Health IT

"In a health-care debate characterized by partisan bickering," Alexi Mostrous of the Washington Post writes, "most lawmakers agree on one thing: American medicine needs to go digital." But how how we make sure it goes digital -- evenly?  In other words, how can we use technology to eliminate health disparities -- not enlarge them?

As we have written before, there is significant evidence that the widespread (and smart) adoption of health information technology will help improve the safety, efficiency and effectiveness of the U.S. health care system. It can also eventually save money or "bend the cost curve." As such, Obama's American Recovery and Reinvestment Act of 2009 (the stimulus bill) made a roughly $30 billion net investment toward Health IT adoption by physicians and hospitals.

But the administration also wants to make sure that health IT reduces -- not deepens -- health disparities. That means making sure the health IT funds benefit the rural, uninsured and underserved populations. 

Remember that funding for health information technology in the stimulus package? We know, it's been a little while, and when it comes to health reform, we've had a lot on our minds lately. But states haven't forgotten about health IT and the American Recovery and Reinvestment Act of 2009 boosted both their motivation and resources to get health IT programs up and running in two to six years. That states are interested in establishing electronic health information exchanges isn't exactly breaking news, but the recent progress in investment, implementation, and infrastructure is pretty exciting.

The stimulus package included the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), which lays the groundwork for advances in health care quality. Late in August, the Obama administration announced $1.2 billion of the stimulus funds would be released in the form of health IT grants, reports American Medical News.

Grand Junction, CO, is the high-quality, low-cost flip side of McAllen, Texas in Atul Gawande's recent New Yorker article. New America's health policy team just published a case study on how Grand Junction's health care system evolved (full paper here, summary here), and what the rest of our country can learn from it. We gave you an overview on our blog Thursday. Now we're going to look at how the community uses health IT to create quality and value.

We all know that health IT in and of itself isn't a cure-all. But it's hard to fix health care without smart use of health IT across the community.

One of the unusual features about the Colorado community is that the main health plan (Rocky Mountain Health Plans) pays a "blended rate" to physicians. That means it's a similar rate for private insurance, Medicare, and Medicaid. Doctors thus don't have any incentive to cherry-pick better paying privately insured patients, and shun the poor. Everybody gets care. The community benefits.

Long before the federal government began its big push to reform the U.S. health care system, states were feeling the strain of rising health care costs and increasing numbers of uninsured. Many states decided to take a crack at health reform in their own way. We've heard a lot about reforms in Massachusetts, but other states have also made progress.

One such state is Vermont. USA Today highlights some of the quality innovations in Vermont that have helped the state save money and improve efficiency. Rather than start with the goal of universal coverage like Massachusetts, Vermont started working towards two other aspects of health reform: lowering cost and improving quality of care. (It already had a -- relatively -- low rate of uninsured residents, and including when Howard Dean was governor, the state had taken steps to cover most children and pregnant women, and as we'll see in a moment, it is also working on covering more adults.)

The story we are about to tell you is probably not what automatically comes to mind when you hear "safety-net hospital."

On Monday, we continued our series of posts on the Health CEOs for Health Reform by looking at how more integrated models of care can deliver higher quality at lower costs.

Today, we'll see how Denver Health -- an urban safety net institution for Denver and the Rocky Mountain Region -- has established a highly integrated system that consistently delivers high-value care to vulnerable population. Health IT and electronic medical records are key to their success, as Patricia Gabow, MD, Denver Health's CEO explains in the video below:

I keep reading and hearing and sometimes even writing about doctors who let patients make appointments online or request prescription refills online. As a full time working mom, I am a big fan of online convenience, online shopping, online communication, anything that keeps me off of "hold."

None of my family's doctors yet offer such a service. But I just had what you could call a hybrid online experience. I pulled up the website (rather than hunt through my old personal phonebook...which I confess is still on paper) for a radiology center. Alongside the phone number was a place to make a request for an appointment online. It wasn't a completely computerized experience, but I filled out a form on the website, saying what test I needed, what days and times were convenient for me, which of their seven  locations I preferred, and what time they could call me. They promised to get back to me the next business day. They called at the specified time, and offered me a choice of three appointments that met my criteria.

It took a minute (not counting the 45 seconds it took for me to pull over and grab a pen, as she called when I was in the car). In past years, this took multiple phone calls and time on "hold." I suspect this saves the clinic money; it's a more efficient use of their schedulers' time. And it's definitely good for my mental health.

The nation’s largest health insurer says we can save well over $300 billion in the health care system over the next decade by streamlining administrative procedures and making better use of technology.

In a report released yesterday, UnitedHealth Group proposed twelve broad reforms to the administrative and transactional aspects of the U.S. health care system that it estimates can save $332 billion over 10 years.

Through twelve building blocks we identify administrative savings opportunities of $332 billion in national health expenditure over the next decade. These savings would be likely to benefit families and employers through lower health care costs. As importantly, they would simplify the lives of patients, and eliminate much frustration on the part of doctors and hospitals.

The Wall Street Journal's health blog brings us the story of a Health IT guru who made a little musical ode to Health IT and put it up on YouTube... We aren't even going to try to summarize it, see for yourself...

The industry groups that gathered at the White House last month and pledged to bring down health costs by $2 trillion in the next decade followed up with a 28-page document to the White House Monday. The letter addresses things like better management of chronic diseases, more administrative simplicity, appropriate utilization of medical services, quality improvement and medical error reduction, expansion of health information technology. In other words, the industry gave a real world vote of approval to what a lot of what academic researchers and health policy experts have been saying about the ways to bring down the costs and improve care.

However, the document (from the American  Medical Association, PhRMA, the American Hospital Association, the SIEU, America's Health Insurance Plans, and AdvaMed, which is the main medical device trade group) was a vague on whether there were any teeth in the pledges to do this, that and the other thing, or on what would happen if these initiatives fall short (or fall apart).

Hundreds of thousands of patients undergo cancer treatment each year, using all sorts of combinations of drugs and treatments and therapies. Not all are in clinical trials—but many of them have something to teach us. We linked to Gooznews touching on this topic a few months ago. Now Merrill Goozner has a longer analysis at Science Progress of how, in part because of advances in health IT, we could tap this untapped pool of knowledge:

A redrawn battle plan—one that focuses on turning the treatment system into a research and learning system that can teach oncologists the best use of the weapons they already have—is long overdue...

…Many of the nation’s 30,000 oncologists are engaged in what could be described as an unobserved and uncontrolled science experiment, especially when it comes to treating the 560,000 Americans who die each year from the more than 100 forms of the disease. As these patients’ cancers advance, their physicians try regimens they read about in journals or hear about from colleagues. The outcomes are never gathered. The data is never analyzed. And the findings are never disseminated.’