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Network is key to digital health records
Peter Bach
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TEXT OF COMMENTARY
Kai Ryssdal: The digitization of health care took another step forward today. General Electric and Intel said they're working together on a way to let doctors monitor their patients remotely -- checking their vital signs or even reminding them to take their medicines.
Kathleen Sebelius, the president's nominee for secretary of Health and Human Services, said this week the administration wants Americans to have electronic health records by 2014. Commentator and physician Peter Bach suggests it's the step after that that's going to make all the difference.
DR. PETER BACH: President Obama knows that the hand-written notes and manila folders that doctors use to keep your medical records have to go. The stimulus package, at his urging, includes $19 billion to help doctors buy computer systems for their offices.
But electronically connecting these systems to one another, so that your medical records are available to any doctor who is treating you, is what will dramatically improve patient care. And that step is going to be much harder.
You might think interconnectivity isn't that important, but imagine this: In aggregate, the patients of one primary-care doctor in the U.S. see 228 other doctors in 117 other medical practices each year. There's no way that a single doctor can keep track of all these other doctors' actions with faxes, photocopies and phone calls. So, errors are made, expensive tests get re-ordered, and costs just go up and up.
Getting doctors interconnected could fix the problem, but there are some roadblocks ahead. No one agrees on the proper data format. Four years of lollygagging public-private "standards committees" haven't fixed that. The layers of privacy and security to protect records have not been totally defined. Most important, doctors and hospitals don't want it to happen. After all, they've spent a lot of money getting you as a patient, buying ads in the newspaper and creating their brand.
You are a revenue-generating asset, made stickier because your records are in their possession. They don't want you to go to another doctor who might be better or cheaper. Hanging on to your records means hanging on to you.
Once records are standardized, what doctors do can be easily looked at too. Those that order too many tests, or fail to practice up-to-date care, will stand out. Competition over price will drive down doctors' incomes. And, the old excuse for repeating a test -- "I just didn't have the results from the other doctor" -- will go away.
So, let's remember that whether or not there's a computer in every doctor's office is not what matters, it's what it's wired to that does.
RYSSDAL: Peter Bach is a physician at Memorial Sloan Kettering Cancer Center. He used to be an adviser to the head of Medicare and Medicaid.
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Given Dr. Peter Bach’s credentials and experience, I was astonished at his utterly wrong interpretation of today’s barriers to a national health information network. Doctors don’t resist electronic records systems because of income fears; doctors resist them because they were built for profit by giant, careless companies and are confusing, time-consuming, and intrusive to the patient visit. Today’s systems do not improve patient care, and were shown by Oregon Health Sciences University researchers to sometimes worsen it. These systems are built to prevent records-sharing, and the companies that make them keep it that way. Our system cannot share patient data with the hospital down the street, even though both systems are from the same company. When we suggested modifications to permit data sharing, we were told it would cost millions and void our warranty. Dr. Bach of all people should know that the *real* income-losers under a national computerized medical records system are the giant companies making today’s over-expensive and nearly unusable systems.
Listening to Peter Bach was most disturbing. My husband has been a physician for 25 years. Bach's comments regarding doctors thoughts and intentions were way off the mark but what would you expect from someone who's been a consultant to Medicare, the government agency that continues to look for ways to cut reimbursement to physicians.
I think the Obama administration is going about this all wrong. And that Dr. Bach is right on about standards. what's missing though is a solution to the problem. The administration has a solution, and they don't even know it. The VA. I work in the software industry, court software to be specific. We have been fighting about those standards now for almost 10 years. I gave up, it's a complete waste of time trying to get a group of software vendors to agree on standards. It takes a benevolent dictator to get anything done. What the administration needs to do is buy development rights for the software that the VA uses to track its patients. Every nurse I've ever talked to who has used it loves it. My wife being one of them. They need to then give that software away on those computers that they help the doctors get. Use that software's data structures as an open standard that all the other venders must be able to import/export to. They can then create a steering commite for making small incremental changes to the standard over time. they need to provide doctors with systems, not just PCs. It's a very daunting takes for someone knowledgeable to decide on a full solution, much less an overworked under 'I.T.' educated doctor and his staff. The only way this will work is providing people with a cheap/free turnkey solution, and a mandate.
