I jumped on the iPhone bandwagon a few weeks ago, and I've mostly enjoyed figuring out how to take advantage of all of its features. One of the apps I discovered early on tracks the time and distance of my walk to the office in the morning and then posts that information to my Outlook calendar.
Pretty nifty, right? Beyond the, "Gee, whiz!" factor, though, being able to share data electronically, easily, securely, and inexpensively holds great practical promise for improving health. For example, if I had diabetes and uploaded my daily exercise routine (perhaps along with what I'm eating and when I take my medication) not only to my calendar but also to a personal health record, that data could give my physicians and me a better sense of how I manage my disease day to day, outside of the doctor's office.
My primary care provider's office could note follow-up appointments in this space; my endocrinologist could upload prescriptions and test results to this same record; my eye doctor could also include notes. Rather than having piecemeal information kept in dozens of file cabinets and shoeboxes, all of my relevant health information would be stored and accessible in one place. My health care providers and I would start to function more like a team managing my diabetes.
This information-sharing becomes even more powerful when we look beyond the individual patient level. Over the last year and a half, there has been a lot of conversation about "meaningful use" of certified electronic health records, focused on how health care providers can best capture and share key clinical and public health information.
The idea is that providers submit aggregate data on a range of measures of health care quality to the Centers for Medicare and Medicaid Services (CMS) to populate an enormous database. Such a rich combined data set will open up tremendous opportunities to learn more about how to improve the quality of health care and, ultimately, reduce health care costs: what are the health care conditions that are being managed well? Where is there room for improvement? What is the best way to address gaps in high-quality care? What might explain variations in quality, cost, and outcomes across different providers, and how can we best address them?
We have the tools and technology to make this work, but there are some barriers. In the short run, the shift to electronic health records and the process of collecting and submitting data electronically are burdensome for providers. (In recognition of this additional effort, providers who meet the criteria for meaningful use are eligible for incentive payments under Medicare and Medicaid.) It requires upfront investment in technology and training of staff, and it fundamentally changes the way that they do their work, their day-to-day interactions with patients. But most of the providers I talk to are focused on the long-term possibilities and see the value of this new approach, the opportunities that shared data opens up to help them improve the care they deliver.
There is momentum, there is energy, there are even dollars to help us take advantage of rapidly advancing information technology to understand the health care landscape and to identify opportunities to improve the quality of health care practice, to improve patients' health, and to reduce unnecessary health care costs and spending.
We need two more ingredients to make the revolution in health information technology happen. First, consumers need to start demanding it from their health care providers. If my friend can learn instantly how his blood pressure has tracked over the past three years, why doesn't my provider make that possible for me?
And, we need to unleash creative forces to continue to develop ways to use the data to improve health and lower costs. Getting back to the iPhone, it is clear that the machine is so effective because thousands of quiet entrepreneurs have independently created apps that address the real needs and interests of consumers. We need this same type of creativity and market forces to shape the use of health care information.