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HEALTH IT: Guest Blog Post by Sen. Sheldon Whitehouse

October 6, 2008 - 11:53am

Rhode Island has been a leader in developing health information technology, and Sen. Sheldon Whitehouse (D-RI) has some interesting ideas on how to get the rest of the country moving in the same direction. We invited the senator to guest blog on his proposal to create a new national entity with the know-how and the authority to get the job done.

By U.S. Senator Sheldon Whitehouse

Our health care system is in serious trouble.

Americans face embarrassingly low life expectancy rates, embarrassingly high obesity and infant mortality rates, and suffer as many as 100,000 deaths every year because of unnecessary and avoidable medical errors, all while our country spends 16 percent of our GDP on health care—more than any other industrialized country and double the EU's average. The annual cost of the system exceeds $2 trillion and is expected soon to double. More American families are bankrupted by health care costs than any other cause. There is more health care than steel in Ford cars, and more health care than coffee beans in Starbucks coffee. What is going wrong?

Health care's fundamental problem is market failure: market forces that should work to lower costs and increase efficiency in the system are instead log-jammed and misdirected. This market failure is nowhere more evident than in the strangled implementation of health information technology (HIT).

Some pretty respectable folks report that anticipated annual savings from a national health information technology system range between $77 billion and $346 billion per year. Those are savings desperately needed by American businesses and American families. Considering these projected savings, you'd think that there must be an organized national effort to capture them, and to achieve the win/win of safer, better and more convenient care.

But there isn't. In my state of Rhode Island, we are lucky that a doctor named Mark Jacobs took time away from his patients to pick the best electronic medical record technology, adapt it to Rhode Island's needs, and try to market it to build critical mass. Thank goodness for Dr. Jacobs, but counting on the Dr. Jacobses of the world to do this is like counting on homeowners to build and maintain the streets in front of their property. We figured out long ago that that's a pretty dumb idea.

If waiting for doctors to adopt HIT on their own is not the right way to solve this national problem, what is?

I would argue first that we need to see our national health information technology as national infrastructure, not unlike the highway system, which requires a national solution proportionate to the problem. In my National Health Information Technology and Privacy Advancement Act, S.1455, I have proposed one way to do this: a national entity with the authority and the know-how to get this process moving.

Second, we need national standards—standards to protect patient privacy, because people will never trust a system that won't protect their privacy; standards for interoperability, so the system can work from Alaska to Alabama, from Texas to Tennessee, from Maine to California; and standards for data quality, so wherever they load your x-ray onto the system, you know it will be at a resolu—tion that a doctor can read properly. So a new entity must have the power to set these standards.

Third, this effort will also need start-up capital. Congress could appropriate the money annually, but we have not, because we get all snarled up in partisan politics every year. Better, I submit, to put this organization outside the budget process, and allow it to establish its own fee schedule, access procedures, and revenue stream. The financial market knows how to capitalize a revenue stream, and the market discipline on the revenues and capital will be beneficial.

Finally, if it has the power to set standards and raise capital, this entity must be accountable to the public. Traditional mechanisms of accountability can accomplish this: presidential appointment of the board with advice and consent of the Senate; application of open meetings and records laws; and requiring notice and comment rulemaking procedures under the Administrative Procedures Act. And this entity will be better motivated if it is not organized for profit.

I have heard from countless Rhode Islanders struggling to pay for health care and afraid of losing insurance coverage on which they and their families depend. I have met nurses frustrated and heartbroken that they must spend so much time filling out paperwork and so little time caring for patients. I have talked with families whose lives and health were shaken by terrifying medical errors—misplaced paperwork, mistaken diagnoses—that should have been avoided.

We have to face our health care problem head on, and we have to face it now. Senate Budget Committee Chairman Kent Conrad (D-ND) has spoken eloquently and with great urgency of the tsunami of health care costs that is sweeping inexorably towards us. Our nation's former Comptroller General, David M. Walker, has expressed similar concerns. Their warnings are not mere predictions: the Baby Boom is a facttime sweeps that population inevitably along - and the increased cost of medical care for the aged is well-established.

The real choice we have is this: if we take action now, we have more options, and more humane options. If we wait to act, we may well be left with only very difficult and unpalatable choices. So let's act now. We have many options before us. One is for Congress to help bring the promise of health information technology and a reformed health care delivery system to every doctor, every hospital, and every patient across this country.

 

Comments

Electronic Dental Records

Dear Senator Whitehouse:

Thank you for the information about interoperable health records. I am encouraged that patient privacy is your top concern. More should follow your lead.

I am a dentist. From where I am sitting, it looks like HIPAA has already failed in dentistry. This means that Electronic Dental Records don’t have a chance of catching on.

