The stimulus package includes a great deal of money for healthcare information technology, or health IT. Much of this funding is directed toward "wiring" doctors and hospitals with electronic health records, or EHRs. Why should anyone care, other than health software vendors and other industry insiders?
Here's why: Because the digitizing of medical records could have a far more profound effect on health -- and on our economy -- than most people realize. The president said the recovery plan will "invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives." All that and much more is possible. With a new HHS Secretary and health czar, and a White House health care summit scheduled this week, this is the right time to act.
"Electronic health records" don't sound like a particularly exciting or innovative idea. But neither did "a network that could quickly reroute digital traffic around failed nodes" in case of military attack, or "dynamic routing protocols to constantly adjust the flow of traffic" between computers. Yet those were the modest original goals of ARPANET -- which evolved into the Internet as we know it today.
Paradoxically, computerizing the health system in this country could make it much more humane than it is today. But that calls for a broad vision of health IT as an "information highway" that stores information, looks for problems, and eases the many routine interactions that make up the health system. A well-designed "health highway" would have features like these:
A common set of programming specifications for coding, storing, sharing, and manipulating health information. Just as XML (eXtensible Markup Language) allowed web designers to create sites that interact with one another, a health markup language or "HML" could allow systems used by doctors, hospitals, patients, and others to easily "talk" with one another.
The ability for systems to "look for" adverse medical reactions together. Certain harmless drugs become deadly in combination with other drugs, or when a person has other medical conditions. One way this technology could be used is to automatically look for these interactions every time a prescription is electronically "written."
Personal convenience. A doctor recommended minor surgery for me last week. What if her office had been able to schedule an appointment for me on the spot, send me a before-and-after personal care plan (tailored to my medical history), pre-authorized the treatment -- and checked my health plan to tell me how much it was going to cost me?
More privacy than we have today. I began tracking health privacy breaches a couple of years ago, but had to stop -- because they're too frequent. Laptops get stolen with medical information on them, storage disks get misplaced, or computers get hacked. (I wrote a paper about potential criminal uses of stolen medical data, but decided not to publish it ...) A comprehensive health IT system would include better protections for health data.
Tools for primary care doctors to manage your health. US and Canadian primary care doctors - the ones who should be managing your overall health -- have historically lagged behind their European counterparts in some vital IT capabilities. Health reform depends on stronger primary care - and health IT can help.
Automatic claim submission. Why shouldn't the health IT network automatically submit my claim after I've received medical treatment? Why shouldn't it tell me how far I've gone in meeting my deductible, and share any other financial information I might need? Our current system is too clerical, too bureaucratic, and too difficult to navigate.
For that matter, why should I have to fill out the same forms over and over -- not only each time I see a new doctor, but when I fill out multiple forms in the same doctor's office? This is a pet peeve of mine. And after I've had to write down my birthday four times during one doctor's office visit -- then I need to tell them my age, too! (I want to ask, if I just gave you my birthday can't you figure out how old I am? Well, a computer can ...)
The government can't create systems to do all these things, even with the dollars that have been budgeted. But that shouldn't be necessary. A comprehensive strategy should lay the foundation for a boom in private initiatives. If the Internet's any example, people will meet these needs... and hundreds of others nobody's thought of yet. That won't just help us save money and improve healthcare. It could also create a new mini-boom in the technology and service sectors of our $2 trillion health economy.
And that sounds a lot like a stimulus to me.
An "electronic health record" may sound dull. Software based on paper-based objects seem inert. But that's what Facebook was originally -- an electronic version of the "facebooks" given to new college students so they can get to know one another. Whenever anything is digitized it becomes dynamic, changeable, active. It acquires the ability to interact with other things. It becomes less like a paper form, and more like a gateway.
Or a highway.