"A Computer Never Healed Anyone"

"Health information technology is just another way for consultants to make money, after all, a computer never healed anyone."

Those are the sentiments I've read and heard from some skeptical physicians. While it's true that a computer never healed a person of its own volition, I do believe that health information technology can play an important role in improving outcomes.

Now, there's another piece of evidence supporting that belief. A study released this month by the Integrated Healthcare Association (IHA) suggests that there is a positive relationship between adoption and use of information technology in physician-hospital organizations (PHOs) and the quality of care delivered to patients.

The study assigned a score to PHOs and their adoption of HIT, and those PHOs with the highest scores had a statistically significant correlation to improved quality of care. A picture of the key chart is in this post above.

The executive summary of the report can be found here, and the data supporting the summary can be found here.

By the way, my response to the HIT-skeptical physican has been, "and neither has a telephone, but do you think the phone has helped outcomes and quality of care?"

Things Are Looking Up

So, the Conference Board released their August report on economic indicators today and things are indeed looking up.

The big news isn't that the leading indicators are trending upward, though that is certainly good news. The big news is that the concurrent index (i.e., indicators of activity going on right now) have flattened for the first time since October 2008.

This could mean that the negative economic conditions have bottomed out, and because the leading indicators are trending up we could see current conditions begin to trend upward next month.

The original publication is here, and a PDF version is here. Pay close attention to the graph in the PDF, it's pretty illustrative of why can be at least a little optimistic.

A Working Alternative

I don't usually do this in my blog, so forgive me for letting the lazy days of summertime get to me and give you a link to read with little added content or analysis.

I read a good Op/Ed piece in the Wall Street Journal this morning written by the CEO of everyone's favorite organic/health food chain, Whole Foods. It's an excellent, comprehensive set of practical proposals that if taken in their entirety (not piecemeal) could actually make a positive change and produce meaningful healthcare reform.

The link is here.

Pay close attention at the end to the real experience Whole Foods has had in the other countries where they do business and employ people. What have employees in countries where healthcare "is a right" asked for from Whole Foods in terms of their healthcare?

What is a PHR Anyway?

The problem: a caregiver needs to know your medical history, but your patient records are scattered with many individual providers. Your dermatologist has some of your medication history and knows you have an allergic reaction to penicillin. Your urologist has the lab results from a creatinine test done on your blood from a year ago. And your primary care physician has a ten-year history of your weight, vitals, and overall health.

How do you bring them together? (Other than with a hailstorm of faxes?)

Enter the PHR, the personal health record. The PHR takes a step to address this problem by creating a place for all your medical history (allergies, medications, encounters, etc.) to be stored. Best of all, you own it and manage it. Many products (Google Health, Microsoft HealthVault, etc.) are being raced to market in the hopes of being the place where you deposit this information. Let's face it, the first place you put it will probably be the place your history stays since you won't want to move your information once you put it there.

An important feature of a PHR allows you to grant access to caregivers not only to view your health information, but also to add to it in a structured fashion. The information systems that your hospital, your physician, and your other caregivers use (such as Epic, Meditech, eClinicalWorks, GE Centricity, etc.) will have interfaces to your PHR to do this, or will through a health information exchange (HIE). The individual contributions of each of these providers will accumulate in your PHR and form a much more complete picture of our medical histories.

In my opinion, putting the right information in the hands of your caregivers is the best use of information technology for improving the health of people, and for improving outcomes.

Can We Be Friends?

Quick sidebar: Economist Arthur Laffer (of the famous Laffer Curve) wrote an editorial in the WSJ this morning that makes a similar argument as I did in this blog for stripping the insulation from healthcare costs (he calls it the "healthcare wedge") that may be an alternative to the current plans being offered for healthcare reform. He argues the point more eloquently than I did, though. Check it out!

It's no secret that most Americans have a deep mistrust of their health insurance company. We firmly believe that it's in the company's best interest to take as much as the market will bear from us in terms of monthly premiums, and give as little as possible in the way of payments when we seek care.

But what if there was a way that our insurance companies could cut costs, and we could be truly, genuinely be healthier because of our relationship with said evil company?

