For you and I in the trenches, a user-friendly system would have four add’l huge advantages.
1) Reduce the hassle and reduce the hemorrhage of providers out of healtycare.
2) Reduce both errors and redundancy rates.
3) Improve quality through learning. Large databases to tell us what works & what doesn’t.
4) Improved surveillance of both natural epidemics and potential bioterrorism threats.

As I wrote a while back (www.thesystemmd.com), we need to stop focusing o the difficulties and the immediate cost, and, as Nike constantly exhorts us, “Just Do It!”

PS. For those not in healthcare, please see the section on medical IT in my forthcoming (next month) book titled “Uproot Healthcare.” For the lay person, it explains why medical IT is (as the section is titled) Both Blessing and Curse.

I spent 3 days in the hospital recently and had every expensive test run on me you could imagine. Total cost $45,000. I only had to pay $2700 but the cost could have been much less for all if one of the doctors would have taken my information on medications I was taking and walked through possible side affects. I finally went off the medications on my own, without any doctors advice, and all the symptoms went away. An easy solution and I had to be the one who came up with it.

Bigger is not always better and more care must be taken to avoid higher costs. It appears many health care facilities see dollar signs as soon as an insured person walks through their doors. This needs to be addressed with a heavy hand and controlled. This is the main reason our health care costs have gone through the roof.

Incentives should be aimed at what has been proven to improve care, based on real-world experience. Incenting premature standards (standards in rapidly evolving ecosystems – in this case healthcare AND technology)can thwart innovation.

Solutions available now cost less than $100 / month / physician – and can be commercially viable at lower rates with higher volume – and they improve care.

E-prescribing + Patient Specific Point-of-care Decision Support (paper or electronic office) + Population Registry (performance reporting and outreach – patients who need attention).

Without e-prescribing, the cost is much less.

Incentives exist for using the systems already – Medicare offers a 4% (2% for e-prescribing and 2% for Quality Reporting) bonus in 2009.

For PQRI 2008 DocSite saw an increase in its userbase of small physicians with more than 1000 new physicians signing up in the last 3 months of 2008 — They collected patient specific (evidence driven decision support) data at the point of care, creating a snapshot of provider performance and patient outliers. Additionally participation in the initiative results in submission of the data to CMS for bonus payment.

The same technology, with ongoing clinical use, has improved care at large PHOs (A1c in poor control from 26% to 12% in 3 months); small practices over time (A1c in good control from 42% to 57% in under a year, perfect care from 4% to 8% in 8 months in a community cohort). The system (and others like it) scale across interoperable state system (DocSite is part of the Vermont Blueprint for Health).

In short, simple, evidence driven improvement systems exist, DocSite is only one of them to be sure. Most are web-native, and Semantically interoperable – that is they carry not only the medical data, but also understand the context of the data as it relates to the patient and the clinical workflow.

Spending healthcare economic stimulus resources on simple, effective, affordable healthcare improvement systems can result in a rapid acceleration in HIT adoption and Care Improvement.

The internet is the great connector. Physician practice portals go a long way to enabling exactly this kind of communication and are extraordinarily inexpensive – in fact should almost immediately start reducing overall practice expenses (including the cost of the portal). Even (secure) email alone would be a giant step forward if widely used.

Patients expect and deserve the efficiency, access and immediacy of provider and health system communication – nothing more than the same kind of access they have now to their banks, airlines, other businesses, retail and services including the DMV!

Patients’ and physicians’ interest in viewing records online has increased, since giving patients online access to their own charts is expected to enhance the doctor-patient relationship and reduce healthcare costs.

“The driver for EMR sales has always been hospital-side, as in ‘this can reduce your costs,’” said Bruce Carlson, publisher of Kalorama Information. “That’s still true, but with PHRs, the driver is also on the consumer side, as in ‘this can make your organization seem friendly and modern to healthcare consumers.’”

We need to tackle INTEROPERABILITY head on. This is a NECESSARY prerequisite to getting bang for our health care IT dollars.

I understand this complicates the issue greatly and is not easily understood by Obama staffers and the general public. I understand this will require tackling CCHIT and vendor business model incentives, but there’s no better time than now.