Would you like to comment about that? Darrell K. Pruitt DDS

Patient privacy is certainly

Patient privacy is certainly eroding. Look at Google Health. It is a a platform designed to have doctors send all their patient data into one main platform. My God! Why would anyone who appreciates privacy want any centralized database of everyone's health information? And certainly Google is not known for moving even slightly towards privacy unless it is a weak PR move. Take a stand!

I dare you to post this

“We have many options before us. One is for Congress to help bring the promise of health information technology and a reformed health care delivery system to every doctor, every hospital, and every patient across this country.” - Sen. Sheldon Whitehouse (D-RI)

Dear Senator Whitehouse:

Even though you declined my invitation to reply to my comment concerning HIPAA last week, and even though the editors of The New Health Dialogue Blog refused to post my last comment in response to their article which invited my comments - exercising their privilege, of course - I will try to engage you once again in meaningful, honest, if blunt, conversation about electronic dental records and HIPAA.

Here is my simple question to you, Sen. Whitehouse: How will health care information technology save money in dental care?

I personally don’t think dentists can move to electronic records without raising fees. Please keep this in mind as you promote electronic health records, Senator Whitehouse. When I have to raise my fees to cover the costs of mandates that at least make sense, children in my neighborhood go to bed with preventable toothaches. Let us not be cruel for personal gain, how about it?

Your reply would be appreciated. Actually, it is demanded.

One more thing, I do not respect small-minded editors who oversee small-minded blogs like The New Health Dialogue Blog., so this comment will also be posted on PennWell forum within minutes under the title, “There’s a new sheriff in town.” Cute, huh?

Your decision to discuss HIPAA on the Internet may have been a terrible political mistake if it turns out that you know nothing about electronic dental records, Senator Whitehouse. Darrell K. Pruitt DDS

I've looked at the

I've looked at the comprehensive annual financial report (not the budget report), and it appears that there is more than enough money to finance completely a universal healthcare system with thorough privacy.

healthcare costs

As a nurse and health care consumer, I have often felt that we as consumers should take a more active role in our health care. I personally have seen blatant misuse by reordering tests and procedures unnecessarily, because it was more time effective for the doctor or nurse to charge the patient for another test than to locate the results of said test/ procedure that was already done/performed. Also, tests are performed unnecessarily because of standing orders instead of viewing the patient as an individual and ordering test specific to them i.e. pregnancy tests on all surgery patients even though patient has had hysterectomy or ordering EKG on patient who had one two weeks prior but was never asked so medical staff automatically perform test. It seems to be a misconception that if the patient has insurance we can and will charge without considering cost to patient with coinsurance and copays. If we were private pay patients or if said medical staff was held accountable (it was coming out of their paycheck) we would be much more careful in making sure the procedure was necessary. Of course, an electronic database would help but only if the staff takes the time to look or if the staff takes the time to talk with the patient about tests they are ordering and why. I feel that the only way this will change is if there is refusal of insurance companies and patients to pay so that medical personnel will be fiscally responsible and spend other people's money as their own. This will only be done if the medical personnel feel it in their own pocket. Right now it seems as if they are just passing it on to the consumers. I know this is just a small part of a very big problem but reform is needed in many areas.

Healthcare cost

s. breitenstein touched my nerve. I can tell five or six stories of my bills being padded because i had insurance. Padded by more tests and/or procedures. What the insurance will pay for is what i get. it is almost everywhere i go. A chiropractor, an eye doctor, a dermatologist, a heart group each taken advantage of my insurance (and me). Perhaps HIT could help but only if used properly by doctors and office managers.

My 86 year old step mother had a broken bone in her foot. It took three doctors, two mris and some X-rays to find the problem. I know a 90 year old missionary in Brazil who fell and went to a local hospital. Her fractures were located and treated and she was sent home to mend the same day. In Brazil. Whats up with that? Seems like we are paying much more for less.

Do you fear me, Senator Sheldon?

Why do you ignore my questions about electronic dental records, Senator? Is it because you have no really are clueless about interoperable EHRs? Or is it because you acccept too much money from healthcare IT stakeholders like insurance companies and IT industry giants like Google?

You can tell me. I'm a doctor.

Darrell K. Pruitt DDS

Graea article

nice article

You seem to forget that

You seem to forget that health care is first and foremost a business. If it wasn't, then many of the methods and medicines which save the lives of millions of people every day wouldn't exist.

Or is it because you acccept

Or is it because you acccept too much money from healthcare IT stakeholders like insurance companies and IT industry giants like Google?

Health Care

It would be nice if Universal Healthcare was the answer to everyone’s dreams but I fear an entirely new set of problems will arise. If everyone in the country is provided health care what happens when the demand for specialists goes up? You will have a ton of people on waiting lists waiting to see surgeons. I wonder how this will be addressed.

Affordable Health Insurance

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Thanks,
Mark Smith