“Currently, the competence of individual residents and fellows is evaluated at the program level with widely varied tools and approaches — usually based on subjective assessments in which, as in Garrison Keillor’s fictional Lake Wobegon, everyone is “above average.” The leadership of the Accreditation Council for Graduate Medical Education (ACGME) in defining core competencies and implementing specialty-specific milestones has established consistent expectations of what physicians should be able to do, but readiness for independent practice is affirmed by each GME program director at the time of graduation. Few standardized assessments (such as board certification exams) allow for comparisons among individuals or programs, and these provide a limited window into overall competence. Ideally, I believe, assessment of clinical competence as an outcome of GME should focus on the unsupervised care delivered by GME graduates; that care has not been systematically measured and linked to GME, though a few investigators have pioneered an effort to do so.”
In the preceding excerpt from the the Perspective article Optimizing GME by Measuring Its Outcomes by Debra F. Weinstein, M.D., in the November 23, 2017 edition of The New England Journal of Medicine (N Engl J Med 2017; 377:2007-2009, DOI:10.1056/NEJMp1711483, http://bit.ly/2A3gDVC), the author’s observation that “Few standardized assessments (such as board certification exams) allow for comparisons among individuals or programs, and these provide a limited window into overall competence … [and] that care has not been systematically measured and linked to GME” explains in part the variability and sub-optimal effectiveness of medical practice and healthcare delivery. The explanation has been completed by the late Lawrence Weed, M.D., in Medicine in Denial (Lawrence L. Weed and Lincoln Weed, Published Version 1.02, February 2013, http://www.world3medicine.org/assets/Medicine_in_Denial_Aug_2017.pdf) as follows (underscoring added for emphasis):
“Essential to health care reform are two elements: standards of care for managing clinical information (analogous to accounting standards for managing financial information), and electronic tools designed to implement those standards. Both elements are external to the physician’s mind. Although in large part already developed, these elements are virtually absent from health care. Without these elements, the physician continues to be relied upon as a repository of knowledge and a vehicle for information processing. The resulting disorder blocks health information technology from realizing its enormous potential, and deprives health care reform of an essential foundation. In contrast, standards and tools designed to integrate detailed patient data with comprehensive medical knowledge make it possible to define the data and knowledge taken into account for decision making. Similarly, standards for organizing patient data over time in medical records make it possible to trace connections among the data collected, the patient’s problems, the practitioner’s assessments, the actions taken, the patient’s progress, the patient’s behaviors and ultimate outcomes.”
Information technology (IT) applications a.k.a. “apps” created by healthcare professional (typically physician) and organizational (typically hospital) healthcare providers using the Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS)© can be the “electronic tools designed to implement those standards of care” described by Dr. Weed, which in turn can facilitate the standardized “assessment of clinical competence as an outcome of GME” described by Dr. Weinstein. Such IT-enabled improvement in GME and in the practices of its exponents will mitigate medical mistakes (currently the third leading cause of patient deaths, re http://bit.ly/1rtW6Sa) and optimize case outcomes.
In particular, CHARTSaaS© enables the creation of mobile apps that leverages the rich and regulated patient data sources that electronic health record (EHR) systems provide to effect continuous/constant monitoring and condition-/criteria-dependent automatic clinician notification, according to the customized specifications of healthcare provider subject matter experts (SMEs). CHARTSaaS© enables healthcare provider SMEs to design, develop, deploy, operate and optimize such apps with virtually no need for either IT coding/programming skills or IT staff/system support. CHARTSaaS©-built apps provide real-time cognitive support, cognitive overload being the root cause of most medical mistakes.. In addition, CHARTSaaS©-built apps can execute continuous monitoring of patients and condition-dependent automatic notification of providers to mitigate “failure to rescue.”
Please validate the foregoing CHARTSaaS©-related propositions to your own satisfaction by reading the white paper at http://bit.ly/2vmK1Rx, viewing the tutorials posted on YouTube (http://bit.ly/2sVajvS and https://www.youtube.com/watch?v=f5OtbCCDNLs) and also by reviewing the details of CHARTSaaS© and the CHARTSaaS© RA in these presentations:
Healthcare providers will benefit significantly from appreciating and then applying a CHARTSaaS© RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths. per Makaray and Daniel (http://bit.ly/1rtW6Sa); thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment, and also accelerating the accrual and facilitating the application of medical knowledge.