Thursday, March 18, 2010

How Did We Get Here?

On January 8, 2009 President-elect Barack Obama gave a speech at George Mason University in Virginia, and this is what he said regarding medical records:
"To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized...... This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests...... it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system,"

Reading the President's words, it seems that making all pertinent information available at all points of care would be the holy grail. The means to achieving such lofty goal would be the humble computer, known for its ability to record, aggregate and disperse information of all shapes and forms.

There can be little argument that physicians armed with the most up to date information for the patient before them, would be able to fulfill Mr. Obama's vision of better medicine at lower costs, both financial and human. One could argue that the cost reductions in the form of less duplication of tests and the error reduction inherent in availability of good comprehensive information, are negligible, but it is hard to argue with the superiority of  a comprehensive readily available record over bits and pieces, or nothing at all.

So the HITECH Act was passed, committees were set up, hundreds of pages of rules and regulations were issued, standards and policies were defined in thousands of power point presentations, and billions of dollars were spent, and are yet to be spent, in the process of.....
In the process of what?

To answer this question, let's look at we've done so far and what we are still intent on doing.
  • In the HITECH Act, legislators felt a need to define HOW physicians should use computers in their practice. More accurately, the legislators defined WHO is going to define HOW physicians use computers.
  • The ONC then proceeded to create an infrastructure of talent, rarely seen aggregated in such quantities, to work on the HOW.
  • CMS and ONC finally produced the criteria of WHAT physicians are supposed to do with their computers, the Meaningful Use.
  • Meaningful Use details an array of data points that physicians must record and a much larger array of items where physicians need to crunch all sorts of numbers and report them to the Government, and a few provisions for sharing the recordings with their patients.
  • In order to verify that physicians are not just Meaningfully caring for patients, but also Meaningfully using computers, a sophisticated array of testing labs and certification authorities are being set up to validate that docs everywhere have the right buttons to click on.
  • And for those clinicians who are not capable of deciding if to order a DES or a triple-DES to complement the MI seen tonight, there are financial incentives to order SOMETHING. And they can start small and sample the menu of approved technologies a-la-carte. The incentive prize money can buy lots of Pepto Bismol.
What ever happened to the President's vision that America's computerized records will "remove red tape"?

The President asked us to get from point A - bits of clinical information stored in paper silos, to point B - patient centric comprehensive medical record readily available to all.
We have a cart and we have horses, and we have great desire to undertake the journey.

Unfortunately we hooked the cart of bureaucracy, standards and regulations in front of the mighty horses of just sharing information and coordinating care by any means necessary to benefit the patient.

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