Rx for America: A Healthy Dose Of Information Technology
In today’s antiquated and bureaucratic health care system, every one of us is in danger of dying as the result of a medical error. In an America slow to adopt health information technology, even the most prepared individuals can be killed by a clerical oversight.
Just ask Dave Canfield.
Well into his 80s, Dave is still very active. He and his wife of many years, Jeanne, travel frequently and love spending time with their seven children and their many grandchildren. Dave lives with a host of chronic conditions, including cardiovascular disease, which prompted him to get a pacemaker years ago. Jeanne is his primary caretaker as well as his most passionate advocate.
Since 1998, Jeanne has meticulously documented every interaction with the dozens of different doctors Dave has seen. She used to carry his paper medical records around in a flip-top folder, but they’ve grown so unwieldy that she now lugs them around in a large briefcase. Like the president and his nuclear “football,” she takes these voluminous records wherever she and Dave go.
Dave recently complained of chronic shoulder pain, so his doctor scheduled him for an MRI. They arrived at the facility, with his paper medical records in tow, and completed the required paperwork. Jeanne indicated on as many as five different forms that he had a pacemaker. As the nurses finished prepping Dave for the MRI, Jeanne mentioned in passing that he had a pacemaker. According to one of the Canfields’ daughters, the technicians stopped dead in their tracks. One aide exclaimed,
“He has a pacemaker? He can’t have an MRI — it will kill him!”
Dave Canfield is lucky. If he did not have an advocate like Jeanne, he would be dead. He would have been one of the nearly 98,000 Americans killed each year by medical errors.
The true irony of this story is that Dave and Jeanne Canfield are the parents of Sally Canfield, the chief health policy advisor to Dennis Hastert, the speaker of the House of Representatives. If this can happen to her father, it could happen to you.
Health information technology — and in particular, an electronic health record — would have caught the error long before Dave was being prepped. An electronic health record would have prevented Dave’s doctor from prescribing an MRI in the first place. That is the power of health information technology. It is a vital tool that can save the lives of tens of thousands of Americans.
That health information technology saves lives and saves money isn’t just a theory. It’s been proven again and again in countless settings. Indiana Heart Hospital in Indianapolis built a new facility that is totally paperless. They reduced medication errors by 85% — an outcome the importance of which is hard to over-state, since medication errors kill nearly 9,000 Americans every year. They also reduced physician administrative time by 30%. This means that doctors can now spend more time with their patients and provide them with higher quality care.
Dozens of other examples exist. Danville Regional Medical Center in Virginia utilized Siemens Medical Systems’ electronic prescribing system and prevented more than 1,200 wrong drugs or dosages, saving countless deaths and untold suffering, as well as more than $730,000. Lehigh Valley Hospital and Health Network in Pennsylvania implemented IDX System Corporation’s computerized provider-order entry and wireless-barcode charting system for medication administration and prevented 50 medication errors per month per 30-bed patient care unit.
Central Utah Multi-Specialty Clinic, the largest independent multi-specialty group in the state of Utah with 59 physicians and nine locations, implemented an electronic medical record provided by Allscripts Healthcare Solutions. During the one-year period of study, the clinic experienced direct reductions in spending and increases in revenue of more than $952,000 compared to the prior year, and they anticipate savings of about $14 million over the next five years.
Yet despite these obvious benefits, many providers — especially community physicians — have been slow to adopt health information technology. For example, the Centers for Disease Control and Prevention report that only 31% of hospital emergency departments, 29% of outpatient departments, and 17% of doctors’ offices have electronic health records to support patient care. Clearly, the adoption of health information technology is much slower than we would hope, for a number of reasons.
One key factor is that small physician groups or community not-for-profit hospitals often do not have the financial resources to make the initial investment in information technology. A second factor is that we currently have no common standard for interoperability. Numerous companies create electronic health records, and they are built on technology platforms that differ from one to the next.
When a hospital and a doctor’s office do not have interoperable technologies, their systems cannot talk with each other and electronically share patient data. For instance, there are thousands of different healthcare facilities across New York, from your community drugstore and lab center to your physician’s office and local nursing home. Their ability to share data is a key component of maximizing both efficiency and safety, but without a common standard, sharing data can be a daunting task.
The private sector must take decisive action to realize the full potential of health information technology, but the federal government must also play a role. One current effort to address funding and systems compatibility is the 21st Century Health Information Act of 2005, introduced by Reps. Tim Murphy, a Pennsylvania Republican, and Patrick Kennedy, a Rhode Island Democrat.
Recently, we joined Democratic Senator Hillary Clinton of New York and the two congressmen at a press conference to promote bipartisan support for the bill, which we believe will play a highly important role in modernizing health care and moving our system into the information age. In addition to providing financial incentives for doctors to invest in health information technology, the legislation allows local hospitals to equip their community doctors with the infrastructure needed to electronically exchange patient information — a practice currently prohibited by law.
Without private sector commitment, however, government directives can affect only so much change in the American health system. The 21st Century Health Information Act also supports private-sector innovation through federal grants to regional groups that are currently trying to electronically connect doctors, hospitals, insurers and patients. Finally, the bill requires that these regional organizations adopt common technology standards so that different systems from different locations can talk with each other.
These are small but important steps to bringing health care into the 21st century. But the federal government can and must do more. Changes to the administration of public health programs could expedite health IT adoption. The Medicare and Medicaid programs should make health IT an essential component of health care delivery.
Unfortunately, two examples tell the story of government’s reluctance — or inability — to embrace health information technology. First, many state Medicaid programs still require that their contractors, such as home health providers, submit paper copies of certain records. In large part, bureaucrats are clinging to the status quo simply because that’s the way it has always been done. The state of New York is one of only 14 states that has updated its Medicaid rules to allow for electronic record-keeping.
Second, Medicare refused to require that the new “Welcome-to-Medicare” physicals be completed using electronic health records — a short-sighted decision, given that the technology is readily available, that the typical senior will be on Medicare for nearly 20 years and that today’s seniors frequently travel away from home, making electronic access to their health records increasingly important.
Dr. David Brailer, President Bush’s national coordinator for health information technology, has said that it could save the health care system upwards of $140 billion a year. These savings could be used to expand coverage to the nearly 45 million Americans who have no health insurance. These savings could also be used to stem the tide of the diabetes and obesity epidemics that plague our nation.
Current federal investment in health information technology is shamefully inadequate. The federal offices and agencies that allocate funds fail to recognize the long-term savings associated with the adoption of health information technology: money spent on it is “scored” as a flat cost, and not as an investment. Our political leaders have a responsibility to change this practice rather than continuing to allow antiquated accounting practices to stand in the way of a safer health system.
By dramatically increasing federal investment in the adoption of health information technology, the United States would recognize it for the top priority that it is: on par with national security. With scores of Americans being killed by the system every day, it is that important.
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