Patients, adept at using the internet to schedule travel, conduct business, and access information with the click of a mouse, are now driving changes in the way state and federal policymakers address health care reform.
“Health IT” is the new buzzword for health care, and information technology proposals for healthcare reform are sprouting like daffodils in April!
Tennessee Gov. Phil Bredesen
So far this year, the National Governor’s Association has announced the creation of the State Alliance for E-Health, co-chaired by Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas. Their purpose is to bring together office holders and policy experts to, “address state-level health information technology (HIT) issues and challenges to enabling appropriate, interoperable, electronic health information exchange (HIE)”.
As quoted in the National Journal’s coverage of the event, Gov. Bredesen explained, “…the states can move much more quickly….I don’t trust the federal government to actually do anything on my watch.”
Don’t expect Congressional leaders to agree with that assessment.
Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA) are reportedly preparing to introduce legislation on the subject. The Senate will be missing one of its most influential and knowledgeable proponents of health care legislation with the retirement of Sen. Bill Frist (R-TN), but Senators Edward Kennedy (D-MA), Hillary Clinton (D-NY), Mike Enzi (R-WY) and Judd Gregg (R-NH) are also drafting Senate legislation.
Wyoming Sen. Mike Enzi
“Passing health IT legislation will bring us closer to enabling all Americans the freedom and security of going to the doctor’s office, or hospital, and presenting an electronic card or identification tag that holds all patient data, insurance and medical history records,” Enzi explained.
In the meantime, America’s health care costs continue to rise year after year. Solutions, such as adopting electronic information technology, could reduce costs, but have been slow to be adopted.
A federal commission, in their report to Congress a year ago, concluded that of the $1.8 trillion spent on health care in 2004, less than 5% was spent on information technology. As a consequence, fewer than 10% of hospitals had electronic records and fewer than 20% of doctor’s offices used electronic systems to manage prescriptions. As a result, hospitals continue to use paper, fax and phone calls for 90% of their transactions.
Secretary of Health and Human Services Mike Leavitt, has reported, “Today, a stupefying 20% of medical tests must be ordered a second time because previous results can’t be found. Such inefficiencies cost our economy as much as $500 billion a year.” In addition, on line IT offers a variety of solutions for doctors to improve the accuracy and quality of billing and medical records.
Former House Speaker Newt Gingrich founded the Center for Health Transformation, one of many new policy shops plowing this fertile field, to address just such discrepancies. In testimony last year before the Medicaid commission, he concluded, “the move to an interconnected national health information network is a matter of national security.”
As an example, Gingrich pointed out, “Hurricane Katrina wiped out over one million paper medical records. Evacuees in places like Houston, who had been undergoing medical treatment in New Orleans for a chronic condition, had little information about where they were in their course of treatment, leaving doctors scrambling to redo tests and recreate therapy regimens.”
Reducing the issue to an easily understood and frequently repeated slogan, Gingrich says, “Paper kills”. But now he has stepped forward to lead a coalition to donate to all U.S. physicians a free internet-based e-prescription software called eRx, created by Allscripts, a healthcare technology vendor, also a member of the coalition.
Newt weighs in
Announcing the donation in mid-January of this year, Gingrich quoted information from the National Institute of Medicine that prescription medication errors contribute to the deaths of more than 7,000 Americans each year.
In a related announcement two days later, another vendor, named SureScripts, also announced the first electronic transmission of a prescription from physician to pharmacist in the nation’s capital. This occurred less than one month after the District of Columbia adopted new rules making e-prescriptions legal, joining 48 states in reducing the barriers to electronic innovations in health care delivery.
These software-based medical applications are simple and inexpensive to adapt. The results significantly improve health care records, as well as increase information and control of prescription drugs. Similar initiatives are being developed to provide software programs to enable internet based resources to assist doctors in such tasks as diagnosing problems and identifying alternative treatments.
Internet tools would also be especially useful for mobile Americans, whose interaction with medical providers can be haphazard, and largely defined by periodic visits to emergency rooms.
The implementation of on-line tools to diagnose, treat, and record medical problems, raises danger flags to ensure patient privacy. Insurance companies, employers, and others should not be allowed to gain inappropriate access to confidential records.
As state and federal policymakers undertake national health reform, there are critical issues to address regarding internet based medical opportunities:
(1) Just as doctors are taught to “first do no harm”, so Congress should resist current suggestions by Google and others to create so-called “network neutrality” regulations that could cause harm by blocking priority medical services and reducing security for medical records.
(2) Integrated state and federal programs should be developed to encourage investment by the medical community in health IT, to support standards making systems compatible and interoperable, and to accelerate the deployment of fiber optic cable connections to homes, hospitals, and clinics, thus making services richer and more varied.
(3) Laws need to be closely reviewed to ensure that patient’s confidential medical records are secure against unauthorized release and abuse. Standards of information access and usage must be clear and clearly enforceable.
(4) Issues of liability and state licensing need to be revised to accommodate these new practices.
The current contrast between what is available for patients on-line, and what the patient encounters in the medical health care system, is stark. Increasingly concerned with maintaining their health, not just treating their maladies, patients now have a much greater ability to access medical information and make their own health choices. The amount of health information, previously available only to trained medical personnel, now available to patients on the internet, is literally staggering, albeit of variable reliability.
Ultimately, technology puts much greater power in the hands of the patients in their entire approach to health, not just health care. As Gingrich noted, what is needed is “a system centered on wellness, prevention, early testing, and incentives for healthy behaviors before, during and after any illness.”
Such an information based and internet accessed system would give patients much greater control over their own health, as well as the way in which their health care is determined and delivered. Speaking on behalf of patients, Verizon’s CEO Ivan Seidenberg, a member of the federal Commission on Systemic Interoperability, pointed out in an op-ed in Investors Business Daily a year ago, “If L.L. Bean can remember the sweater we ordered last Christmas, why should we have to fill out a new medical history every time we go to the hospital?”