THE BLOG
03/18/2010 05:12 am ET | Updated Nov 17, 2011

Point 6: Connectivity Is Key To Care Improvement

Health care is remarkably unconnected.

The lack of connectivity tools in health care is absolutely stunning.

Health care providers in America have a very hard time connecting and sharing patient information with each other. Most medical records are still sitting in individual paper files locked in metal cabinets, totally isolated by doctor and care site. Those paper records are not interactive or accessible in any convenient way.

It is sad and ironic that an information-dependent profession is denied convenient access to needed information in an age when we connect other aspects of our infrastructure easily and often.

Seventy-five percent of health care costs in America come from patients with chronic conditions. Eighty percent of those costs come from patients with co-morbidities -- multiple health care problems -- and that means multiple doctors from different specialties for most of those patients. Those multiple doctors very often do not have access to the patient information they need to deliver optimal care.

With rare exceptions -- like organized multi-specialty group practices -- most American doctors who share patients have no mechanisms to also share information about diagnosis, care plans, patient studies, or even the various prescription drugs that they are each prescribing.

Doctors and hospitals also tend not to share important elements of basic medical information with each other. Each care site and care "business entity" has its own isolated data set for each patient -- and the data sets do not usually link up.

It's a functionally unlinked world, when it comes to basic information about care.

Patients tend to have minimal convenient connectivity to their caregivers, and caregivers tend to have even more minimal connectivity with each other.

It's really pretty sad.

So what should we do?

We are about to spend the better part of a trillion dollars to reform health care in America. Connectivity needs to be on the front burner of that reform agenda. Health care reform in America should insist on a world of data availability, data sharing, and patient focused data care support for American health care.

Insurers should be required to use their databases to help connect caregivers.

Funding for electronic medical records should insist on caregiver connectivity as an absolute condition of the funding. Funding electronic medical records that do not and can not connect with each other is breathtakingly stupid if we want to use patient information to improve patient care.

Doctors need better information. Doctors treating patients in America should have real time data about patients and that information should be updated as care is being delivered.

Patients should also have all of their own medical information -- easily available in an absolutely secure way wherever the patient happens to be.

The goal and the result of computerizing the health care delivery sites of America should not be to turn today's isolated paper siloes into tomorrow's isolated electronic siloes.

Asthma is the fastest growing disease for kids in America. It is expensive and it is the leading cause of death for kids. What is pathetic is that we know that the American infrastructure of care gets care right for American kids with asthma only 46 percent of the time.

What's worse -- we do not know which 46 percent. There is no mechanism in the highest cost health care infrastructure in the world to track care for kids with asthma. There is also no mechanism for hospitals who have kids suffering from a life threatening asthma attack to notify the kid's clinics, or physicians, or other non-hospital caregivers that the crisis actually happened.

We need universal coverage as a key step in the process.

When kids don't have insurance coverage, there isn't even a computerized insurance payment database that can be tapped to look back at the asthma care insurance claims filed by the doctors and hospitals to figure out which kids are not getting enough care or the right care.

We can and should do a lot better. We need a well-thought-through data flow agenda for America that focuses the caregivers and the care support on the kids who need care the most.

We need computerized data files to track care for each kid.

When the right computerized support systems are in place, the rate of crisis level asthma attacks can be cut in half.

Similar databases combined with focused care support teams can cut the number of congestive heart failure crisis in half -- and can significantly reduce the death rate from heart attacks.

We need care connectors for American health care. Setting up needed connectors should not be left to chance or someone's good intentions. Every payor should be required to support patient-focused care connectors and care registries. Caregivers who use registries to improve care should be rewarded -- and caregivers who duck supporting coordinated care and who cut off or don't support data flow for their patients with those conditions should be paid less and should also tell their patients that have chosen non-connected care.

We need the right tool kit to make care better in America.

Connectors should be right in the middle of that tool kit.

We should not fund a national health care IT agenda that doesn't end up directly supporting well coordinated patient care.

We need to cover everyone in America. We also need to better connect our caregivers so that care gets better and less expensive and we can afford to cover everyone in America.

Connectors should be part of the reform package.