National Academy of Medicine - Vital Directions for Health and Health Care

Introduction

Every once in awhile, the National Academy of Medicine (formerly known as IOM, the Institute of Medicine) has published an era-defining paper or book (for example: To Err Is Human: Building a Safer Health System (2000) and Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013)).

On March 21, 2017, they issued a new report: Vital Directions for Health and Health Care (2017). It is the culmination of many workgroups over the past year or so. It brings together the thinking of a wide range of experts.

NAM Vital Directions - Overall Summary: Vision, Goals, Actions, Infrastructure

Better Health & Well-Being

A strong message of the report is to focus on better health and to look broadly at what that means and what leads to good health. 

Determinants of Health

NAM Vital Directions - Figure 5: The leading health determinants.
SOURCE: Adapted from McGinnis, 2002

The usual reaction to improving health is to jump to care as the primary driver of health. However, there is growing recognition that our health, and the health of the population as a whole, depends on much more: our genetics, our behavior and our social and physical environment. While the healthcare system can provide decisive intervention at critical moments, there are many other factors that must also be addressed. We have to address acute crises, chronic conditions as well as economic, social and educational status and access to services and information. Living a good life is about acting on the values of the individual and broad support provided by their multiple communities.

McGinnis, J. M., P. Williams-Russo, and T. R. Knickman. 2002. The case for more active policy attention to health promotion. Health Affairs 21(2):78–93.


An earlier post put forward the interaction of being, doing and environment. It reframes the determinants into three areas of influence - our inner experience, our actions and the world around us.

The Action Priorities 

The report has a long list of action priorities. Here are a few highlights.

• Pay for value - Deliver better health and better results for all
• Remove barriers to integration of social services with medical services
• Link care and personal context
• Ensure patient data access, ownership and privacy
• Connect Care - Implement seamless digital interfaces for best care
• Measure What Matters Most - Use consistent core metrics to sharpen focus and performance
• Accelerate Real-World Evidence - Derive evidence from each care experience
• Foster a culture of data sharing by strengthening incentives and standards

Future posts will address these and other areas of the report.

Notification Service - Who What Where When

Where is a person receiving care? Who is providing that care? What clinical or payment program is the individual in?

Knowing where an individual has received care or other services is perhaps the minimum necessary information for quickly assessing history. Knowing the care model (clinical and payment) provides the parameters for next steps. While this is a limited amount of information, it can be critical for taking action in a timely manner. It provides a key overview of relationships and supports many payment models. It is a core tool for care coordination and care management.

Updates include change in status, care provider or location, as well updates to descriptive information

• Registration
• Demographics
• Admit or Discharge
• Appointment 
• Prescription Fill
• Plan Enrollment
• Program Attribution

A Notification Service

• Receives updates from entities with relationships to the individual
• Matches the individual in the update with known individuals
• Enforces privacy rules
• Maintains current and historical information on individual, entities and programs
• Maintains the current and historical linkages between individuals and organizational entities
• Maintains the current and historical linkages between individuals and programs
• Sends notifications of updates to entities with relationships to the individual

The core data include

• Individual Demographics
• Entity Demographics (the organization, for example, provider or payor, that is interacting with the individual
• Program Definition (the "program" that the individual is in, could be a clinical program or a payment program)
• The Individual-to-Entity Relationship
• The Individual-to-Program Relationship

This article from October 2016 describes notification services. Notification Service for Care Coordination in Value-Based Payment Models.

A Month of Meditation - January 2017

I have recently returned from Karme Choling, a Shambhala Buddhist meditation center in Barnet, VT. I was one of the meditation instructors for the Winter Dathun, a month-long practice intensive.

When I arrived, I wrote a short note of aspiration:

• May I find personal healing. May I hold the space for others to heal.
• May I be ordinary in this extraordinary time and place. May I mix the ordinary and extraordinary with mindfulness and kindness. May I take that out into the world to live in the mind of meditation long after leaving here.

It was a powerful month of people gathering to meditate, to step into a place where they could settle, set aside the usual demands of life, and to experience their own being, one breath at a time, for day after day. It's amazing how people can open to themselves. 

It was also a month of the ordinary. Leading yoga every morning. Finding time to do laundry. Making sure there was a supply of tissues in the meditation hall. Eating a meal. Taking a walk. Putting out the candles on the shrine at the end of the day.

As I was preparing to leave, I wrote some additional aspirations:

• May I be helpful. May I slow down, feel my heart, rest in the moment, act from stillness
• May others feel their own brilliance. May they know kindness. May they know love. May they heal their hurts. May they be whole and fully alive.
• May society call forth our collective wisdom. May we be one global village. May we be undaunted in our quests for greatness. May we live in peace.