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TR: You mean lose him or her to a competing hospital.
DB: That's right.
TR: The Institute of Medicine has said that between 44,000 and 98,000 Americans die every year from medical errors of various kinds, and that IT can help. Are patients dying because of a lack of information exchange?
DB: Patients are suffering because necessary information is not available at the point of care. With robust health-information exchange, there can be improved quality of care and improved care coördination. Today, the average 65-year-old with five chronic conditions has 14 doctors and is on multiple medications.
TR: Do any technological barriers, such as conflicting standards, stand in the way of these hospital exchanges? Would we need to give everyone a national health-care ID to properly merge or reconcile their records?
DB: No. I think we have almost all the standards we need, but we have to get people to use them. And we can do this without a single health-care ID.
TR: Why not a single health-care ID? Wouldn't that make things simpler?
DB: We have a big job ahead of us to achieve widespread adoption and meaningful use of electronic records. We can get to where we want to go without a single health-care ID.
TR: Was the changeover to electronic records difficult for you personally?
DB: At some time over the last 10 years, I was basically required to use electronic records. I learned it gradually over time. As I got more capable, I became increasingly convinced of its value in clinical care. It was making me a better physician.
TR: How, for example?
DB: A couple of years ago, I saw a patient with a urinary-tract infection. I entered the order for Bactrim [a sulfa drug] on my computerized physician-order-entry system--and a warning came up saying this patient is allergic to sulfa. I am sure in the paper record there was a record of that, but it's often easy to overlook things in a voluminous paper record. That kind of gain, repeated hundreds of thousands of times across the country, can result in real improvements in care.
EHR is a step in the right direction
I'm glad to see that we have someone focused on trying to get the healthcare industry moving toward providing doctors and other healthcare providers with the information they need to do their job more effectively. The article last week in TR http://www.technologyreview.com/computing/23545/?nlid=2443 points up the need to have the right information available at the point of service. It's not only a cost issue, but also a patient care issue.
There is also an article in Newsweek http://www.newsweek.com/id/218235 that illustrates the need for more publicly available outcomes research so that the patient can work with their physician to determine the best course of treatment for an ailment.
I wish Dr Blumenthal all the luck in the world - he will need it to cut the Gordian knot in healthcare information sharing.
Hmmm..
"there has never been a business case for information exchange"
But spending $21 billion of taxpayer dollars to save $12 billion over 10 years makes total business sense ???
The interview states that the average 65 year old with 5 chronic conditions has 14 doctors and multiple prescriptions. I believe this statistic is reversed.
People 65-69 years old on average have five chronic conditions and take 14 medications. They might have multiple doctors, but probably not 14. See "Textbook of Therapeutics: Drug and Disease Management", pg. 1830
Thanks for the comment. My colleague Matt Mahoney, our research editor, reports that a passage in a NEJM paper very closely matches the facts as stated by David Blumenthal. We're checking further into this, but meantime here is the passage:
"Any policymaker who is considering the modernization of Medicare must recognize that the 23 percent of beneficiaries with five or more chronic conditions account for 68 percent of the program’s spending. In addition, the treatment of these beneficiaries is likely to remain a high-cost item until they die, since every year they see an average of 13 physicians and fill an average of 50 prescriptions."
Gerard Anderson, "Medicare and Chronic Conditions," NEJM July 21, 2005
The question about the need for a single medical id was a good one. I've worked in the Health IT field far longer than that name has existed and specifically been involved in integrating EHRs and ancillary systems like Pharmacy and Lab for over fifteen years. Nothing is more crucial than having a common ID and processes for merging data together for the right person. As I look ahead to the challenges for a National Health IT I see the lack of a single medical ID as a very sizable achilles heel that will be faced by all architects and systems analysts that have to solve the same problem. Without a single medical id you are left with patient demographic data (e.g. address and human mediation.) That alone will create large numbers of errors and patient safety problems. Unfortunately, there are not many vendors or health care providers who fully appreciate the size of this problem because they lack the longitudinal experience.
I agree completely the single medical ID is critical point. Further however, is the question of the authentication to the network and individual records to ensure 1)the person accessing the information is authorized and 2)they pull-up the proper record. The last thing anyone wants is to have someone else's information in our medical record. In other countries smart cards are issued to both patients and healthcare professionals to manage records. It would be helpful if Blumenthal would look at theose systems.
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The Big Picture
Federal funding may be encouraging a move toward EHR, but there's more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=1499
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