Health IT

You know all those bad jokes about how doctors are always on the golf course. Wrong sport. Turns out they are jumping through hoops—$31 billion worth of hoops.

Two new studies released this week online by Health Affairs examine how health care providers, particularly physician practices, interact with insurers. One study found that doctors personally spend the equivalent of three full weeks a year on billing and related insurance information. The overall cost to their practices (their time as well as other medical and clerical personnel) was about $31 billion a year (in 2006)—which as study author Larry Casalino noted, was about six times what we spent at the time on the State Children's Health Insurance Program and nearly 7 percent of total national expenses on physician and clinical services. Primary care practices spent more time on these administrative tasks than specialists. Very little of the data—only about two hours a year for the doctor—pertained to quality data.

We posted an overview earlier this week of the recent O'Neill Institute Legal Solutions in Health Reform symposium. Now we want to talk about the legal framework around Health information technology.

The good news is that personal health information is becoming more accessible to patients and providers via technology. That's also the bad news. Americans are comfortable with credit card and banking information traveling in cyberspace, but they are anxious about medical information hackery and thievery. This fear is reinforced when they read, for instance, about hackers demanding ransom after they claim to have deleted millions of patient records used by pharmacists on a Virginia web site. Indeed, the new Health Information Czar himself, David Blumenthal, recently acknowledged that privacy remains an impediment. (Also, the FTC published its proposed rule on notification of breaches of electronic health information,

Politico was abuzz today on the subject of health care reform, offering a veritable smorgasbord of big names and big ideas—along with some caveats about caution. There's also a good run-down of the heavy advertising on health care so far this year  with much of it promoting a pro-reform, fix it now because all Americans deserve a better, fairer, more affordable, more secure health care system message.

Senator Edward Kennedy, a Massachusetts Democrat and chair of the HELP committee, reminds us of the tragedy that health care costs can bring upon American families such as the Walkers, who cannot afford health care coverage for their son, a 21-year-old cancer survivor. He calls for five principles of reform: affordable, quality, coverage for all Americans; delivery and payment system reform; an emphasis on wellness and preventative care; sustainable and long-term support for the disabled; and the elimination of fraud and abuse in both public and private health care sectors. "I want Jake Walker and millions of others in his position to know he is in our minds, our hearts and our prayers," said Kennedy. "Most of all, I want to make 2009 the year we end this unacceptable American tragedy."

There are a lot of reasons that doctors haven't rushed to install computerized medical records. Among them, it's hard. The American Medical Association hopes to make it a bit easier for doctors to get wired.

The AMA has joined up with a software company to launch a new internet service for physicians. It will include e-prescribing (which Medicare is encouraging and will within a few years require) reference materials, and electronic medical records. The new "platform" is intended to allow physicians to utilize health information technology, including electronic medical records and clinical decision support tools. And naturally, the vendor promises there will be "personalized content" and "networking opportunities"("MyCase?").

You know all those polls that show Americans distrust Congress—but like their own Congressman (or woman)? Well, here's the health care corollary. About half of Americans now believe that people get unnecessary tests and treatments. But—yep, you guessed it—the tests and treatments they themselves get aren't unnecessary.

Half of those surveyed said we have a "major problem" with unnecessary tests and treatments, and two-thirds said too many patients are "not getting medical tests and treatments they need." But only 16 percent thought they had ever received any unnecessary care. Guess it's the Dartmouth Atlas equivalent of NIMBY.

I recently interviewed a man in his late 60s with three advanced chronic diseases—diabetes, congestive heart failure, and COPD. I'll call him "Jim" because he died unexpectedly before I could get his explicit consent to share his story on this blog. After being extremely sick in the ICU last fall, Jim enjoyed several months of  reasonably good health, good enough to tell jokes and golf in Florida and tell me about how well his wife of 38 years took care of him. The article I interviewed him for is, in part, about chronic disease management, but one of the things that struck me as we spoke is how Jim personified the reasons we need more health information technology.

Jim lived in a suburb of a big city, and got his care from physicians who all know each other and share affiliations at a local community hospital with a stellar reputation. He had Medicare and good supplemental insurance, as well as a primary care physician who took the time to coordinate his care and track what all the specialists were prescribing and recommending. But all that data lived in the head and the paper files of the primary care physician. Some of it (not all) lived in an electronic medical record at his usual hospital, which I'll just call St. X. But that wasn't much use when Jim collapsed and was rushed by ambulance to the nearest emergency room—just about 25 or 30 miles away from St. X hospital and the physicians who usually treat him.

With health care having found its place in the budget, the reform discussion is shifting gears from a focus on broad principles to specific proposals. When it comes to financing health reform, President Obama and other lawmakers have made it clear that every option is on the table.

George Halvorson, the CEO of Kaiser Permanente, hopes they'll take a long hard look at the potential savings from improving the way care is delivered. Noting numerous studies showing the potential to save 25 to 30 percent from our current system through quality improvements, Halvorson told attendees at an Alliance for Health Reform briefing (transcript and video here) last week:

What we have in front of us is an opportunity to save a huge amount of money in American health care by getting care right. This isn't by rationing. This isn't by denying care. This isn't by shifting cost. It is just from getting care right.

We've finally had time to go through our 12 pages of notes from last week's fascinating discussion of the Wireless Future of Health IT, co-hosted by New America and CTIA-The Wireless Association.

Last week, we summarized the event's key takeways. Later, we'll post on the some of the real-world examples of how health IT coupled with pervasive broadband access can revolutionize the way we treat diseases and manage chronic conditions. But first, we'd like to give you some of the highlights from Intel chairman Craig Barrett's speech.

Entertaining and insightful, Barrett had much to say on health IT and health care in general. Barrett runs a company that provides health care coverage to over 50,000 workers. He also runs a small ranch in Montana. All of the workers at the ranch have health coverage. So do all of the ranch's 45 horses—but only the equines have complete, electronic medical records. While only a few of us would prefer to be treated by a veterinarian, the lack of connectivity in human health care is a troubling issue and one which Barrett argued had much to do with the way we pay for and organize services in our current medical system.

With the President's promise to pledge $19 billion to health information technology, both doctors and hospitals are looking ahead with hope, and some wariness, at the adoption of HIT on their home turf.

Part of Obama's strategy in successfully implementing health IT has been to appoint Dr. David Blumenthal, a Harvard Medical School practicing physician, professor, and policy director for Massachusetts General Hospital, as "National Coordinator for Health Information Technology." Dr. Blumenthal's experience and expertise in so many different areas of health care has made him a trusted facilitator of the implementation of health information technology. In a series of essays about Health Information Technology, Dr. Blumenthal writes that there is a growing consensus that "wiring the health care system is fundamental to enhancing quality and containing cost—and thus improving overall system efficiency," and the government should play a role in helping HIT attain its full potential.

In the past, for 99 cents a minute, a cell phone could tell us the future in a thick Jamaican accent. In the future, it may be able to help you manage your diabetes, help doctors share information, and potentially help our country save billions of dollars while delivering higher quality health care.

The $19 billion in funding for health IT has many hoping the future is now, but whether that future is a health care system transformed by the power of information technology remains to be seen. As the AP writes:

Here's the best-case scenario for the government's plans to spend $19 billion on computerized medical records: seamless communication among doctors and patients, and far fewer mistakes.

And the worst-case: $19 billion goes down the drain.