How to Take American Health Care From Worst to First

Stanley Feld M.D.,FACP,MACE

Billy Beane, Newt Gingrich, and John Kerry wrote an op-ed piece in the New York Times October 24th that brought into focus several fuzzy thoughts I have had about Newt Gingrich and John Kerry’s concept of e-prescriptions and electronic medical records.

My first thought is they do not have an in depth understanding of information technology nor an understanding of medical practice or the medical profession.

Newt Gingrich sounds good sometimes but on close inspection in only sounds good because he picks one aspect of a problem and frames it in a simple solution.

John Kerry has the appearance of being an intellectual but does not understand the complexity of the problem or the mentality of the medical profession.

This op-ed article about electronic medical records demonstrates both these “experts’ ” weaknesses. I refer you to my electronic medical record series of articles.

Electronic Medical Records are a great idea and will save money, increase quality of care (after we define improved quality of care) and avoid medical errors. The great issue is how to execute the implementation of the electronic medical record that is fully functional.

Messer’s Beane, Gingrich and Kerry make a tepid argument comparing baseball’s data driven information revolution to medicine’s need for an information revolution.

“In the past decade, baseball has experienced a data-driven information revolution. Numbers-crunchers now routinely use statistics to put better teams on the field for less money. Our overpriced, underperforming health care system needs a similar revolution.”

There is no argument in the medical profession that we need a robust information technology revolution. In fact the medical profession is slowly evolving toward the goal of information driven medical care. The op-ed authors sound like they have made a revolutionary discovery.

Evidence-based health care would not strip doctors of their decision-making authority nor replace their expertise. Instead, data and evidence should complement a lifetime of experience, so that doctors can deliver the best quality care at the lowest possible cost.

Like most politicians Gingrich and Kerry do not get to the basic questions. The main issue is how can our healthcare system distribute a uniform information software system, at an affordable cost, with an education module that decreases the steepness of the learning curve for physicians? How can the software be compelling to physicians so they will abandon their ineffective software? How can the data produced by the software be rewarding rather than punitive to physicians?

How can the data be a teaching experience to physicians rather than a test of a physician’s ability that could be used to decrease physician reimbursement in an environment of stakeholder mistrust?

Many physicians have invested heavily in electronic medical records only to discover that the electronic medical record they purchased can not be fully functional.

“Another example is Intermountain Healthcare, a nonprofit health-care system in Utah, where 80 percent of the care is based on evidence. Treatment data is collected by electronic medical records. The data is analyzed by researchers, and the best practices are then incorporated into the clinical process, resulting in far better quality care at a cost that is one-third less than the national average. (Disclosure: Intermountain Healthcare is a member of Mr. Gingrich’s organization.)”

I challenge the authors to provide the data that the Intermountain Healthcare electronic medical record is fully functional. I challenge the statement that Intermountain Healthcare has data based evidence of “better quality care at a cost that is one-third less than the national average.” The investment of an EMR started in 2005 by Intermountain Healthcare will be $100 million dollars over ten years. How many clinics can afford $100 million dollars over a ten year time period?

Our healthcare system should have all physicians practicing data driven evidence based medicine. The question is how do you produce a uniform electronic medical record that is fully functional and affordable for all physicians? The authors do not offer a solution. My article on the Ideal Electronic Medical Record offers viable solutions to the problem.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.