Politics, money, and health care IT

Ask medical professionals what's wrong with health care today and you'll get an earful. I quickly discovered that during the series interviews leading up to this week's Computerworld cover story about the financial disincentives that are retarding the development of interoperable electronic health record systems in the U.S.

Many of the folks I spoke with - from medical practices, hospitals and industry organizations - had strong feelings on the subject, but not all of those comments made it into the final story. I've culled some of the more colorful - and thought-provoking - comments from the cutting room floor and posted them here.

America, get your priorities straight

"Federal dollars pay a large amount of the money toward people in the last 30 days of their life. We have to make a decision. Are we doing to invest in things that are going to help a lot of people broadly or in things that help a narrow band of people? A lot of people knock Britain but they have a much better information infrastructure because they have very different spending priorities - and their spending as a percent of GDP is a lot lower."

-- Joshua Lee, M.D., associate clinical professor at the School of Medicine, University of California San Diego Medical Center.

Politics is killing health care

"There is no obvious authority or incentives to interconnect these [electronic medical record] systems. It gets down to politics. We are [ranked] thirty-something in longevity but double any other country in dollars per capita [spent on health care].

The British and Canadians are different. They do seem to be making much more substantial investments both with public funds and in aligning the financial systems they use to incent the adoption of electronic heath records that are interoperable."

-- Charles Jaffe, CEO, Health Level 7 Inc. (HL7).

Lack of automation creates wasted efforts

"There are estimates that one in five lab tests and X-rays are repeated because the data from the original exam is unavailable at the time a decision must be made.

There are many options to optimize the return on investment for [electronic medical records] systems, but ultimately the patient benefits in a care delivery model as well as in a framework of preventive medicine." -- Charles Jaffe

The health IT problem is way too complicated

"Health care may arguably be the most complex enterprise that exists on the face of the earth. Having an electronic health records system that supports that is also complex and difficult to do."

--Robert M. Smith, M.D., associate chief of staff for health care analysis, VA San Diego Health Care System.

On Google Health and Health Vault and other emerging personal electronic health record systems...

"If you take an elderly person with ten different doctors, there is no one that can assemble all of the health records except for the patient. The U.S. doesn't have a health care system. We have a lot of health care providers, but there is no system. Right now, the personal health record seems to be the best hope."

-- John Halamka, CIO, Beth Israel Deaconess Hospital, CIO, Harvard Medical School and chair of the Healthcare Information Technology Standards Panel.

"There is no such thing as 'your medical records.' It's scattered across hell's half acre...at dentists, doctors, pharmacies...[with] probably 20 medical record systems in different specialities and clinics.

You are the only place where that data can be assembled in one place. The individual deserves to get a copy of that information and let them decide what to do with it. It can't be much worse than the current system."

-- Colin Evans, president and CEO, DOSSIA.

"Right now it's a little bit of the Wild West. Some vendors want to gain access to patient infomration that might be linked up to genomic information. It raises issues."

-- Robert M. Smith, M.D.

Copyright © 2008 IDG Communications, Inc.

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