“Working in the Dark”
Information technology–used properly and broadly–could help remake the U.S. health-care system. In 2006, the National Academies’ Institute of Medicine (IOM) called for a nationwide health-IT system to help prevent the drug errors that it said injure 1.5 million Americans every year. Electronic prescriptions, the organization argued, could eliminate problems caused by hard-to-read handwriting, and they could be incorporated into systems that would automatically catch physicians’ mistakes. The IOM had previously called for “electronic databases and interfaces” in a 1999 report finding that 44,000 to 98,000 Americans die annually from medical errors of all kinds. Using such technology, it found, could not only prevent fatal mistakes but also ensure that patients aren’t subjected to redundant tests, that they get cancer screenings in time, and that they manage chronic diseases more effectively. Yet progress has been painfully slow: though the number of physicians using electronic records has inched up over the past decade, 83 percent of them still use paper records today.
Besides improving or even saving patients’ lives, electronic records can potentially save money by reducing hospitalizations and eliminating unnecessary procedures, as they did for Sinue. In 2005, a think tank run by Partners HealthCare, the organization formed by Massachusetts General and Brigham and Women’s Hospitals (whose own network of hospitals and physicians uses some of the most advanced electronic-records applications in the nation), estimated that introducing this technology would save $78 billion nationwide.Though subsequent analyses have questioned that figure, nobody disagrees that the $2.3 trillion annual U.S. health-care bill includes staggering levels of waste. “If you ask how much in total medical spending there is in the country that doesn’t need to happen–providing absolutely no clinical benefit–the answer is probably about $700 billion a year,” says David Cutler, an economist at Harvard University and a former health-care advisor to President Obama. “Health-care IT is a fundamental part of getting rid of that. It is not the only important thing. But without information, you’ll never get rid of it.”
To promote effective use of such technology, Congress included huge incentives for health-IT purchases in the stimulus legislation passed earlier this year (see “Can Technology Save the Economy?” May/June 2009). Physicians and hospitals can collect cash–as much as $44,000 over five years for individual doctors, and millions of dollars for hospitals–if they document not only the adoption of electronic records but the “meaningful use” of that technology before 2012. “Meaningful use” is now being defined in detail by the Office of the National Coördinator for Health IT, led by David Blumenthal, a physician and former director of Partners HealthCare’s Institute for Health Policy (see Q&A). Doctors who don’t meet that standard before 2015 will face financial penalties: 1 percent taken from their Medicare fees in the first year, 2 percent in the second, and 3 percent in the third and subsequent years.
The ultimate goal: a privacy-protected Nationwide Health Information Network that would allow medical institutions across the country to exchange patient records. Hardly any of them coöperate in this way today; sharing electronic records between hospitals is a huge step beyond using them within hospitals. While a few robust regional networks have been running for years, they remain geographically limited. “As with electronic medical records, there are a few showcase places, and then there’s the whole rest of the world,” says Bonnie Kaplan, a lecturer in medical informatics at the Yale School of Medicine.
The public-health advantages of an integrated network could be tremendous: huge sets of regional and national data could be analyzed to help researchers to discern optimal treatment strategies, unearth dangerous drug side effects, and give early warning of epidemics and other large-scale problems. But lower-income patients might benefit more directly than any other group. They are more likely to have bounced around among various providers; they suffer disproportionately from chronic health problems such as diabetes, heart disease, and asthma; and they often end up getting primary care at emergency rooms. “Our patients, probably more than other patients, are not as able to advocate for themselves,” says Meg Aranow, the vice president and CIO of BMC. “They may have language issues. And we have cultural barriers, such that people are more or less comfortable talking to another gender or someone who is perceived to be of a different class. There are a ton of communication issues that burden our practice.” Even when such issues don’t arise, doctors or nurses often need records from other hospitals in order to give patients proper care. And today that generally means phoning records clerks and waiting for faxes to come through–a process that can take hours or days.