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The Future of Healthcare

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Information technology (I.T.) is the answer to healthcare, say many pundits. Reality check: I.T. is both blessing and curse.

The Blessing
A nation-wide fully integrated (inter-operable) health information system [HIS] would cost around $276 billion over a ten-year implementation period: a ton of money. During that time, it would save about $613 billion for a net profit of $337 billion. So, when someone complains about the cost, just ask them: what is the NET?

It is fascinating that partial rather than full implementation of an HIS would cost more than it saves. This is not my guess. There is good hard data to prove this. Therefore, we should go whole hog or not at all.

The medical benefits, in addition to financial, would be enormous. An HIS would help answer these concerns.
• What really works for breast cancer?
• Imagine anticipating rather than reacting to the next flu epidemic.
• Dosing errors and incompatible medications would be things of the past.
• An HIS would help prevent and certainly minimize any bioterrorism attack.
• If we had a Chernobyl here, where could we care for the victims?
• Answers to all sorts of questions about the less common diseases: they still kill.
• Today, can I get an online consult on a patient's X-ray from two colleagues - one in Boston and the other in Seattle? No. With an HIS, yes.

The Curse
We do not have a national HIS but we do have lots of stand-alone information technology systems. Why are they more curse than blessing? Three reasons: seduction; legacy; and programmers.

Modern computers make it easy to track and calculate huge amounts of data. It is just so seductive to make all those charts, tables, reports and presentations. As one wag said, power corrupts; Powerpoint corrupts absolutely. Because we can, we do, even when most of these measurements and reports are not worth the time and effort. That time could be much better spent with patients (for doctors and nurses) and with the doctors and nurses (for managers).

Every hospital without exception has sunk millions of dollars into various computer systems from maintenance to finance. Our electronic medical records system has separate (non-communicating) programs in Radiology, Cardiology, Labs, patient scheduling, etc. Reluctant to throw away all that "sunk cost," the hospital reasons: We spent so much on all those [legacy] systems. We can't just throw them away! Yes, they can and must, if they want something that really works.

Programmers love all the things that they can make computers do. They think: the more choices available, the better. So, the screen on which I am supposed to sign my medical records has 74 (!) different command buttons. Like every other end-user, I am drowning in information overload and too many choices. Programmers, designers and managers rarely take the end-users' needs into account and never choose simplicity over complexity.

Why don't we have one now?
Why don't we have a nation-wide inter-operable health information system now? There are three reasons and none suffices. First, everyone looks at the $276 billion price tag, and says I - solo medical practice; hospital; healthcare system; pharmaceutical company; insurance company; etc. - cannot afford it. Besides, why should I pay for an HIS? Secondly, no one who has developed a proprietary information system - for X-rays; medical records; turnover calculation - wants to lose the money they invested. Third, there are a host of regulations and laws that prevent a fully integrated HIS. Just think HIPAA. Just think confidentiality versus mis-use of MY medical records. Without strong leadership from Congress, there will never be an effective, workable national HIS.

If it sounds like I support an integrated national health information system, you bet I do. It must be carefully designed. Before even the design phase, the public must agree to accept the consequences, both the good and the bad.