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  • Storing Medical Records

    Operating in a Vacuum


    By NEWT GINGRICH and PATRICK KENNEDY


    WASHINGTON - Health care policy is a partisan minefield, with Democrats and
    Republicans differing on everything from Medicare changes to malpractice
    reform to strategies for covering the uninsured. Yet, while the two of us
    have been on opposite sides of most of those battles, we both believe that
    America's health care delivery system must be transformed. To begin that
    transformation, we should heed President Bush's call last week for
    widespread adoption of electronic health records. As the president noted,
    "The 21st-century health care system is using a 19th-century paperwork
    system."

    The archaic information systems of our hospitals and clinics directly
    affect the quality of care we receive. When you go to a new doctor, the
    office most likely has little information about you, no ability to track
    how other providers are treating you, and no systematic way to keep up
    with scientific breakthroughs that might help you.

    The results are predictable. For example, approximately 20 percent of
    medical tests are ordered a second time simply because previous results
    can't be found. Research shows that 30 cents of every dollar spent on
    health care does nothing to make sick people better. That's $7.4 trillion
    over the next decade for duplicate tests, preventable errors, unnecessary
    hospitalizations and other waste.

    Not only do these unnecessary costs contribute to skyrocketing
    insurance premiums, but the lack of good information makes improvements in
    quality and efficiency nearly impossible. Every year some 98,000 Americans die in the hospital from preventable medical errors, like receiving the wrong
    medication. Nearly half of patients do not get all the treatments or tests
    that should have been administered. This is usually not the fault of
    doctors, nurses and other health professionals - these problems persist
    because of systemic failures stemming from the absence of good health
    information.

    The problem is not that we need innovation: existing technology can
    transform health care just as it has nearly every other part of society.
    If all Americans' electronic health records were connected in secure
    computer networks that safeguarded patient privacy, health care providers
    would have complete records for their patients, so they would no longer
    have to re-order tests that have already been done.

    In addition, most referrals and prescriptions are still written by
    hand; computerized entry would eliminate errors caused by sloppy
    handwriting.
    Computer programs can warn doctors of possible adverse drug and allergy
    interactions, and remind them of new advances in evidence-based practice
    guidelines. Patients could also have easier access to their important
    health information, allowing them to be active participants in their own
    care.

    Moreover, in a post-9/11 world, electronic health information networks
    would allow doctors, hospitals and public health officials to rapidly
    detect and respond to a bioterrorism attack.

    Unfortunately, health care providers are famously stingy investors in
    information technology. The primary reason is that when new technology
    reduces the duplication, errors and unnecessary care, most of the
    financial benefits don't go to the providers who generate the savings, but
    to insurers and patients.

    Therefore, widespread adoption of technology will depend in large part
    on federally organized public-private partnerships. Treasury dollars could
    help bring providers in a particular part of the country together to map
    out plans for a regional health information network, and to divide up the
    costs and the savings fairly between them. Medicare could sweeten the pot
    by reimbursing providers for money spent to use electronic health records
    connected to a regional network.

    New information systems would also allow us to reinvent the way
    providers get paid. Right now, most doctors and hospitals get paid by the
    procedure,
    regardless of quality. They get paid even if they make mistakes, and then
    paid again to fix the mistakes. And under our current perverse payment
    practices, when providers improve quality and efficiency, it frequently
    hurts their bottom lines.

    New information systems would give us nationwide data to develop
    standardized performance measurements for providers, so anybody can get n apples-to-apples comparison about how good a job a doctor or hospital
    does. This data would also allow Medicare and private plans to restructure
    their reimbursement practices, so that the market would drive competition
    in quality and value among hospitals and doctors, just as in most other
    fields.

    Politicians like to say that the United States has the best health care
    system in the world. Actually, what we have right now is the best medical
    talent, technology and facilities in the world - but the system that
    delivers our care is badly broken. Democrats and Republicans should agree
    that moving American medicine into the 21st century is not only an
    important goal, it is also literally a matter of life and death.


    Newt Gingrich, a former Republican speaker of the House, is the founder
    of the Center for Health Transformation, a for-profit organization. Patrick
    J. Kennedy, a Democrat, is a representative from Rhode Island.
    Bob Pyke Jr.


    "The best journeys are the ones that answer questions that at the outset you never even thought to ask."
    Rick Ridgeway

    "There are certain spots in the world where you can stand that will change the way that you look at things forever."
    Pete Whitaker

  • #2
    I've always compared EMR/EHR to Electronic Voting Machines, everyone's talkin about them, everyone thinks they need one, no uniform standards, functionality and prices vary so widely.

    IMHO the federal gov needs to do more in terms of uniform standards and funding.
    Bigdoc

    Comment


    • #3
      Originally posted by BigDoc
      I've always compared EMR/EHR to Electronic Voting Machines, everyone's talkin about them, everyone thinks they need one, no uniform standards, functionality and prices vary so widely.

