Using electronic health records, in combination with data mining and search technology, would make this kind of analysis much easier. Patients who fit specific criteria could be identified and tracked automatically, for example. Researchers would be able to analyze larger numbers of patients and a wider variety of treatments. With easy access to this kind of information, wasteful spending could be identified more readily, allowing payers, whether Medicare or private insurers, to stop reimbursing for expensive but unnecessary tests and procedures.
An even bigger threat to the sickness industry’s business model is that by allowing automated tracking of patients over time, electronic health records would set the stage for early detection and preventive medicine. Currently, the entire industry is organized around treating sickness, rather than keeping people healthy in the first place. Three-quarters of health-care spending is devoted to chronic care, but the National Cancer Institute and the Centers for Disease Control and Prevention allot just 12 percent of their budgets to research on early detection. Moreover, the payment system is structured around reimbursement for treatment rather than prevention.
With widespread use of electronic health records, it would be easier to expand preventive medicine, not only by educating patients about lifestyle changes but also by conducting mass screenings. A recent American Cancer Society study concludes that prevention, early detection, and better treatment decreased cancer death rates between 1990 and 2005 by 19 percent for men and 11 percent for women. I would like to see funding for technologies that could ultimately improve early detection. Studies are now being launched on CT scans that can evaluate a patient’s heart in less than one heartbeat. They produce finer resolution than existing technologies and return fewer false positives. These tests cost $1,000 now, but within five years, thanks to expected advances in computing power, we should see a $200 CT scan to detect heart disease before a heart attack.
The ability to detect cancer early enough and cheaply enough for effective treatment would prove much more cost effective than the current approach, which involves spending hundreds of thousands of dollars to extend the life of a cancer patient for a few months–generally, with low quality of life.
As valuable as electronic health records are for streamlining costs, their biggest contribution will lie in moving medicine toward early detection. Let’s hope that the adoption of this screening technology is not postponed as long as electronic medical records have been, in a misplaced desire to protect the lucrative status quo. Like all good technology, it’s probably going to get off the ground on the grassroots level. Expect your local Walgreens to promote these tests sooner than your doctor does.
Andy Kessler is a Wall Street analyst turned author, most recently of The End of Medicine.