In their WSJ article, Stephen Soumerai and Ross Koppel point out that physicians and hospitals have spent billions of dollars on costly healthcare information technologies and have not realized benefits of these expenses. While everything they are saying is mostly accurate, I believe they are missing the bigger picture. Meaningful Use stage one is not about direct savings. Instead, this is building the stage for real reform down the road.
When I was in college, my bank installed an Automated Teller Machine (ATM). I walked to the front door of my bank, inserted a card, entered a PIN, and retrieved my own cash. I had access to a single machine that was physically attached to a single branch of my bank. At that time, this was remarkable technology. Today, I can withdraw money out of any machine all over the world. This is an elegant solution with relatively simple data and it took us nearly 30 years to get there.
When it comes to sharing patient information, The US healthcare system is where the banking industry was thirty years ago. Many of those creating patient chart data do this on paper or electronically within the confines of their local office. Hopefully we will see this information available anywhere, anytime to people who have the PIN in far less than thirty years. Let’s explore the evolution.
Earlier in my career, I designed electronic medical record software for one of the largest EHR vendors. We believed our database was a great competitive advantage. This was for several reasons. First the schema was optimized for patient records and ours was better than all others on the market. Second, our customers would have to spend a lot of time and money to migrate all this data from our solution to a competing solution, so we had created a mini-monopoly with each account based on the difficulty of moving all this data. All our competition thought the same way. Because of the competition, the problem has little chance of correction without outside intervention.
The HITECH Act and Meaningful Use stage one are about moving a lot of physicians from paper to online. The goal here isn’t to realize an immediate improvement in outcomes, but to lay the foundation for these improvements. Stage two is released and, guest what, it builds the walls. Meaningful Use stage two is about moving this data out of the physicians’ offices and hospitals and making it available electronically to patients who can then transport it to other physicians and hospitals in a format that can be readily consumed. Stage three is over the horizon, but I guess it will expand on making patient data ubiquitous.
Everything the authors of the article say is accurate, but I am convinced there is a much bigger picture they are not showing. In short, the industry will find ways to share highly complex data in far less than thirty years. Only then will we see the costs savings, health improvements and benefits. This is a drastic change over the current process. Drastic change has a lot of speed bumps. Drastic change takes time. Drastic change often hurts.
