FRAMINGHAM (10/06/2003) - We must face the reality that 76 million baby boomers are nearing retirement and consider how that will affect the future of health and health care. As the baby boomers age, they will begin to use the health-care system with greater frequency. And they will expect what they have always received: high quality at low cost.
The best way to continue this level of service and improve upon it is by harnessing the power of information technology. Up until now, however, the health-care industry has failed to utilize IT systems that could dramatically improve the safety of health care while lowering overall costs.
As every IT professional knows, the world in which we all live is replete with consumer-based expert systems that are handling millions of transactions every day in real-time. They operate seamlessly and are amazingly accurate. So accurate, in fact, that many consumers no longer get a receipt for their electronic transactions. As an example, look at gasoline purchases. Consumers are so confident that a gas pump anywhere in the country will be so fast that they do not even think about the two seconds it takes for the credit card to turn the pump on. They also believe that that same gas pump is so safe and accurate that they are willing to allow their personal financial information to travel through an electronic network to take money from their personal account. All from a gas pump.
Now, let's contrast that with a health-care system in which sick patients are routinely expected to fill out multiple forms with the same information that they have been asked to fill out numerous times before. A health-care system in which the Institute of Medicine reports that we lose between 44,000 and 96,000 Americans every year due to medical errors--the equivalent of a New York to Washington airline shuttle full of passengers crashing every day, killing everyone on board. Our current health-care system tolerates 2 million hospital-induced illnesses a year. In other words, if you spend more than four days in a hospital, the chances are even money that the hospital will give you a disease that the hospital will then charge you to treat.
Today, there are 18 people in the health-care system for every doctor. Instead of paying the doctor to provide us with health care, we are paying the health insurance company to pay the doctor to pay the clerical people to determine what kind of health care the insurance company believes we are eligible to receive.
There is no reason that an expert electronic system could not verify the services you are eligible to receive while you are still in the doctor's office. It could file claims instantly while sending your prescription electronically to the pharmacist. There is no reason the doctor's office could not print out your "Explanation of Benefits" from your insurer, listing what you were charged for, how much you were charged, how much the insurance paid, and how much you owe. The doctor could then give that to you as you walk out the door. There is no reason why there cannot be a similar printout from the insurance company when the claim is filed so that the patient could pay the doctor for his portion of the bill. All of which would reduce the number of clerical people the doctor and insurance company need to employ.
Computerized order-entry systems also offer enormous potential. Doctors continue to write billions of handwritten prescriptions every year, more than 150 million of which require the pharmacist to call the doctor back for one of three basic reasons: the pharmacist cannot read the writing; the drug is not compatible with another drug the patient is taking; or the pharmacist wants to substitute a drug so that the patient's insurance will cover it. That is an enormous waste of time and resources for an easily correctable problem.
But more important, written prescriptions kill people because errors are going to happen with billions of handwritten prescriptions. Yet, according to a 2002 Harris Survey, even with the technology readily available, only 16 percent of office-based physicians are using electronic prescribing tools, and only 2 percent to 3 percent of the prescriptions dispensed annually are currently processed electronically.
Medication errors contribute to more than 7,000 deaths annually, exceeding those resulting from workplace injuries. Yet we have no OSHA-like response in health care. According to a report by the Institute for Safe Medication Practices, medication errors could be cut by 55 percent if physicians switched to electronic prescriptions. But this is more than a theory. A computerized physician order-entry system at the Metropolitan Hospital Center in New York City helped reduce medication errors by more than 40 percent. Incorrect drug orders fell by 45 percent, and illegible orders all but disappeared.
I served on the Aviation Subcommittee in Congress. If a pilot decided he did not feel like doing a procedure that the Federal Aviation Administration required to ensure a safe flight, that pilot would be grounded. If an airline announced that it had a policy of being "as safe as our quarterly report would permit," the airline would be shut down. Yet we have tolerated this in medicine. Prescriptions should be electronically administered, period. The time for encouraging their use with increased compensation has passed. The number of lives and dollars wasted demand that Congress mandate electronic prescriptions.
As the first giant step toward this mandate, Congress should fund the construction of a sophisticated nationwide real-time IT system as a first responder to a biological attack to connect every pharmacist, every veterinarian, every hospital, every nursing home, and every pharmacy in the country. Creating such an IT backbone for our health-care system is imperative. And once it is built, we should use the system routinely to share information to improve patient care and save millions of health-care dollars by providing every medical professional with access to the latest information on best practices.
Doctors could consult on difficult cases across state lines in real-time by sharing lab results, images and medical history. Moreover, such a system could be used as a platform to create an electronic drug-purchasing system and insurance-purchasing system not unlike the travel sites Expedia or Travelocity. That would rapidly begin a downward pressure on health-care prices.
In order for such a system to work, we should encourage entirely digital environments in doctors' offices and hospitals, like the systems at the Mayo Clinic in Jacksonville, Fla., or the Indiana Heart Hospital. Those systems allow doctors to access, with your permission (or without your permission in an emergency), your complete health history, including any allergies you might have and the medications that you are currently taking. Congress should reward hospitals and doctors for reducing medical mistakes, but in order to do that, we must establish a real system of medical justice. This system might include a health court that would allow medical professionals to report errors while protecting them from predatory litigation.
With all of the information technology available today, we can no longer accept suffering and death because of prescription errors or any other preventable errors.
Seventy-six million baby boomers and their children will demand no less.
What He Thinks About: History, military issues and international affairs, health care issues.
Where He Thinks: He is founder of the Center for Health Transformation.
What He's Written: Saving Lives & Saving Money: Transforming Health and Healthcare.
Where He Is On The Web: His website.
Bio Bit: As a young child, the former Republican Speaker of the House wanted to become a zoo curator. At ten years old, he lobbied the mayor of Harrisburg, Penn., to open a city zoo.