Rick Peters, who founded Oceania and has been around the health care EMR scene for a while, keynotes at TEPR.  He points out a few facts obvious to TCHB readers, costs are up–employers can’t afford health benefits  and so are dropping coverage and putting people into Medical and uninsurance slices on that nice chart from the California Health Care Foundation. And in the new high deductible world, costs are way too much for sick people. He didn’t mention Walmart by name but he and Paul Krugman are on the same page here….

He had a few other fastballs…

• Med malpractice is a red herring and premiums are are up because the insurance companies really screwed up that

• EBM: we’re not doing it but DSM may not save much money.  Finally under pay for performance, won’t the sicker patients be kicked out of the practice by the doctor?  So EBM may not be a panacea.  Because 80% of what doctors do is unnecessary, and 80% of these workups were done before.
• And I think he says (because his slides are horrible) that if we cut back to generic only drugs we’d save a fortune….physicians are not doing the cost effective thing.  And cant blame it all on pharma, 20% of patients who see the ad ask for it, but 70% of the time the doc will write the script/  Plus 60% of scripts are for off-label use (and therefore not EBM).

The result of all this is that we’re doing P4P and building the measurement systems for it. The  focus is getting measurements of what’s going on (and going wrong) not on getting the data that we need, and no ones forcing that on the system (no mandates).  Meanwhile admin overhead costs  physicians 40-60% of their revenue.  We know that EHR along can reduce office visits 9%, PCP visits 11%, and the % of members with 3 or more visits goes down 11% (all KP data).

So why ain’t happening? Generally computer technology is going to Internet based architecture and XML.  Why does health care think its different. Still opposing the adoption of these advanced techniques.  OK, so IT spending is higher elsewhere. But Wall Street spends limited amounts of its money on infrastructure–which it rents–and most of its money is spent on other advanced techniques like data mining.

We are preoccupied with duplicating the patient chart.  Peters thinks that a PDF alone would be good enough to move that data around.  We just need to get the data in useful form. We need that data in whatever form from whatever.  (By the way, for those of you with long memories this sounds like Chris Mayaud’s "physicians as short order cook" line that he was using in in 1997!)

Other artificial opposition — HIS v Amb record vendors; big institutions are not good innovators, but all the money goes to the big elephants. (He was pretty brutal about the IBM UPMC deal). Peters believes that innovation is coming in the smaller vendors integrating PMS/EHR.  But existing vendors cant switch to ASP as they’ll take a revenue hit.  So technology is blocked by business issues.

He thinks that ePrescribing is taking off. Although 99% of mail order/retail pharmacy is already automated. He thinks that SureScripts is driving this very quickly.  SureScripts is an utility infrastructure that is rented not owned.

Rolling this altogether (employer costs, Medicare costs, infrastructure we can plug into is there, tech development tools are better, OPM [Opium or other people’s money] is available if we want it) Peters thinks that we should go straight to revolution and chuck out the evolutionary phase that we’re in.