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Health Geeks Like Obama’s Health IT Plan, So Should You

Posted Aug 27 2009 11:37pm

(First Posted Feb. 27. Reposted due to technical glitch)

Last night I went to a health-geek fest at the Seaport Hotel in Boston.  H.I.L. Forum’s “Transforming Healthcare Summit” was crammed with professionals electrified by the news that Obama’s 2010 budget proposes more than $630 billion for reforming the health care system.  Doubtless, there will be a lot of tussling over that plan, but President Obama has just put health care reform front and center.

The attendees, mainly business folks who sell advice or tools to hospitals and doctors’ offices, were most interested in the $20 billion or so pledged for health information technology. That money is part of the just passed stimulus package, and is aimed at getting doctors to do all their record keeping, prescribing, etc. electronically.  There are lots of things wrong with the health care system, but this is one of the fixes many people think is a “no brainer.”

The bulk of that $20 billion is for “incentives” to get doctors and hospitals to get online. While everyone agrees that electronic record keeping can save time, money, and lives over time, it’s very disruptive and expensive for docs to make that switch. So, the government is trying to encourage them to do so by waving money at them.

Will this strategy work? H.I.L. pulled together a great panel with deep and varied health care experience and lots of political savvy to answer that.  This being Boston, everyone was terribly amused that there were actually three republicans on the panel, which meant it wasn’t just a lot of cheerleading:  James Roosevelt heads up one of our top local health care plan – Tufts, and is a member of the Democratic National Committee.  Charlie Baker heads up another health plan – Harvard Pilgrim.  Jonathan Bush is head of athenahealth – they sell IT systems to hospitals and doctors offices.  John Glaser is the head IT guy at Partners Healthcare, which is one hospital systems that is ahead of the pack in terms of getting stuff online:  A big hospital organization (H&HN) has named Partners one of the nation’s Top 100 “Most Wired” hospitals every year for the last ten years.

The President’s goal is for every single American to have an electronic health record within five years from now. Given that only between 4% to 15% of medical records are electronic now, the experts think this is extremely unlikely to happen. Glaser put it most succinctly:  “Good money, tight schedule, and no leadership yet.”  That last comment refers to the fact that there is no Secretary of Health and Human Services yet.

Even if it’s unlikely we’ll succeed, that doesn’t mean we shouldn’t keep trying.  Sure, having everyone’s health records online would be great because then we’d get the really big payoff from electronic records. We’ll be able to scan across all those records to notice epidemics very quickly, figure out the most cost-effective treatments, and make better judgments about how different things, like diet or drugs, affect people’s health.  But in the meantime, just having your own doctor’s office wired is still very useful.  Electronic prescribing alone cuts back drastically on medication errors, which are much more common than you’d think.

The intoxicating big vision for e-health goes way beyond just getting doctors to work with patient records electronically.  Imagine if you could book appointments online? Order a prescription refill? Check when you need that cancer screening again? Or, find out your test results?  As Jonathan Bush said, wouldn’t you love to get rid of that phrase: “If we don’t call you with your test result, that means it’s normal, so don’t worry.” Don’t worry? As Bush said,  “How do you know the test result is normal? What if they just lost it?”

Even better, if you end up in the emergency room somewhere, and you’re unconscious, wouldn’t it be great if the ER docs could pull up your records in a flash?  That’s the part – where the world of health records is a vast, seamless, network — that should be the real end game here.

We’ve got a long way to go. As John Glaser said, doctors tend to “hate and love” electronic record systems. It’s a huge hassle to implement, and it actually takes more work to use them:  Nobody has devised an e-prescription system that’s as quick and convenient as scribbling a prescription on a pad of paper.  Hospitals also tend to cram all kinds of things onto electronic forms, like reminders to ask patients if they smoke or have had certain screening. And if doctors don’t fill out the entire form, they might be penalized.

These electronic systems also have to be secure because privacy is a real issue, and they have to be able to talk to each other.  Since this is about technology, it’s also absolutely essential that the system should be flexible.  Better new tools are bound to come along, so they should have a chance to succeed. Too often, government projects end up going to the usual suspects, and the fresh new ideas are left behind.

It’s going to be a bumpy ride, and we probably won’t get health care wired as quickly as we want, but it’s great news for patients that someone is trying.

Speaking of patients, one of the highlights of the meeting was when Patient Dave jumped up right as the panel was kvetching about how difficult it is to get doctors to work online.  Patients, he pointed out, are literally swarming online to build social networking sites for specific diseases. “Why not take 1% of 1% of that [health IT] stimulus money and put it into social networking for patients!” Dave suggested. John Glaser concurred, saying it was an “oversight” by the administration.

I couldn’t agree more.  So many times when I’m talking to someone who’s got a really nasty health problem they say “But I can’t believe the great information I got from my online support group.”  A lot of times its not just a pat on the back either, it’s real, actionable, life-impacting information.

Let’s hope the e-health movement moves as fast as possible and that it doesn’t end up, as Glaser conceded it could, just as a confused “rush for the money.”

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