September 15-19 marks Health IT week, a relatively new and largely unnoticed week in the healthcare calendar.
The revolution in health - the one coming 'really soon' - is meant to come to us via the imposing sounding Health Information Technology, also known as HIT. The simple idea mirrors that of the Web, greater access and ease of use. Beyond the basic, Apple et al. are developing wearable technology to aid consumers in personal health; the Affordable Care Act (ACA) literally pays doctors to move from paper medical records to electronic medical records; and HIT already allows more doctors in more places to see, test, image and even operate on patients anywhere. So is this the dawning of better health, lower cost and Aquarius? Not exactly.
All of this may portend better health and lower cost, but the road to the future is already strewn with rather spectacular messes. One well-known example comes to us courtesy of Jon Stewart; he hectored Congress until that body eventually acted on a small 'hiccup' - transferring Electronic Health Records (EHR) from the Department of Defense (DoD) to Veterans Administration (VA).
According to NPR (March 31, 2010) approximately 2.3 million Americans serve in the armed forces, less than 1% of the overall US population. And on any given day, hundreds of active military personnel - covered by the DoD - transition to veteran status - covered by the VA. Many of these former soldiers require seamless continuity of care to manage combat-related mental and medical health conditions. That relies on moving a new veteran's records quickly - dare I say near instantly - from the DoD to the VA. That sounds easy enough, but it's not.
In 2014, the Inspector General determined that it takes 45 days, on average, for a DoD health record to become a VA record. That means a 45-day interruption in care, which would be bad enough. Unfortunately, 77% of all cases took longer than 45 days and 28% were incomplete. In other words, two federal departments large enough to merit cabinet secretaries dealing with less than 1% of the population have thus far failed to make HIT work. Keep in mind that soldiers and veterans are the product of a single-payer (federal government) system, which is far simpler than the multi-payer landscape the rest of us inhabit.
This is both a tragedy and a powerful object lesson. Healthcare IT holds great promise, from electronic records to the burgeoning field of teletherapy, in which behavioral care is delivered by licensed professionals to individuals the comfort of their own homes. But technology isn't magic and new approaches are only meaningful when the full continuum of care actually works. HIT will transform health care, but only after we do the hard work to turn today's potential into tomorrow's reality.