Back on November 20, I attended a seminar at the Reagan Building on how healthcare in the U.S. could be improved through information technology. As an alumnus of the business school, and someone who’d worked in healthcare IT before, I wanted to learn about a part of the healthcare debate that I hadn’t seen much coverage lately. Dr. Ritu Agarwal gave the talk and answered questions during and after her presentation.
The main problem with healthcare in the U.S. could probably be summed up this way:
Despite spending more on healthcare than any other country in the world, our clinical outcomes are no better than in countries that spend far less.
Even more disturbing, of the 30 countries in the OECD, the U.S. has the highest infant mortality rate.
In the past 10 years, premiums for employer-based health insurance have risen 120%. Over the same period, inflation grew 44%, while salaries grew only 29%. So healthcare costs are increasing far faster than inflation (and our ability to pay for it with our salaries).
As far as healthcare IT goes, Dr. Agarwal gave the following reasons for the slow pace of adoption by healthcare providers:
- it’s a public good–patients get the benefits–not the healthcare providers
- lack of common standards
Adding to the inertia point is the fact that healthcare in the U.S. has many stakeholders–patients, medical professionals, hospitals, pharmaceutical companies, insurance companies, and more.
Dr. Agarwal pointed to a number of countries with successful implementations of healthcare IT. They included Canada, Australia, and the United Kingdom. Australia in particular was singled out as being 5-10 years ahead of the U.S.
One thing I didn’t expect was that the Veterans Administration and the Department of Defense would be held up as native models of successful healthcare IT implementations. One key factor noted by one of the other seminar participants was that the VA and DOD systems were closed. Providers, specialists, hospitals, etc were all part of the government. This enables them to enforce standards, in patient records and other areas. Another point I considered later (which didn’t come up in the Q & A) was that the government model is non-profit as well.
Dr. Agarwal’s proposed solution to improving the current state of IT use in healthcare (as I recall it) was an regional exchange model. Healthcare providers in a particular region of the U.S. would choose a standard for electronic health records (EHR) and other protocols. Connections between these regional exchanges would ultimately form a national health information exchange. Building on existing protocols and technologies (instead of attempting to build a national exchange from scratch) would be the most practical choice.
For more information, check out the slides from the presentation.
I live in Indiana, where we have one of the more successful RHIO’s run by Regenstrief Institute. They are actively pushing out open source and open standard software for other institutions and exchanges to pick up.
I’m not sure I completely see the path to healthcare savings via this, but as an engineer the idea of sharing the data is appealing and ‘right’.
In the discussion afterwards, one of the biggest challenges to implementing this is that healthcare companies don’t see the financial benefits. I’ll add a link to Dr. Agarwal’s slides that point out where she sees potential savings.