The American health care system has many problems, but one of them is at once obvious and generally ignored: most doctors and hospitals still work in the buggy-whip era of information technology, dependent on pen, paper and manila folders.
At the turn of this century, when the average industry was investing $8,000 per employee on computer technology, health care was spending $1,000. By now, if you belong to a frequent shopper club, your grocery store almost certainly has far more computerized data about you than does your doctor.
Why is this important? Partly because it wastes enormous amounts of money: the National Coordinator for Health Information Technology estimates that simply by using electronic health records we could save between 7.5 percent and 30 percent of the $1.6 trillion dollars now spent annually on healthcare. But beyond that, a fully computerized medical system will allow some remarkable new features and services for patients. And that doesn’t mean waiting for new breakthroughs — it can be done with the same information technology that almost every other business in the country has already adopted.
Think of the transformation that banking has undergone: global ATM networks, online banking, debit cards, paperless checking. If applied to health care, those same technologies could produce some astonishing results.
- You’ll go to your physician’s Web site to make an appointment. The site will include a secure messaging system to access test results and send pre- or post-visit questions; cyber-savvy offices will probably have a nurse who fields the questions and passes the more complex ones on to a physician.
- You’ll be able to access your own medical records online to add updates on your health or issues to follow up on your next visit. If you’re visiting a new doctor, you’ll be able to send on your entire medical record beforehand, including not only other doctors’ notes, but test results and images such as X-ray and MRI. You might even carry your records with you on a plastic card, or — for emergencies — in a tiny chip implanted under your skin.
- The diagnostic devices in your doctor’s office, from the fever thermometer and stethoscope to a mini-MRI or X-ray device, could wirelessly transmit the results directly into your health records.
- You could have diagnostic devices at home — blood pressure, blood sugar, heart rate, urinalysis and others — that automatically send results to your doctor’s office.
- Rural physicians will be able to “call in” specialists from major teaching hospitals to “see” patients via video conferencing. The consultant can have the patient’s full history right in front of them, along with real-time test results.
- In hospitals, RFID chips — the tiny radio chips that will replace barcodes in retail stores — can take on multiple roles. Each patient would have an RFID chip in their bracelet that would communicate with the tablet-style PC that nurses and doctors uses to update records. Each drug out of the hospital pharmacy would have an RFID chip as well and if it didn’t match with the patient’s chip a warning would sound.
- Medicine could use the data-mining technologies that retailers like Wal-Mart already employ to improve service and efficiency. When patient records are in digital form, it will be far easier to determine if antibiotic A is superior to antibiotic B in treating a given ailment. It will also widen the sort of disease tracking that the Centers for Disease Control and Prevention now does on a national basis. A doctor in Milwaukee can immediately see what the doctors on the other side of town have encountered in recent weeks, providing an instant picture of health trends in the local area.
- Doctors will order prescriptions and tests on handheld devices or desktop computers that will connect straight to pharmacies and labs with no potential misreadings. (Physicians’ bad handwriting has long been a source of humor, but there’s nothing funny about sloppy data entry when lives are at stake. Electronic entry should improve the process significantly.)
In fact, all of those innovations are already being offered, on a very limited (and sometimes experimental) basis, by a handful of doctors and hospitals today. But how and when will these services become available to all of us?
First, electronic health records, whether at the doctor’s office or on your home computer, will require extremely good security to convince patients that their privacy is fully protected. But this may not prove to be a major hurdle. Experts believe that health-care records won’t attract the same level of organized criminal hacking as have financial records: a cholesterol count isn’t quite as valuable as a credit-card number. And federal regulation called HIPAA, enacted a decade ago, already enforces stringent controls on the handling and security of health data in preparation for the brave new world of digital medical information.
A more serious sticking point is in the doctor’s office, where computers may now schedule the appointments and track the billing, but that’s usually where it ends. Only about 10 percent of physician’s offices — generally larger, multiple-physician practices — use electronic health care records. Those without aren’t in a hurry to upgrade.
Doctors aren’t like, say, insurance agents, where the central office says “computerize” and so it is. Older physicians have their ways of practice well established — and even if they want to change, converting existing paper into digital isn’t easy or cheap. On top of that, the cost savings in electronic health records are distributed across the whole healthcare infrastructure, and may not appear as immediate benefits to the physician’s own bottom line.
Then there’s the ever-troublesome question of standards: a national system of interchangeable health records will require standard formats to ensure one office can read another office’s files. As it is, some current computer standards date back to the mainframe era. And the problem is larger than computer code compatibility — there are still no national standards for medical terminology itself; laboratory procedures and results, for example, can have different names in different parts of the country. (There’s actually a plus side to the primitive state of medical information standards — once adopted, the new versions will be state-of-the-art and fully adapted for the Internet.)
Observers increasingly suggest that the federal government — which already pays over 40 percent of the health care costs in the U.S. — needs to help solve both the funding and standards problems. Congress will look at several bills this fall that provide funds for pilot computerization programs and also require standards for any clinical equipment purchased with federal funds. But it will take more than that. In August a team of experts writing for the Annals of Internal Medicine estimated that a full national health information system could be put in place for about $156 billion. Although that sounds like a big number, it’s only two percent of current annual healthcare spending—and with the potential savings in the trillions, that’s a great return on investment. The current spending projection, however, is only a third of what is required.
There are clearly enormous social and political challenges involved in overhauling the American healthcare system, and so far progress has been slow. But with trillions of dollars in savings available simply by upgrading to the information technology that the rest of business takes for granted, perhaps it’s time for the health care industry to write itself a prescription for a major dose of new technology.
© 2013 MSNBC Interactive. Reprints