Peter Bach
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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.