      IMHO the federal gov needs to do more in terms of uniform standards and funding.
      Why is there all the controversy over the voting machines, can't they set up the software to print a reciept in case of a recount?
      I was watching CNN, a political group is going to court to ban E-voting machines in Maryland, because they have no paper trail.
      M
      Mel
      There is no place like 127.0.0.1

      Comment


      • #4
        Originally posted by mel
        Why is there all the controversy over the voting machines, can't they set up the software to print a reciept in case of a recount?
        I was watching CNN, a political group is going to court to ban E-voting machines in Maryland, because they have no paper trail.
        M
        $$$$ makes the machines more expensive
        I am the witchdoctor and I approve this message

        Comment


        • #5
          Originally posted by repyke
          Operating in a Vacuum
          ...To begin that transformation, we should heed President Bush's call last week for widespread adoption of electronic health records. As the president noted, "The 21st-century health care system is using a 19th-century paperwork system."
          And GW should now... a 21st cent pres with a 19th cent intellect...

          Originally posted by repyke
          When you go to a new doctor, the office most likely has little information about you, no ability to track how other providers are treating you...
          Too true, especially in pediatrics. Try tracking immunization status when parents are too forgetful to safeguard their records.

          Originally posted by repyke
          Research shows that 30 cents of every dollar spent on
          health care does nothing to make sick people better.
          Does that include the massive amount siphoned off by HMOs etc for overhead?

          Originally posted by repyke
          Every year some 98,000 Americans die in the hospital from preventable medical errors, like receiving the wrong medication. Nearly half of patients do not get all the treatments or tests that should have been administered. This is usually not the fault of doctors, nurses and other health professionals - these problems persist because of systemic failures stemming from the absence of good health information.
          Well, sometimes it is our fault. Ordering tests that aren't needed etc. also drives up costs tremendously.

          Originally posted by repyke
          In addition, most referrals and prescriptions are still written by hand; computerized entry would eliminate errors caused by sloppy
          handwriting. Computer programs can warn doctors of possible adverse drug and allergy interactions, and remind them of new advances in evidence-based practice guidelines.
          In large part I agree. I use such a system, but its accuracy still depends on those that use it. Too many warnings re: allergies, interactions, etc, are more of a drag. But how many are enough? And who assures their accuracy?

          Originally posted by repyke
          Patients could also have easier access to their important
          health information, allowing them to be active participants in their own
          care.
          Huh? If patients can access this system then I dare anyone to make it secure!!!!

          Originally posted by repyke
          Unfortunately, health care providers are famously stingy investors in information technology. The primary reason is that when new technology reduces the duplication, errors and unnecessary care, most of the
          financial benefits don't go to the providers who generate the savings, but
          to insurers and patients.
          Or maybe the initial investment? It's estimated the advocated national EMR system witll cost $30-50 billion to implement, and few if any of the compters or EMR programs now in use will be adaptable. Thus new hardware and software for all!

          Originally posted by repyke
          Medicare could sweeten the pot by reimbursing providers for money spent to use electronic health records connected to a regional network.
          And private pay or uninsured patients?

          Originally posted by repyke
          New information systems would also allow us to reinvent the way providers get paid. Right now, most doctors and hospitals get paid by the
          procedure, regardless of quality.... New information systems would give us nationwide data to develop standardized performance measurements for providers, so anybody can get n apples-to-apples comparison about how good a job a doctor or hospital does.
          Partly right IMHO. Payment depends on coding for one thing, as we all know, and on what codes we get paid for. Standardizing that would help a lot. And the idea of comparing hospital to hospital still hasn't been done right. The severity of illness treated has to be accounted for, not just numbers treated + outcome. They continue to think this is a simple matter.

          Originally posted by repyke
          Politicians like to say that the United States has the best health care system in the world. Actually, what we have right now is the best medica talent, technology and facilities in the world - but the system that delivers our care is badly broken.
          Can't argue that...

          Originally posted by repyke
          Newt Gingrich, a former Republican speaker of the House, is the founder of the Center for Health Transformation, a for-profit organization.
          NB: a for-profit organization ... wonder how much that can drain off the top?

          I'm not against nationwide EMR but I do believe any dollar savings will accrue to the HMOs etc, not docs. And, IMHO, it really won't decrease mistakes, duplication, etc all that much for years and years.
          Growing old is mandantory, Growing up is optional.

          Comment


          • #6
            EMR is a completely safe political argument. It looks like you care about patient safety. Healthcare has been vilified so onerous govt oversight is "justified" and no one thinks about the cost or they plan on forcing the cost of the change on doctors and hospitals like they always have in the past. So naturally politicians will jump on this topic emphatically - no political downside, trivial funding, blame the healthcare sector if it goes wrong. No politician will ever have to USE an EMR so what do they care?

            Comment

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