Health IT

As the Wall Street Journal blog suggested in a recent post, combine prescription pads, publicity about drug errors, and doctors' notoriously sloppy handwriting, and you've got to wonder why e-prescribing hasn't taken off. In some places—we'll talk about the auto industry in a moment—e-prescribing is becoming increasingly common. Yet, electronic prescriptions remain the exception, not the rule.

A recent Center for Health Transformation study (brought to our attention by BNA - subscription required) reviewed the benefits of, and barrier to, e-prescribing. The study, Electronic Prescribing: Building, Deploying and Using E-Prescribing to Save Lives and Money, concluded that an electronic prescribing system would improve patient safety and control costs. But the barriers to wider adoption of e-prescribing are substantial. Implementing a system is costly; fear of change is also a factor.

There are several e-prescribing initiatives that illustrate that these barriers can be overcome. Here's an example:

We had hoped to see progress in the Senate this week on the Wired for Health Care Quality Act, which would have given a big boost to the growth of health IT. Just last week, a reported agreement between Senators Patrick Leahy and Edward Kennedy on protecting the privacy of electronic health records generated movement on the bill. But some senators apparently still needed some persuading. And now of course, with WIRED as well as with countless other legislative issues dear to our hearts, we are sadly reminded just how hard it is to get things accomplished with Sen. Kennedy absent from the Senate, at least for now, because of his brain tumor. The senator and his family are in our thoughts, hearts and prayers.

"Patient-centered medicine" is one of the buzzwords in health these days, so it was refreshing to hear from patients who actually had a voice in finding that center. Four spoke at a panel this spring sponsored by the Institute for Healthcare Improvement. Four patients. Four very different experiences. All had some success in creating a more responsive health care system. And when we at New America talk about reforming health care, we don't just mean insuring people. We want everyone to be covered so they can be part of a system that delivers high-quality, cost-effective, patient-responsive care.

(If you are interested in the difference between "patient-centered health care" which involves how we deliver care that patients need, and "consumer-directed medicine" which is a market-oriented approach to financing health care, read this Healthbeat post. They are not necessarily mutually exclusive, but they aren't synonymous.)

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The Aspen Institute's Health Stewardship Project this week held one of those forums about the presidential candidates and their health reform plans that have been popping up around Washington, and we were glad they added their voice to the call for health reform that addresses not just health insurance but also cost, quality, preventive care etc. We were particularly interested in a few elements of a Zogby poll Aspen commissioned on public attitudes toward personal responsibility in health care and also how people are using the Internet for their own health decisions.

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.