Health IT and the 2009 Stimulus Package

A Health IT TAG (Technology Association of Georgia) event was held on Thursday March 12th 7:30am until 9am and was well worth the $20 admission price.  A panel of experts provided insight into the stimulus and issues associated with Health IT. On the previous day (March 11th) I also attended a private lecture by a top Georgia Tech professor on the topic of Health care, Health IT, and specifically electronic medical records. These two meetings were both revelations to me that drove home the urgency of why we have to gain control over health care costs in the US and why it has to happen right now and the role played by health IT in our health care system. 

Highlights of the two meetings include: 

Health care costs have been rising much faster than inflation. Today they cost 2.5 trillion and by 2015 will cost 4 trillion, which is the entire GDP of Japan. The US pays far more for health care per person than any other industrial country and yet by all measures we are ranked between 23 and 30 in terms of outcome and quality. So we spend more and get less. Our system of health care can best be described as a complex adaptive system where the various agents attempt to optimize benefits for themselves often at odds with the other agents in the system. In other words nobody is in charge. 

While cost of administration is 30% in private health care insurers it is only 3% in medicare and even less in the Veterans Administration hospital system. 

Today the US government pays around 47% of health care in America and if you crank in tax breaks enjoyed by companies for paying private insurance premiums the government portion is even higher. 

Life expectancy is governed 40% by behavior (smoking, diet, exercise), 30% by genetics, 20% by environment, and 10% by health care delivery. Since the 1970's when life expectancy increased dramatically from 1900 until the mid 1970's average life expectancy has not increased significantly in spite of the inventions of modern medical technologies during this period. 

44,000 to 98,000 Americans die every year from preventable medical mistakes in hospitals. 

Medical knowledge doubles every eight years and there is no requirement for doctors to "keep up" even if it were possible to do so. 

The chance of a doctor prescribing the "best" treatment is 50% and in chronic care only 25% of patients are on the right treatment. 

75% of all health care is to treat chronic disease and 90% of medicare cost is treating chronic disease. Half of all chronic disease is preventable. 

Evidence based practice (EBP) promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments and facilitate cost-effective care.

EBP represents a solution to the problem of prescribing wrong or less than optimal treatment for chronic illness, and provides a scientific basis for ordering tests...versus ordering tests just to save doctor time or as a defense against malpractice. 

The only way to achieve EBP is through the use of electronic medical records. Without electronic records the data to support EBP simply does not exist. 

It is this relationship between EBP, EMRs, and the subsequent improvement to diagnosis and treatment that was my ephiney during these two meetings. Now it all makes sense...the promanent role of Health IT particulary electronic medical records in the stimulus package. 

In other countries with far better healthcare at far lower cost than the USA, penetration of EMR systems is nearly 100% among physicians of all practice sizes. 

Healthcare is literally going to eat our economy if we don't do something to stop it beginning right now, today. Healthcare is the biggest threat to our economic well being in this century. And all evidence points to electroic medical records as a major piece of the solution.