Prescribe Standardization for Sick Health Care System

By David Chess

Published October 10, 2003, issue of October 10, 2003.
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The American health care system is, quite literally, sick.

Our health care system was not designed. It was not thought out. It is no more than hundreds of patchwork pieces, stitched together over time. The resulting mosaic is a confusing tapestry — with gaps and pieces dangling in the air, and connections that make no sense, and themes that are jumbled. Together, this makes for a confusing, inefficient and often dangerous place to be a patient.

This is how it often works for many patients: Take the case of Mrs. Smith, 82, who is hospitalized for heart failure. Her pharmacy benefit only allows for a one-month supply of medication. When it runs out, she has a respiratory infection and is not able to get to the pharmacy. Her lungs fill with fluid because she is not taking her heart medicine and she requires further hospitalization, though not for the ailment which kept her home to start with.

In the hospital, she is stabilized on new drugs. She then goes to a nursing home for recovery, where she has a new doctor who is not aware of her medical history and how sensitive she is to different medications. Her prescriptions are changed according to a “preferred” medication list, or formulary. Finally, she goes home and begins taking her old medications, in addition to her new ones. Her regular doctor is unaware of her medication in the hospital and nursing home. She stands up, her blood pressure drops; she falls and breaks her hip — and back Mrs. Smith goes to the hospital.

Such hypothetical cases are, in reality, not unusual. The Institute of Medicine of the National Academy of Sciences reported more than 50,000 hospital deaths per year due to medical errors. In my home state of Connecticut alone, hospitals reported recently more than 400 medical errors over a three-month period — 39 of them were fatal.

Such statistics are indeed terrifying, all the more so because the United States boasts the most sophisticated health care system in the world and our health care providers, hospitals and managed-care organizations are highly respected across the globe. Our system is dangerous not because we lack excellent personnel and institutions, but rather because it is a patchwork of disconnected pieces.

With more patients suffering unnecessarily each day, it is time for the health care community to start stitching the patchwork together.

The health care system is already being overhauled at great cost in order to ensure the protection of patients’ privacy. The industry-wide price tag for compliance with the Health Insurance Portability and Accountability Act has been estimated by the Department of Health and Human Services to top $6.7 billion by 2006. Health insurance giant Blue Cross/Blue Shield has estimated the number at $43 billion.

Protecting patients’ privacy is, of course, a noble and necessary goal. But isn’t saving some of the 50,000 lives lost each year because of medical error at least as worthwhile a cause? Why aren’t comparable sums of money being spent on solutions to a problem that can be avoided relatively easily?

Both the government and the private sector need to develop ways to make patient care actually work for patients. While the task is daunting — after all, it’s our health that’s at stake — it is not beyond our means.

To begin with, patient-privacy legislation has already moved the health care industry toward standardization of information systems. But such measures primarily have the limited aim of improving information security.

It is time for a mandated common electronic language that will follow the patient from the doctor’s office to the hospital, to the nursing home and back home again. Mechanisms need to be created to gather critical elements of an individual’s medical record, and to store them in a medical ID card or an encrypted Web page. To ensure that treatment is coordinated properly, these records needs to be securely available from all sites where patients are cared for.

Quite obviously, such an effort is no small undertaking. Nor will we reap the benefits of reform without a significant cost. But without a concerted effort to stitch together our patchwork health care system, America will continue to be an unnecessarily dangerous place to receive medical care.

Dr. David Chess, an internist and geriatrician, is president of Project Patient Care, a Connecticut-based organization focused on improving individual patient care.

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