Melvin Young

The potential of HIT to influence the outcome of health reform

Currently, the health care system is in a continual state of technological

innovation. Electronic Health Records have been steadily gaining steam, especially

with the advent of meaningful use. EHRs have been in a constant state of flux,

particularly in the last ten years. At its peak, there were over 1,000 vendors each

selling products which may or may not serve the needs of clients. Now, meaningful

use guidelines are being established, and there are only 300+ EHR vendors left in

America. CCHIT and other certification agencies will allow providers to be certain

the purchased product will have meaningful use capability. A decade ago the

national government was scrambling to set a framework to guide EHR

implementation because of its potential to provide numerous benefits: greater

efficiency, lower cost, and better health outcomes being three of the most

significant. There was little hard data on these potential benefits; unfortunately, this

remains the current state of affairs. It’s actually quite disappointing how few

differences there are when reading and comparing articles on the state of EHRs

from as far back as the early 2000s to 2010. Perhaps now significant progress will

be achievable as the carrot and stick system of EHR implementation and

meaningful use is being established.

In my opinion, the greatest catalyst of change has already arrived with the

government mandate regarding implementation of EHRs with meaningful use as a

quality benchmark. We have already seen the pattern of vendors acquiring other

vendors or going bankrupt without having a viable EHR product. This process will

only accelerate when the U.S. health care system converts from ICD-9-CM to ICD-

10-CM in the year 2013. U.S. based EHR software will finally be capable of being

sold overseas to foreign providers. Likewise, American providers will have the

opportunity to purchase established overseas ICD-10 based systems. This opens

up the market tremendously for the larger more established vendors, helped by the

more advanced state of EHR implementation in many European countries. It will

also allow the larger vendors to gain in affluence and cause a further consolidation

of power. The number of vendors should steadily decrease until there are only

several recognizable names much like the computer OS industry or computer IT

industry.

At this stage, it would be easy to assume that interfaces would exist

between the larger EHR systems, allowing far greater interoperability of information

than we have now. This allows for not only a great improvement in patient care, but

also significant lowering of costs from multiple factors such as less duplication of

tests and better decision making from the increase of information. It will also spur

the establishment of Health Information Exchanges, impacting quality of health on

a population level. One of the greatest hopes of EHR use is the involvement of the

patient in his or her own care whether via patient portals or personal health records.

The assumption is that once patients are more invested in their own care, the issue

of moral hazards will be reduced. Proper health information exchanges will be

required for PHRs and EHRs to populate each other and reach their full potential.

Ideally, a traveler would have direct access to his or her records after a severe

injury, whether across state borders or even overseas.

Something that would be essential for all this to occur would be a dramatic

shift in reimbursement from fee-for-service to fee-for-performance. There have

been many studies that show how doctors react to insurance companies reducing

payments by simply inflating the number of provided services. As an extreme, the

current state of health care can be thought of as a tug of war between insurance

companies and providers. One party tries to cut costs as much as possible at the

possible detriment of health due to insufficient service, while the other tries to

increase profits with the possible detriment of health due to oversupply of services.

One possible way this system could be cleaned up would be via unbiased

scientifically derived clinical decision support systems built into the EHRs. Perhaps

nothing moves the federal government better than a looming crisis, whether

economic or military in nature. Congress tends to be plodding and sluggish until

thrust before an imminent danger; the advent of health care bankrupting the U.S.

economy will assuredly be considered as a crisis. There are multiple projections

showing how Medicaid and Medicare will be bankrupt within the decade. So far,

wealthy special interests groups have prevented the health care delivery system

from moving forward from the self-destructive and administration heavy

fee-for-service system. This coming crisis could force the government to establish

new rules and guidelines for health care reimbursement, centered on a

fee-for-performance system.

Government intervention would likely cause a marked rise in primary care

physicians along with a corresponding drop in specialty physicians, triggering an

overall improvement in health care outcomes along with a decrease in cost.

Several studies illustrate how areas with high ratios of specialty physicians do not

actually have better health outcomes; they only cause an increase in cost. In many

quality metrics the U.S. ranks rather poorly, despite the average cost per citizen

being nearly three times higher than better performing systems. Numerous

universal health care systems with higher quality and lower costs exist in Europe.

The change in focus to primary care physicians would help the U.S. control costs

while improving the quality of care.

In summary, the implementation of Electronic Health Records could trigger a

domino effect, with change spreading across all facets of the current health care

system. From increased government control, strong yet feasible regulations and

guidelines would arise, eliminating the self-inflicted costs from the divergent

interests that plague the current health care system. Consolidation would offer

consistent standards across the entire health care system instead of the current

state of fragmentation. Ultimately this would lead to improvement of care at a

significantly lower cost per citizen as primary care physicians’ rise in importance.

The United States would have a health care system that could serve all its citizens,

instead of one dominated by the diverse interest groups which populate the

industry today and restrict the care offered to those who live in this country.