Health IT

Looks like we aren't the only ones excited by the iPhone's potential application to medicine. Yesterday's San Francisco Chronicle tells the story of Steven Cheng, tech savy-primary care doc, who collected over 800 signatures in a petition trying to convince Apple to make it's latest iPhone 3G compatible with Epocrates Rx—free software that puts important drug information and clinical support at a doctor's fingertips.

Cheng's prayers (if not the specific petition he hand-delivered to Apple's headquarters in Cupertino) were answered. As our colleague Elena Harman noted, Epocrates was one of the applications prominently featured in demonstrations of the new iPhone. (See a demonstration of its "drug identifier" function here.) Already the program is one of the most popular applications with more than 120,000 downloads since the new iPhone's release last month.

At an Alliance for Health Reform briefing on Health Information Technology and Its Future (we blogged about it here) earlier this summer, an audience member asked why can’t we have access to electronic health records the same way banks have ATM cards? ATMs allowed banks to cut costs and improve service, so why can’t it work for health records?

Community Health Network, based in Indianapolis, thinks it can. On Wednesday they launched myCommunity, a new service that offers participating patients credit-card-sized myCommunity health records and a mobile eCommunity network, according to the Indianapolis Star. Using the same technology that's in the express check-in kiosks at airports, the myCommunity cards can be swiped at kiosks in hospitals to instantaneously provide doctors with information about a patient’s allergies, medications, past medical history, insurance, and emergency contacts.

In all the excitement of the Senate vote, the Bush veto and the subsequent override of the veto that made the Medicare physician payment bill the law of the land, an important component was nearly overlooked: e-prescribing. Medicare will reward doctors who use e-prescribing through 2013, and penalize those who do not start in 2012, according to a USA Today article. E-prescribing means doctors send a prescription directly from a computer or handheld device to a pharmacy. It eliminates paper, illegible handwriting, and some of the waiting for consumers. It is of course just one  aspect of health information technology (along with electronic medical records, decision support tools, and interoperable health information networks) but e-prescribing got this push because it is “an area where significant progress could be made quickly,” according Health and Human Services Secretary Mike Leavitt.

 The Medicare bill would:

Medicare reform is in the air this month, with events and forums all over Washington (even more than usual—it's not exactly like Medicare is ever off the table in D.C.). The Century Foundation is chiming in, starting a reform task force, including some of the experts we had at our own Medicare conference last week. They plan on issuing a report later this year, in time for any new administration to take their thoughts into account. Maybe it's wishful thinking on our part, but the whole debate seems to have shifted significantly in the last year or so. (Or maybe it's just me spending more time listening to think tankers and less time wandering around Congress). But there seems to be less partisan fighting about privatization and premium support, and more bipartisan discussion about how to use Medicare as a model for an improved health care delivery system for everyone. Topics that Century will address include:

 One problem identified by quality improvement initiatives is that even when we learn that something works, it takes a long time to be adopted by a critical mass of doctors or hospitals. We need to figure out how to disseminate the information better, and develop incentives to get it acted on quickly. HealthCare IT News reports that 19 New England hospitals are taking up that challenge, forming a "Rapid Adoption" virtual network that will help them exchange information and speed up clinical improvement.

The initiative includes both a few big academic medical centers like Dartmouth-Hitchcock Medical Center as well as hospitals in smaller communities throughout New England.

The goal is very specific - preventing pressure ulcers (severe bed sores) using techniques that have been proven to work elsewhere. Pressure ulcers - which are often preventable - lead to higher infection rates, debility, pain, as well as the cost of medication and the treatment of wound care. They can be lethal.

The House Energy and Commerce Committee has approved the PRO(TECH)T Act, advancing legislation that would help doctors and hospitals acquire Health IT systems and speed up the process of moving federal health programs into electronic medical records.

The House Ways and Means Committee is also addressing Health IT, but we're still hoping legislation gets to the full House, that the Senate acts on its WIRED legislation, and the two can be reconciled and signed into law this year. It's a good sign that the Energy and Commerce bill is bipartisan and was passed on a voice vote after some of the privacy concerns were worked out. Privacy will likely remain a sticking point for some lawmakers going forward, but this is progress.

HR 6357 the "Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008" will promote more use of electronic medical records, which can improve health care quality, reduce errors, and bring down costs. It also promotes the nationwide adoption of a health IT infrastructure so that health information can be shared from one hospital or doctor's office to another, across the country.

Apple technology brings to mind sleek, hip devices, maybe a miniature music player or a laptop thinner than your hand. Medical technology conjures up thoughts of scary-looking big imaging machines, or maybe computerized health records.

What happens when you put the two together? No, not an MRI machine that plays Johnny Nash. When the iPhone G3 is released tomorrow, it will be paired up with some new medical applications (developed by independent companies) that will put new technologies literally at a doctor's fingertips. Here's a sneak peek at how three widely publicized programs could help improve the quality of care.

We all know Medicare has problems. What you may not know is that we really do know a fair amount about how to fix it—and part of the solution has to do with changing the kind of medicine we use to take care of our over-65 population. Inside E Street, an AARP television production, (click here to watch—and you don't have to be 50 to learn something from it) invited several experts including New America's health policy program director Len Nichols to brainstorm.

Among the suggestions: use technology not only to keep better medical records that help doctors coordinate care across several specialists, but also to take better care of people at home. We have the means—and we'll develop more in coming years—to monitor people at home, and know when and how to intervene before a crisis develops in a patient with conditions like diabetes or congestive heart failure.

Len reminds us that Medicare can be a catalyst because the program has so much influence over the whole health sector. So fixing Medicare is good for all of us—not just because of the economic implications but because by getting care right for the elderly we can probably improve health for us all.

If reforming the health care system is like making buttered toast, then health IT is like plugging in the toaster—it is necessary, but not an end in and of itself, according to CBO director Peter Orszag, and echoed by fellow panelists Sara Rosenbaum and Janet Wright at Friday’s Alliance for Health Reform event, “Health Information Technology and Its Future: More Than the Money.” The event examined where health IT is today, and what the future has in store.

Orszag spoke about the potential of health IT, but cautioned the audience (continuing the hot breakfast metaphor) not to put all their eggs in the health IT basket. Orszag said that while policy makers have good reasons to be excited about health IT, the oft-cited RAND study—predicting $80 billion in annual savings from the adoption of health IT—focuses on potential benefits instead of the likely benefits. "They studied a much different question than the one relevant to policy makers," said Orszag. "The question relevant to policy makers is what is the likely effect of a broader set of HIT systems, not what is the maximum potential impact if you're doing everything else right." (See the full CBO report here.)

It's no secret that U.S. doctors haven't rushed pell-mell to ditch all their paperwork and adopt electronic medical records. As we've heard repeatedly, money, resistance to change, money, concerns about obsolescence, money, and unanswered questions about how the whole system will work ("interoperability," or how one system will "talk" to another) are among the barriers.

But is it about to change? A new survey supported by the Robert Wood Johnson Foundation, conducted by the Institute for Health Policy at Massachusetts General Hospital and published online by New England Journal of Medicine, suggests we might be nearing a tipping point. As one doc put it, it's time to trade in the mule for a tractor.

Only four percent of the more than 2,700 doctors surveyed have a fully functional electronic health record system, (and another 13 percent have a basic system). But more than four in ten of those surveyed reported that they currently are setting up an EHR system or plan to do so within two years. And those figures were gathered by March, before Medicare's recent announcement of a $150 million pilot program to assist physicians, mostly in small practices, in 12 cities and states who want to go electronic.