This is the first of probably three columns on health care. The Obama Administration right now has in Congress legislation for reforming the U.S. health system so that sets my agenda. But the point of these columns isn’t to comment, per se, on the current proposals, but instead to look at what I believe to be my two areas of some strength — Information Technology and understanding complex systems — and see how they can be applied to this problem.
And it IS a problem. That’s the only part of this debate that all sides agree on. The doctors feel beleaguered and Lord knows that sick and uninsured people sure do, too. Even corporate fat cats are appalled at the explosive growth in health spending which today takes more of our GDP than any other expense category, costing approximately $2.5 TRILLION per year.
So if we can all agree on the goals of better and more efficient health care with some way to make it available to the largest possible number of people, the question then becomes what’s the best way to do that?
Government isn’t very good at answering such questions, but then in many cases neither is industry if their business model has to include ever-increasing earnings.
Imagine, just for a moment, what the U.S. health care industry would look like if it were managed solely by that paragon of capitalism, Goldman Sachs. The 48 million Americans without health insurance would probably be ignored completely while those who could pay more would get boutique medical services beyond belief and doctors would come to rely on substantial year-end bonuses. For some, such a system would be better but for most it would be worse, though supremely profitable. And when that “most of us” come to constitute most of the American working population, too, it will ultimately come to effect U.S. productivity and then we’re hosed.
So while it is convenient and fun to criticize government programs, let they who are without sin cast the first stones.
There are some things government is actually good at, among which are setting goals for good behavior. The Clean Air Act and Clean Water Act in the 1960s changed America for the better by setting environmental goals then letting the marketplace figure out how best to reach those goals. Without a target and a penalty for not reaching it, we wouldn’t have improved our environment as much.
So let’s step gently into this health care debate by looking at one area where Information Technology is central — health records.
There are lots of advantages to computerizing health records. A couple of years ago I visited the Mayo Clinic in Rochester, Minnesota, to discuss this very issue. Mayo has been in the forefront of digitizing all of its six million patient records. This is a bigger job than most of us realize since it involves not just blood tests and doctor’s notes but also X-Rays and CAT scans.
Mayo, which was a century ago the first clinic in America to standardize the way it kept records in the first place, is also at the forefront in creative ways to use those records once they are in the system. You see Mayo doesn’t have six million patients, they have six million patient records — many of those being records of people long dead. But keeping extensive records of dead people creates a powerful database for statistical testing of possible treatments and even drug interactions. “Surely in those six million records there is something similar to this medical mystery we are trying to solve today.” And often there is.
Figuring out from an analysis of records that combining drugs A, B, and G sometimes kills people can be good to know.
Mayo is taking the process even further to include DNA data for many patients with the goal of being able to statistically identify genetic trends within the population through records analysis.
That’s the good side. The negative side of all this record keeping is that many people see it as a possible invasion of patient privacy. This is what led to the Health Insurance Portability and Accountability Act (HIPAA) of a few years ago which forced health providers to be more strict in how they managed health records, adding at the same time about $25 billion per year to the cost of keeping us all in the system.
Hey, isn’t Information Technology supposed to SAVE money?
Sometimes. Ideally, it should.
So medical records are an area where IT could make us healthier and, if done correctly, ought to save lots of money, too. What we need is some form of centralized medical record keeping that preserves patient privacy yet, at the same time, keeps us from shopping all over town for bogus Oxycontin prescriptions.
Here is an ideal opportunity for government to set a standard for medical records and possibly even to develop medical records software, though I don’t think it has to go that far. What’s required is a specification that would allow health care providers to interface with a medical database, knowing how to insert and retrieve data. It’s a specification, NOT a national database.
And here’s what we do with the specification. We establish that patients own their own records. Supposedly they already to but doctors and clinics do a darned good job of keeping us from moving by retaining those records. Under my system we’d take the records away from the health care providers entirely, at the same time relieving them of the need for records clerks and much of their current HIPAA responsibilities.
Then we’d let a thousand databases bloom. Organizations could establish health record databases compliant with the Federal standard but not otherwise subject to Federal control. These databases could be accessed by any authorized medical care provider — authorized by you.
Patients could decide where they’d like their health records to reside, with that service possibly becoming a perk for membership in certain organizations. So you could keep your health records at the National Rifle Association, for example, while I might keep mine at the American Civil Liberties Union (or at Pep Boys, whichever is cheaper). If you are worried about government snooping, trust your records to an organization mortally opposed to government ANYTHING.
Record access becomes a lot like an electronic funds transfer. Banks have spent a lot of money working-out the technical details of giving and denying access to databases with a variety of key systems. You give your doctor access to records of a certain kind for a certain period of time and that’s it. The system ought to work well for everyone.
And it even can be the basis of new types of business. I can see third-party outfits popping-up to parse your records (at YOUR request) to look for likely genetic problems or for past and present medical mistakes concerning multiple prescriptions, bad drug interactions, etc. Here $10 per year could save hundreds — maybe thousands — of not just dollars, but lives.
And what does this record system look like, when you come down to it? It’s the World Wide Web — medical records as a web app. And one thing we know about web apps, as opposed to any kind of medical technology — the price only drops over time.
More to come.