- The Washington Times - Friday, February 20, 2009




What if your airline pilot announced he would forgo the designated flight plan in favor of a route plotted on fold-out maps? Would you feel safe knowing the integrated information, navigation, weather and communication systems that successfully coordinate thousands of flights each day had been turned off? If the suggestions seem preposterous, ask yourself why we accept this approach in health care.

The majority of care delivered today is coordinated via handwritten paper medical records sent amongst physician offices and hospitals. And far too often, physicians rely on a medical history recalled from the patient’s own memory to design an appropriate treatment “flight plan.” With chronic conditions affecting nearly half of Americans, medical errors resulting in thousands of unnecessary deaths and excess costs, and our system’s failure to provide the best available care nearly 50 percent of the time, this patchwork system of health information exchange cannot, and will not support the required transformation of U.S. health care.

Our country must invest in a health information system that delivers a patient’s complete health record at the point-of-care to guide better-informed decision-making by physicians and patients.

The Obama administration and Congress have acknowledged a health information technology gap through the HITECH Act, a $20 billion health information technology investment included in the economic recovery package. Yet much of the dialogue in Washington surrounding how to spend these dollars has centered on digitizing physician office records to create electronic medical records. Revitalizing our economy through health information technology, however, will take more than converting paper file cabinets to electronic ones. Simply, an electronic medical record in the absence of connectivity and sharing of clinical knowledge, is a bridge to nowhere.

With an aging population and rapidly increasing shortage of primary care physicians, electronic medical records and other efforts that improve the office efficiency of solo or small group physician practices should certainly be applauded. These practices typically cannot afford to make the investments in health information technology made by larger integrated medical groups. Yet, while research has demonstrated electronic medical record use can result in administrative efficiency, greater billing accuracy, and a reduced risk of malpractice claims, other studies found stand-alone electronic medical records do not improve the quality of care for chronic conditions, and may actually perpetuate medical errors and increase costs.

To realize the true health-care quality, safety and efficiency benefits of health information technology, the HITECH Act investment must reach beyond individual physicians’ offices. Investments must require combining a patient’s medical, pharmacy and laboratory information and deploying this integrated health record to the patient, her physicians, hospitals, and the entire care team. Research has projected this type of “informed” health information technology system could save more than $160 billion annually.

In Dayton, Ohio, WellPoint members have experienced the benefits of integrated health information technology firsthand. Patients can view their combined medical claims, pharmacy, laboratory and physician chart records online. A primary care physician treating a patient with heart disease is able to view examination notes and lab results from her patient’s cardiologist. An emergency room physician can access a patient’s prescription drug history in real-time, avoiding the dangerous guesswork based on his patient’s description of the color and shape of pills. Patients with diabetes and asthma can receive actionable messages and reminders to obtain recommended care.

These, and additional successful models advanced by integrated health-care delivery systems such as Kaiser and Geisinger, all share a common theme: integrated data-sharing and connectivity promote health-care quality and safety.

While digitizing physician offices can provide some efficiencies, electronic medical records represent only a first step toward improving health-care quality and reducing health care costs.

The HITECH Act investment must connect physicians, patients and health information to better inform health care decisions - at the hospital, in the emergency room and in physician offices across the country. Fueled by clinical knowledge, this investment can prevent adverse drug events and unnecessary medical services, promote improved chronic illness care, support improved prevention, and achieve billions in health-care savings.

Sam Nussbaum, M.D., is executive vice president for clinical health policy and chief medical officer at WellPoint Inc. Charles Kennedy, M.D., is vice president for health information technology at WellPoint.

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