What a week last week! First the disgraced cyclist confession and later the baffling college-football-player-and-his nonexistent-(dead)-girlfriend story, with the RAND report sandwiched somewhere in between. It’s positively a scandal-palooza.
What’s that? You don’t feel like the recent RAND report, which basically says that a 2005 RAND study financed by GE and Cerner was wildly optimistic in predicting about $81 billion in potential health care cost savings through widespread adoption of electronic health records, qualifies as a genuine hoax, controversy, scandal?
But it does neatly frame what is arguably a unique characteristic of the healthcare industry—a trait that extends to peripheral industries as well. Basically, healthcare is an interconnected environment. Call it the systems theory of healthcare, co-dependency … or just regular dependency. Call it what you want, but there is an interconnectedness in healthcare that we ignore at the expense of national wellness.
Witness key data points provided by the RAND report:
- Modern health IT systems are not interconnected and interoperable, functioning “less as ‘ATM cards,’ allowing a patient or provider to access needed health information anywhere at any time, than as ‘frequent flier cards’ intended to enforce brand loyalty…”
- Neither are they widely adopted, with an estimated 27 percent of hospitals utilizing a basic electronic record. Without broad adoption, interoperability is far less relevant.
- Improvements in quality of care / patient safety and reductions in healthcare costs (which have grown by $800 billion since 2005) are not manifesting with EHR adoption, in part because hospitals and clinics are rushing to adopt mediocre solutions and garner federal funds.
- The provision of care is the same as it ever was, even though EHRs are frequently promoted as the optimal tool for a different kind of care.
The reasons for these disappointing stats are readily apparent and unalterably interconnected.
- We still live in a fee-for-service healthcare system: Doctors and hospitals are still paid based on the procedures and examinations they perform. And because most EHRs evolved from billing systems, it now appears EHRs have made it easier to bill but not easier to provide quality care.
- Many doctors are not on board: In a fee-for-service system, doctors understandably don’t want to adopt a technology that will make their jobs harder. They don’t want to see fewer patients in a day and bill less than before they invested millions in health IT. And they don’t want to stay at work until after dark updating patient records. They can hardly be blamed for not embracing this scenario when …
- EHR solutions are hard to use: We’ve succeeded in creating technological solutions that would be most impressive to a physician in 1985. Now? Not so much. And the vendor community really doesn’t want to do the interoperability dance to the extent that the RAND report said some industry insiders are convinced many health IT vendors are “opposed to interoperability.”
As I survey the health IT landscape, I see four groups of stakeholders—health IT vendors, hospitals and clinics, government, and patients—with sometimes overlapping and sometimes conflicting goals. If this health IT project is going to make a difference in healthcare, each group may have to take some initiative and make a few sacrifices to keep this whole endeavor on the rails.
- Health IT Vendors: Are we really making systems doctors want to use? If not, we need to step it up and improve the quality of our offerings, and we need to make our systems communicate. Can the format wars between Blu-Ray and HD DVD, Betamax and VHS, in consumer electronics serve as some kind of industry standards guide? Can HIMSS play a constructive role?
- Hospitals and Clinics: Admittedly, significant change will be difficult while fee-for-service is predominant, so some initiative will be required. Until EHRs are used to keep patients well instead of billing for itemized treatments after they are already sick, costs will not come down.
- Government: Personally, I think the use of incentives / penalties by the government is appropriate. I know many people disagree and think the market should be permitted to function. But for how many years did the AMA, AHA and other industry groups fail to act before the government stepped in? Healthcare threatens to bankrupt the nation. We need action. And if healthcare IT can’t establish standard formats ourselves, I would argue the government is correct in doing so.
- Patients: Even when you visit those hospitals and clinics that offer personal health records, you aren’t using them. As a consumer of healthcare, you need to take some control over the product you receive and insist on quality and prevention. Do your research. Be aware of your own personal health data. Ask your physician why he still uses paper.
Can we all work together to ensure this grand health IT experiment contributes to saving healthcare in America? I don’t know. If it requires putting aside personal and organizational concerns for the greater good, I’m skeptical.
What are your thoughts? Should we slow the Meaningful Use train, as an increasingly loud chorus suggests? Who should step up, and how, to make this all work? Are we all just rearranging the deck chairs?
Edmund Billings, MD, is the chief medical officer for Medsphere Systems Corporation.