Health IT

The Boston Globe reminded us that starting next month, doctors who e-prescribe will get a modest bonus (up to two percent) from Medicare. After two years of carrots, Medicare will reach for the stick and penalize doctors who won't give up their paper prescription pads. This brought to mind this recent study from the Agency for Healthcare Research and Quality on how e-prescribing can bring down drug costs, for patients and the overall system.

Many insurers have drug formularies and tiered pricing to encourage use of generics or specific brand name drugs. But those formularies and pricing categories change frequently. Having an e-prescribing system that is linked to current formulary information helps doctors choose lower cost drugs. The study found it saved $845,000 per 100,000 patients per year and that could rise to $3.9 million, as the systems become more widely available and easier to use. Some of those saving, in the form of lower co-pays, directly help patients.

Kaiser Permanente, the Mayo Clinic and Intermountain Health Care, three health systems known for their emphasis on primary care, care coordination and integrated delivery systems, have collaborated on a five-year vision for improving how we deliver health care. The paper outlines practical steps that would move us from a fragmented, inefficient, and expensive system to one based on teamwork, care coordination and sound medical evidence to guide clinical decision-making. The five-year plan is built around an expanded health information technology infrastructure and an ambitious set of pilot programs, drawing in Medicare, other public programs and private insurers, that would lead us to a system where we pay for good value, and good quality. Hallmarks would include:

Ok, so may be we don't have a non-fatal strain of the hantavirus... In today's New York Times:

If that headache plaguing you this morning led you first to a Web search and then to the conclusion that you must have a brain tumor, you may instead be suffering from cyberchondria.

On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.

The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them.

Further evidence that your Google home page is no subsitute for having a medical home to can help guide you through the complex decisions and treatment options of modern medicine.

We just spent more than an hour listening to Eric Schmidt, Google Chairman and CEO and the chairman of  New America Foundation's board, give a presentation to a packed crowd at the Ronald Reagan Building on the intersection between technology, the economy, and public trust in government. (Watch it here). 

As one might expect, Schmidt spoke mostly about technology, energy, and infrastructure—defining infrastructure to encompass not just roads and old-economy power plants but clean energy and information. He argued that economic stimulus done correctly means  job creation, and long-term investment in a clean-energy, high-growth, information-rich, citizen-empowering economy.

But before he delved into all those very Googly topics, we here at the New America health policy program (who don't really want Schmidt to know how long it took us to figure out which of the three remotes would find C-Span 3 on the office TV set) would like to point out that Schmidt, who is also an economic adviser to President-elect Barack Obama's transition, said we also need to do two other things Right Away. Fix schools. And fix health care.

The financial crisis and economic turmoil has many Americans and voters wondering, what's next? Lloyd Dean, the CEO of Catholic Health Care West (the country's eighth-largest hospital network) tells the San Francisco Chronicle in an interview  that: "the next financial crisis won't be what we're currently experiencing; it will be a health care crisis." Dean believes that while financial stability will eventually return to our economy, our way of delivering health care remains unsustainable. As such, Dean has been an outspoken advocate for health reform. And a key component of health reform, he said, is covering the uninsured:

I would and will continue to advocate some kind of universal health care in this country. I think that health care is a right. I don't think that it's a privilege. It is a shame that a country of our means has 46 million individuals who do not have access or have no way of paying for their health care.

Many individuals I see and talk to—and even in my own family—have to choose whether they are going to spend money on medicine or spend money on food. Am I going to split my pill in half so that I can buy oil to heat my home through the whole winter?

I have advocated forming coalitions at any level—at the federal level like we do with the Catholic Health Association of the United States, here with the Healthy San Francisco program—I believe it is in the best interest of the country that everyone has access to a minimal level of health services.

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?

What would you do with $700 billion? (Aside from buying the fabric ($2.10 a yard) needed to make 3.6 billion golden parachutes.)

Here at the New Health Dialogue, we like to talk about how a quality health care system will actually save us money. But while watching the ups and downs of the Wall Stree bailout plan all week, we couldn't resist indulging in a little health care spending fantasy. So we asked our director Len Nichols how he might spend $700 billion.

We've written often about the need for more health information technology (used wisely in combination with other delivery reforms as the CBO has made clear). We have also written that patients will be more comfortable with electronic medical records when privacy breaches stop making headlines. We can protect computerized records, and we do protect computerized records in many settings, including electronic health records. But the breaches persist, and we draw attention to them not because we don't think the problem can be fixed but precisely because we believe the problem can and must be fixed. Grady Memorial Hospital is the latest to have patient medical information end up on a publicly accessible web site. As the Atlanta Journal-Constitution reported:

Grady outsourced the job of transcribing the notes to a Marietta firm, Metro Transcribing Inc., which outsourced the work to a Nevada contractor, Renee Lella. Lella, in turn, turned the work over to a firm in India, Primetech Infosystems.

What do Britney Spears and Farrah Fawcett have in common with California First Lady Maria Shriver? How soon we forget: someone snooped in their medical files. The California state Senate hasn't forgotten. It just passed legislation that would require health care providers to monitor employees to ensure that they do not violate patients' medical rights, the LA Times reports. California Gov. Arnold Schwarzenegger—Shriver's husband—supports the bill, which still must pass the state Assembly.

Much of the language in the California bill sounds like the federal HIPAA Privacy law. It would require health care providers to have clear and appropriate safeguards to protect patient privacy and "reasonably safeguard confidential medical information from unauthorized or unlawful access, use or disclosure."

But the California initiative differs from HIPAA in several ways. First, it  would allow an individual to sue the person who negligently released confidential medical information. The federal law, in contrast, only allows the Secretary of Health and Human Services to investigate complaints and assess penalties. California would also impose fines up to $25,000—but this pales in comparison to the possible monetary damages available in a civil lawsuit.

The Health Affairs Web site has several perspectives on Health IT, as well as the first in a series of companion essays on what it all means. The main perspectives come from Carol Diamond of the Markle Foundation (read her guest posts on NHD here and here) and Clay Shirky of NYU, who emphasize how IT fits into health, not just the technical standards aspects, Robert Kolodner, HHS's Health IT national coordinator who updates us on federal policy, and David Kibbe of the American Academy of Family Physicians, who sums up what the private sector is doing. If you have followed this issue at all, you'll know these players, but it's a useful recap. Keep in mind that the CBO has emphasized that IT isn't a magic bullet—it's got to be used in a way that improves health and health care if it's going to reap all the savings that everybody's been talking about.