Sunday, September 16, 2007

Healthcare Reform Needs IT support

In 2006, the New England Journal of Medicine published a study that found regardless of an individual's socioeconomic, demographics, and health care insurance status that uniformly Americans only received the recommended medical care just a little more than half the time. Slightly better than a coin flip. Perhaps more concerning is what was not said, - our nation does not have the desire or the plan to overhaul and implement the "large-scale, system-wide changes" to our dysfunctional health care system needed to provide quality health care to all.

Two-thirds of Americans currently rate the health care system as fair or poor. Fewer employers are offering health care insurance to their workers and retirees due to unstoppable increases in premiums. Instead of improving the system, the federal government and health care insurers major focus is the active promotion of health savings accounts and consumer driven health plans with high deductibles. By not insulating patients from the actual costs of care, it is hoped that market forces will slow costs and improve quality as patients also become consumers.

But gains in health care quality will not be driven by an informed public. Unlike other goods and services consumers compare routinely, evaluating medical care is not easy. In a system requiring more patient responsibility, a survey found two-thirds of Americans would still simply follow the advice of their physicians rather than researching the options. Yet the vast majority of patients get their care by physicians who need to rely on and sort through paper charts trying desperately to find the information they need to give the right intervention and do so only 55% of the time. Annually it is estimated that 83,000 Americans died simply because they did not receive the recommended care.

The good news is that there already are a few health care organizations and medical groups that consistently provide their patients the recommended care. Organizations like the National Committee of Quality Assurance and the Leapfrog Group continue to identify providers, health plans, and hospitals that perform at this high level. Unfortunately these groups are more the exception than the rule.

One of these high performers is the Veterans Administration. In a study published two years ago, the VA performed as well and at times better than the best commercial health plans in diabetes care. This was not always the case. The VA's recent success was due a leadership change that focused relentlessly on delivering quality care and provided its physicians the information technology infrastructure and tools to not only collect, evaluate, and improve their patient care, but to do that repeatedly and routinely across all VA medical centers.

It is clear then that the path to improve health care quality is not shifting more costs to the patients, nor is it going to be solved by requiring employers and the government to spend more money on a health care system that cannot deliver on its potential.

Unless the public and our leaders demand a complete system overhaul, the rapid implementation information technology support systems to help all providers focus on health care quality, our current and future generations cannot and should not expect to live healthier and longer than their predecessors. This is not a prediction. As it stands, this is our legacy to our children. This is their destiny.

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