June 2008

Patient Focused Health Care Reform

Many options to reform healthcare are being offered, e.g. employer and individual mandates, expanding prevention programs, chronic disease management, pay-for-performance, state high-risk pools, primary care networks, association health plans, tax credits/vouchers, expanding Medicare, and on and on.

If any part of this heady list is implemented, the resulting reform can still be improved with a coordinated medical record.

An average person’s healthcare record is scattered among at least 13 different locations. Patients and physicians need to rely on memory, repetition and guesswork at every care site. Fragmentation is a major contributor to the high incidences of misdiagnoses, inappropriate medications, duplication of tests, frequent emergency room visits, unnecessary hospitalizations and fraud.

Coordinating patient records can produce a single, comprehensive, privacy-protected, patient-controlled record which is available every time a patient is seen, no matter where.

Modeling this medical record after the credit card industry, demonstrates the technical feasibility of establishing such a system for our healthcare. The credit card system captures information from numerous disconnected sites, coordinates it in a central location, keeps it secure, and distributes it efficiently at the end of each month.

Of course security, privacy and confidentiality are major concerns. The system must be protected by a first-tier data processing company such as IBM or EDS. These companies are in the business of keeping large amounts of data safe and secure. There is no reason to believe that a coordinated information system will be less secure than the fragmented systems that currently exist.

Some healthcare providers may argue that they already have sophisticated electronic medical record systems. However, it is not that their systems are electronic that is important. Their systems aren’t comprehensively coordinated with all your doctors, your hospitals, your pharmacies, your laboratories and radiology centers, to name a few. Your record must be consistently available anywhere you present for care. Just ask to see your current medical record at any healthcare site. It’s frightening how fragmented it really is.

Some providers may argue that they do not want to share their information with others. However, no healthcare provider has any proprietary information. In the 21st century, patients should have the right to control their own medical record.

From two demonstration projects in Michigan, which created a coordinated healthcare record for about 100,000 patients in each project, the cost of establishing and maintaining the information system was shown to be about 15%, considerably less than the sum total of what was being spent on the numerous fragmented information systems that were currently in use.

Allocating a small portion of that savings to maintain a coordinated medical record, allowed the rest to be used to lower healthcare costs for the individuals paying for care. More individuals can afford care when it costs less. Decreasing healthcare costs also allows the same government programs to cover more people. Data allows us to make better public health decisions as well as identify appropriate healthcare costs for increased savings in the future.

Coordinating our medical records doesn’t require any other change first. We can start with this step. It can, and should, be incorporated into almost any change we devise in the future. In fact, if we get to universal healthcare, we will need a coordinated record in place. Let’s start with it.

–Dr. Lauren O. Florence, MD
President Healthcare Information Initiative of Utah

President’s Message

Pondering our plans to have a “Thomas Paine Day” I had to admit to myself was that I really have not read, I mean really read, much of his writings. I had scanned and read parts of several of his more famous pamphlets and letters, but it isn’t anything you could call thorough. So I am starting that process now, carefully reading everything from The Rights of Man to Common Sense as well as many of his other political writings; some of, his writings on agrarian matters don’t appeal to me very much.

But for the purpose of our “event,” I think Paine can be a point of focus in exploring the beginnings of our nation. While today Darwin and his contributions are attacked and degraded outright, it seems that Thomas Paine has been “shelved,” still there but kind of ignored. I think we need to bring him out of the archives and help put him back where he belongs, alongside the other founding fathers. He stood up to the tyranny of the monarchy and to the tyranny of the church, who were often in cahoots with each other.

Having said that, when one reads his Age of Reason it becomes apparent why the religious didn’t like Paine. In “The Author’s Profession of Faith” in Age of Reason, there is a sentence I like, and one that I’m sure is still upsetting to many: “All national institutions of churches, whether Jewish, Christian, or Turkish, appear to me no other than human inventions set up to terrify and enslave mankind, and monopolize power and profit.”

Rather to the point, and I certainly agree with him. However, I don’t want to get mired down in a debate about religion, except where it is germane to our discussion of separation of church and state or perhaps as part of an exploration of the make up of the early colonies.

However we decide to proceed with a Thomas Paine event, I hope that some of you will think about it and make suggestions. Send us your ideas; we would love to hear from you.

On Thursday, June 12, we will have our first Movie Night (with others planned during the summer). We’ve chosen Monty Python’s The Life of Brian. It will be shown at 7:00 PM. in the little theater in the Student Union Building at the University of Utah. I will bring my decadent popcorn and there will be other goodies to enjoy. Please join us; The Life of Brian is a classic.

–Robert Lane
President, HoU