As an aside, this same strategy applies to the financial system, the insurance industry and every where else where there is to much paper, that the government tracks. They own AIG don't they, and I'm sure AIG uses a hell of a software package.
This argument is way off. I personally have gone to the same doctor since I was a child, because he's friendly, intelligent and reliable. Any Doctor who meets the above standards and is available to develop a relationship with their clients need not worry about losing them to more cost-efficient doctors. If I heard a doctor down the street was slashing costs and offering the "cheapest treatment in town" like some kind of used car salesman I wouldn't care in the slightest, because I enjoy a personal relationship with my doctor, like everyone else on this planet.
Dr. Bach`s remark about patients being revenue generating assets is offensive and most inappropriate in this discussion.There are, I am sure, some physician behaviors to support his claim; but there are also corrupt politicians and incompetent government advisors as well.Such name calling and flimsy accusations will get us nowhere.
Interconnection would help my practice by minimizing the time required for me or my nurse to track down records of patients sent to tertiary care centers. I have no interns residents or fellows. There is much refinement to be done. Computer generated template records are almost worthless.
If Dr. Bach is really interested in progress and improvement, he should not begin by insulting his fellow physicians.
Alan Solomon MD
General Surgeon
Arkansas
I thought Dr Bach's comments were thoughtful and insightful. I do however disagree with him on the point that heterogeneous nature of the formats used in EMR precludes them from being shared. There are several systems available right now that will translate these EMR records from one format to another. Microsoft's Biztalk suite is an example of such a software. As EMR systems become more ubiquitous there are bound to be more vendors that will enter the market with similar products.
Dr. Bach's assertion that physicians resist these innovations because they don't want to lose pt's is yet another example of the ongoing assault on the doctor/patient relationship in the name of the marketplace. This same reductionism brought us managed care which cut Dr's fees, raised pt's fees and created a level of Orwellian bureaucracy leading to shareholder profits and AIG-like executive compensation.
Most Dr's are not guided by a profit motive, but an apparently now arcane desire to be of some service. A visit to any waiting room will confirm that there is a surplus of patients who are not viewed as commodoties but as people suffering and in need of help. Most Dr.'s make referrals to other physicians to help with tx. and dx. and welcome second opinions.
Any resistance to electronic records is more likely the result of poorly defined privacy laws and the limitations of already overworked staff trying to wrangle legitimately earned fees from managed care companies.
I am disappointed in Dr. Bach's simplistic reduction of such a complex problem to a bad doctor/good marketplace formula. Let's not be fooled again.
Sent to Marketplace: EK comments: I totally agree. a) The records belong to us, patients. If WE can keep our records always with us, (like in a flash drive in our key chain) 1st: in case of an emergency, whoever takes care of you can have your information immediately (ie: I carry a copy of my latest EKG with notes; my advanced directives; and a do not resuscitate form). b) I have had the problem mentioned above: being allowed to choose Doctors and systems, I was forced to take the same X-Rays twice as the Doctors didn't have the information of the previous one, or it couldn't be found. This could be avoided if I kept my records. I try to do it and started asking for and keeping copies of the Doctors' notes and X-Rays (that of late they have given me in CDs); but wouldn't it be better if I had all the information and records in my own flash drive, instead of having to go and get them, have them in all kinds of formats, and waste paper, etc. I can also travel, and not worry about getting information from one place to the other. c) Yes, the only way to be able to do this is to standardize all the information. d) I think what might make it possible would b e by instituting Single Payer in the US: one institution (like medicare, but with corrections) instead of different insurance companies would control our records; the same prices would be charged for the same procedures; and all this information could be kept in one place.
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