type of clinical decision. Recognition of clinician knowledge gaps remains a serious impediment to the application of appropriate directed learning. Identifying these gaps is made harder because current documentation and data capture methods are inadequate as a basis for detailed problem-based assessment. The Lifecom system is designed to present real-time opportunities to clinicians of all levels based upon the kinds of conditions or scenarios being assessed. These learning aids are attached to the set of information contained within the system's database and can be accessed directly from the AKE's interactive reports during an assessment if needed. PBLI is an important contributor to improvements in safety. For this reason an extensive discussion detailing the Lifecom system approach to PBLI is included at this time.


Lifecom approach to PBLI:

PBLI involves identifying areas for improvement, engaging in learning appropriate to identified knowledge gaps, applying the new knowledge and skills to practice, and providing a means to check for and maintain improvements. Each of these steps present unique challenges in design adoption and implementation which are described in the following summary. A brief outline of the Lifecom solution to these issues ends each section. Lifecom's overall approach is to view all clinical decision environments (diagnostics, disease management, triage, etc.) as variations on a theme rather than separate methodologies. The rationale is two fold: 1) a global method avoids siloing of information by incorporating data and knowledge from any situationally relevant set of data or knowledge preventing a wide range of cognitive errors, and 2) a single method reduces training requirements and allows for easy transition amongst decision environments.