Health IT

Earlier this week we posted our interview about the future of health IT with Carol Diamond of the Markle Foundation. (Part one, and part two). Today we'd like to point you to The Hill 's interview with Health and Human Services Secretary Mike Leavitt on the same topic.

Two points struck us. First, neither the article nor the full Leavitt transcript mentions the word "privacy"—a big issue both for policymakers and for the public who keep reading about nosy hospital staff, researchers who do sloppy things like leave laptops with patient records in the car, and thieves who steal credit card numbers and other financial identity information from medical records. Not insurmountable but essential if we're going to get the country on board with health IT. Second, Leavitt really depicted the health IT challenge primarily as a technology question involving interoperability (letting different computer systems talk to each other) while Markle's Connecting for Health program and conversations with some other experts have made us think about a far broader range of policy challenges that won't be solved only by the computer geeks.

Yesterday we posted the first part of our conversation with Carol Diamond, M.D., M.P.H., the Managing Director of the Health Program at the Markle Foundation in New York. She spoke about the potential of health information technology to improve the quality and restrain the costs of our care, as well as the research benefits. Today, in the second and final installment, she discusses some of the barriers to bringing 21st century tools to a paper-based health system, and the path to overcome them.

Q: What are the challenges to a national health information technology system?

A: There can't be one information technology "system." We start with a vast, highly fragmented and very diverse health care delivery model that is not centrally controlled or run. The only practical way forward is to acknowledge existing networks, and let them grow incrementally under a basic, common sense set of policies and standards. That's how the Internet grew.

The health care sector has a set of unique challenges that need to be overcome—and some have nothing to do with technology.

The first critical challenge is trust. Without it, patients and physicians will not be willing to use new technologies due to fear of privacy breach or the misuse of personal health information.

We're suckers for medical mysteries like the one in today's Washington Post health section headlined "Five Doctors, Stumped." Today's medical whodunit (or more accurately who-didn't-do-it) was about the misdiagnosis of a woman named Bettie Munro, thought to have Parkinson's disease. Munro did not have Parkinson's. Instead, an upset stomach among other things had changed how her aging body was absorbing lithium, creating a toxic condition. One sentence near the end of the story particularly struck us, "One physician said he thought another had checked her (lithium) level, so he didn't bother." It made us think about the interview we just posted with Dr. Carol Diamond, an expert on health information technology at the Markle Foundation. We don't believe (and Diamond doesn't assert) that health IT will stop every medical mistake, avoid every misdiagnosis, create a perfect world of health and harmony.

Many Washington, D.C. policymakers (including the presidential candidates) talk about the need for more health information technology.  Everyone seems to agree that health IT will improve quality and can help control costs.  For instance, RAND has estimated that greater use of health IT will yield an annual efficiency savings of $77 billion over 15 years. A study in JAMA showed that when doctors use computers to order medications, preventable errors drop by as much as 55 percent.  Another study in the Annals of Internal Medicine showed 12 to 20 percent improvements in compliance with physician guidelines and other benefits.  Despite all this agreement, we haven't quite figured out how to get from here to there. So we asked Carol Diamond, M.D., M.P.H., the Managing Director of the Health Program at the Markle Foundation in New York, to share her insight into how we can overcome the policy and technical challenges and bring 21st century tools to our paper-based health system.

Q: Health IT can be confusing. If you were at a cocktail party, how would you describe what you do?

The Wall Street Journal had a great piece and blog item yesterday about Health IT and privacy breaches — we would have blogged about it then had we not, coincidentally, been out much of the day with some other think-tankers and foundation folks educating ourselves about that very topic. Among other things, the Journal article made the key point that privacy breaches are rarely prosecuted. That's not the right way to build public confidence in electronic health records.

Some 35,000 reports of privacy violations have been reported to the Department of Health and Human Services under HIPAA (Health Insurance Portability and Accountabilty Act) since 2003, but not a single civil fine has been levied, WSJ reported. HHS says several hundred reports of violations have been referred to the Department of Justice for criminal prosecution; about 200 cases have been filed although it's not clear how many of them were under HIPAA.

New Health Dialogue is pleased to welcome Phillip Longman, a Schwartz Senior Fellow at New America Foundation, to share his expertise on the health IT systems of the Veterans Health Administration.

A visit to almost any VA medical center these days demonstrates how the system has overcome its bad old days to become a model of 21st century health care—if only we don't undo the very changes that got it there. At the VA medical center in Durham, North Carolina, for example, a computer-driven robot fills prescriptions, automatically putting the right pills, in the right number, in the right bottles, with the right labels and barcodes, based on orders doctors enter digitally into the VA's world-class electronic health record software.

Tired of waiting for Washington to fix health care, doctors across America are doing it themselves. I just attended a conference in Dallas where hundreds of physicians exchanged ideas on how to improve the quality of care they deliver, make their clinics more efficient—and rediscover the joy of practicing medicine. In future posts, we'll touch base with some really smart and dedicated people we met there and highlight specific innovations that got our attention—new ways of reaching hard-to-serve populations, managing chronic diseases like diabetes, involving patients in their own care, new twists on "shared visits."

Brief update - As expected, the Pennsylvania House did approve a scaled-back version of Gov. Ed Rendell's health coverage plan this week. Rendell has now embraced the compromise and strongly urged the state Senate—which has been more skeptical about the finances—to pass it. As coverage expansion needs to go hand in hand with insurance market reform, particularly to help small businesses and individuals purchase policies, Rendell is also pushing for an insurance package in the House. AP has the details.

You know the clichés about bloggers in their pajamas? Well, we think the Health Care Blog has found the medical world's equivalent - a young doctor in Brooklyn who runs a "virtual office" from a laptop in his bedroom. (On the youtube video, however, he was not in pajamas). We don't agree with Parkinson about everything - his cyber-savvy practice catering to young, uninsured but artsy New Yorkers who can't afford insurance but can pay $175 for an occasional visit from a young artsy New York doctor (Parkinson is also a photographer) isn't a model for fixing U.S. healthcare today and it's easy to be cavalier about being uninsured until you get a high-cost illness or are struck by that proverbial bus. But we like seeing creative ways of harnessing efficient and patient-friendly high tech into doctor's practices. Parkinson's patients, for instance, can book their own appointments at their convenience in his online calender without anyone putting them on "hold." And we were fascinated not just by the post on him but also the comments it has provoked from readers.