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The Politics of Health Care

Thinking Beyond EHRs

Published February 9, 2009 12:22 PM by Frank Irving
Guest commentary from Ned Moore, CEO and co-founder, Portico Systems, Inc.

With the passage of the Obama economic stimulus package by the House of Representatives, now in Senate review, there has been a lot of discussion about what the $20 billion slated for health care IT will mean for the industry. The plan places heavy emphasis on electronic health records (EHRs) as a way to lower costs and improve care. While this is an important first step, the administration needs to be thinking about what comes after EHRs and include payers in the provider-patient equation.

The stimulus plan proposes the creation of a nationwide health information network built on an interoperable technology architecture that supports electronic exchange and use of health information. It promises that every person in the United States will have an electronic health record by 2014. There is a tremendous opportunity to extend these efforts to enable transparency of cost and quality information.

American consumers have come to expect the availability of vast amounts of Web-based information thanks to the technology investment made by dozens of other industries. Only in health care do consumers consent to pay for services without access to cost and quality information. Numerous studies have shown that the fees for medical procedures and services can vary greatly even in the same geographic region. Controlling the cost of health care requires that consumers have access to the same level of information that they get from other industries.

The health information network should be built with a framework that supports extending transparency beyond health records to enable providers, patients and payers to exchange cost and quality information and facilitate collaboration between these stakeholders. Consideration needs to be given now to the technology tools needed to make cost and quality information available to consumers. Waiting until later will increase the cost and burden of implementation and negatively impact consumer adoption. We've seen historically low EMR and Health Information Exchange adoption rates. It makes sense to leverage the efforts of the government to make health information available and extend that push to cost and quality transparency. 

Driving down the cost of health care and improving care has to include accessibility to what providers charge and how well they deliver care as a critical component to decision-making. Without access to this information, we run the risk of having suboptimal cost savings after a large investment in technology platforms that do not support informed decision-making on the part of those consuming health care services.

2 comments

There is one straightforward policy approach to guaranteeing all Americans access to high quality, cost-effective health care services and products that has not yet been tried in any nation.

It would be based on the efforts launched by the federal government and HHS Secretary, Michael Leavitt in 2004 to create the “four cornerstones” of a consumer-centric, value-driven healthcare industry.

These cornerstones are (1) creating the easy-to-use and ubiquitous interoperable HIT that would enable both transparent (2) pricing and (3) quality and (4) establishing meaningful incentives for all healthcare parties to promote quality and efficiency of care. (See: http://hhs.gov/valuedriven).

There is growing evidence of waste and unsustainability in existing healthcare systems in America and other developed nations now operating without these market-friendly, pro-consumer characteristics.

Based on the track record of these cornerstones operating in many other global consumer markets, who can convincingly argue that this untried approach might not be the best way to ensure the consumer choice, higher quality and lower costs that are necessary for long-term sustainability?

Robert Coli, MD March 13, 2009 3:10 PM
Plainfield NH

There is an illusion being perpetrated about the promise of interoperable, EHR and other IT solutions.  While I applaud the efforts to let evidence shape practice and the trend toward transparency of information and outcomes, the current environment does not conduce to the sort of quality improvement methods that other industries (manufacturing) have embraced.  So long as the Tort sytem serves to discourage honest, open examination of quality measures, we risk chasing technological solutions that fail to address certain systemic issues.  As greater transparency is achieved, we should also strive to reward providers who deal with quality issues rather than ignoring the risks associated with identifying (and quantifying) medical errors and publicizing one's outcome data.

Len Cruz, MD, ME

Len Cruz, Chief Medical Officer February 27, 2009 2:42 PM

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