I think there's a way to do it, and it's through predictive analytics.

Health insurance companies have a wealth of historical information about subscribers in the form of claims data. Every time I go to the doctor, or have a test done, or see a specialist, my healthcare professional would like to get paid for their services, and so they file a claim with my insurance company.

Over time, the millions of claims being filed by healthcare professionals for services performed on all of us becomes a treasure trove of data for analysis. Each one of those claims is coded with certain pieces of information, and something that's present on every claim is an element called a "service type code", or in other words "what kind service did I perform on the patient?"

Imagine if we performed an analysis on the dates of service and service type codes and found a statistically significant pattern of claims that looked like this:

Patient: Male, age >55, smoker, BMI >28.7
Claim 1, Day 1: Office visit
Claim 2, Day 3: Lipid profile
Claim 3, Day 30: Office visit
Claim 4, Day 35: Emergency room admission, heart attack

This is a simplification, but it's to illustrate a point. If this pattern had predictive power, wouldn't it be a great win for both the patient AND his insurance company if they made a call to his doctor on day 31 saying, "we've noticed that your patient has just fallen into our high-risk profile for heart attack in the immediate future. Please make a wellness outreach and begin an immediate statin and anticoagulant regimen if appropriate." (This assumes healthcare professionals get paid for proactive outreach, which is a topic for another day.)

I know I'd appreciate not having the heart attack, and certainly the health insurance company would like to avoid paying the tens of thousands of dollars it would cost to save my life. I benefit, and they benefit.

If this were done for all of us, we might have more reasons to like our health insurance companies!

Stripping the Insulation from Healthcare

First, a shameless plug for my suggestion to reform Medicare first before asking the American people for more responsibility: Peggy Noonan, an editorial writer for the Wall Street Journal makes the same suggestion,in the ghostly form of FDR, in her weekly Declarations column on August 1, 2009. Maybe I'm not crazy after all!? Link here.

So, in my previous blog entries, I wrote that by making consumers and providers more aware of the real cost of care, we would take a step towards reforming the system. In this entry I will walk through a very simplified ripple effect of how it might work.

• People know the cost of their care (e.g., my angioplasty costs $7500)
• People pay more up-front for their care with Medicare's new high deductables (e.g., I pay $5000 out of pocket for that angioplasty. Ouch!)
• More physicians get paid more directly, and more quickly (claims have a lot of friction, cash is immediate and transparent)
• More physicians want to take Medicare patients into their practice (now Medicare pays well, and quickly)
• Brief tangent: as a whole, reimbursement rates for healthcare professionals usually do not cover the cost of care. For example, the doctor incurs 100% of the cost of your checkup, and your insurance company decided that 60% of that amount is "reasonable". This leads physicians to be tempted to "cost shift" and perform services that have higher reimbursement rates in order to cover what they should have been paid in the first place. How would you feel if the government declared that you were being paid 40% too much for your job?
• Over time, more med students and RNs go into primary care to get paid Medicare's higher reimbursements instead of the current trend of more students and RNs fleeing into higher-paid specialties.
• As supply of primary care physicians increases, prices decline, quality increases (simple elasticity of supply)
• As Americans realize cost of care, they proactively take better care of themselves, use services less, pay smaller premiums and copays (simple elasticity of demand)

In the end we have more docs, willing to provide more care, at lower cost, higher quality, and healthier Americans. No, this is not a silver bullet (this is) and there are many other pieces to the puzzle, such as policy changes in subsidies that make unhealthy food cheaper than healthy food, and the inevitable cultural angst we will feel with changing from conspicuous consumption to consumption with integrity. In other words, if you exercise your freedom to engage in unhealthy behavior, you have the integrity to exercise your freedom to pay for it.

And as an old friend of mine mentioned, this plan should not include people with congenital illnesses or genetic causes to what ails them. I do believe we are a fair, generous, and compassionate nation, but if we are to take good care of the people who truly need it, we must take better care of ourselves first with better information and better choices. We are insulated from the cost of care, and strippling that insulation away might yield some unexpectedly positive results.