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E-Medicine's Perfect Storm

A look, in numbers, at the forces shaping electronic medicine.
September 7, 2011

A recent video that appeared on YouTube asked: What if air travel worked like health care?

The hilarious answer (here) shows an imaginary traveler attempting to book a flight to Eugene, Oregon, on Air Health Care. Frustration mounts as he’s instead offered a flight to Chicago for $17,885, but only if he first faxes in his “complete flight history.”

There are plenty of reasons that health care isn’t as automated as airline reservations or check processing. Each person’s health situation is, if not unique, immensely personal. Would anyone want to book radiation treatment on a medical Orbitz?

Even so, automating the collection and processing of medical information is a huge opportunity for hospitals and software companies. The U.S. medical establishment has yet to universalize even simple look-ups, such as what drugs a patient is taking, and has only begun to harness such phenomena as cell-phone apps and Web 2.0 trends like crowdsourcing to improve health care.

The first step is to get the data digitized. That means doctors need to switch to electronic medical records (EMRs)—an electronic version of your paper medical record. In countries such as Denmark, nearly all physicians use EMRs already. In the U.S., uptake has lagged, but is now accelerating rapidly.

Source: HHS

By 2014, EMRs—also known as EHRs, or electronic health records—should be nearly universal, according to the Obama administration, which in 2009 put in place the system of financial carrots and sticks that is fueling EMR adoption. The stick: any doctor that doesn’t use EMRs by 2015 will see his or her Medicare payments fall, first by 1 percent and then up to 5 percent. The carrot: more than $40,000 in incentive payments per doc who adopts EMRs.

Although the nearly $27 billion in incentives the government intends to dole out may sound rich, the stimulus looks a lot smaller when compared to the size of government health outlays.

Source: CMS

The next step is for hospitals and doctors to share patient records electronically (instead of by fax), so that your health record can follow you everywhere and be accessible to you and your doctors via the Web. Such data-sharing is still incipient, but could grow extremely rapidly on the back of EMRs, as the data on the next page indicate. 

Source: Surescripts

The figures come from Surescripts, an association of pharmacies and drug-benefit mangers that now permits doctors to order prescriptions electronically, instead of scribbling out a paper order. The data show two things. First, how recently e-prescribing began. Only in 2008 did the numbers become significant enough to track. Second, how rapid the uptake has been. This year, more than one in three drug prescriptions are expected to be written electronically.

Worth noting is that Surescripts—a company few people have heard of—has now become the largest exchanger of medical information in the U.S. That is because its system also queries pharmacies to learn all the medications a patient has purchased in the past. That means it provides doctors with a medication history, letting them know what medicine you take, potentially avoiding dangerous drug reactions. 

In the future, the idea is that doctors will be able exchange not only medication histories, but your entire health-care dossier. Of course, as medical records go online, security is a looming concern. Since 2009, hospitals and doctors have been reporting to the Department of Health and Human Services all thefts or loss of protected patient data (such as Social Security numbers or medication histories) affecting more than 500 people. Consider the following summary of breaches reported in 2010.

Source: HHS

Lost and stolen laptops were a major culprit, followed by lost hard drives and hacker invasions of hospital servers. According to these data, paper seems like a comparatively safe way to store medical records. What’s certain is that if the pace of data loss continues, just about every American can expect to have their health information privacy breached in their lifetime.

According to surveys, hospital executives don’t think they can protect your electronic data, either.             

Percent of hospitals believing they can meet government rules for protecting privacy of electronic medical records: 45 percent                

Source: AHA

Just as with using programs like Facebook, people may simply need to get used to the idea that they are giving up some privacy in order to gain the benefits of having their data connected to a wider network of innovation in health-care software.

Data show that doctors are aggressive consumers of new technology, particularly tablet computers.

American adults who own an iPad: < 8 percent

U.S. doctors who own an iPad: 30 percent

Doctors who plan to buy one in next six months: 28 percent

Sources: Pew Internet, Manhattan Research, Q1 2011

By contrast, consumers aren’t adopting mobile medicine quite so rapidly. While many people use the Internet to research health information (59 percent of adults, according to Pew Internet), far fewer are prepared to accept electronic media as a substitute for a check up with a real doctor. Technology Review found the following data points worth noting.

Percentage of people who don’t want to chat or IM with their doctor: 78 percent

Percentage of people not interested in talking with their doctor over Facebook or Twitter: 84 percent

The odds that a woman wants to chat online with a doctor, compared to a man: +100 percent

Percentage of adults who think online health records will negatively affect their privacy: 49 percent

Sources: Public Policy Polling, Deloitte, CDW            

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