From the day I took a break from my medical practice more than a decade ago to enter public service, I’ve seen two very different technological trends shape American medicine.
On one hand, American clinical medical technology has moved ahead at an astonishing rate. From multimillion-dollar CT scan machines to cheap digital thermometers, new clinical technology helps doctors get their work done more quickly, make better diagnoses and achieve better results. On the other hand, our systems for managing medical information remain far behind the times. Today’s doctors keep records the same way my father did in his medical practice: on paper.
Of all major economic sectors, medicine spends the smallest amount on information technology, just about 3 percent of its revenue. Particularly in emergencies, doctors remain at the mercy of shaken patients or their family for medical histories. This leads to needless, costly testing at best and deadly errors at worst. It misallocates lots of money too: Researchers at Dartmouth College have found America wastes as much as a third of the $1.8 trillion we spend on medical care. By the end of this decade, we will spend nearly 20 percent of our national income on health care, which is up from about 10 percent two decades ago.
Last month, the Institute of Medicine announced thousands still die each year due to easily avoidable drug interaction errors. Without an effective way to track patient care, many fall through the cracks. One study from the University of Michigan and Rand Corp. showed that, on average, patients get only 55 percent of the care experts agree they should. Of course, without good information, there’s almost no way to track which doctors and hospitals do well and which fail their patients. Without better information technology, we will soon face a real health care cost crisis.
But we can avert it. The Veterans Affairs Department hospital system — once widely loathed — has almost entirely turned itself around, thanks largely to a well designed computer system called Vista. When the New England Journal of Medicine used 11 measures to compare VA patients with Medicare patients treated on a fee-for-service basis, the VA’s patients were in better health and received more appropriate treatment, though Medicare-paid care, on average, actually costs more than services from VA hospitals. District-area hospitals have also gotten into the act, developing their own recordkeeping software, Azyxxi, that’s so impressive Microsoft bought it in July.
Even these systems — good as they are — don’t solve medicine’s information problems. For the most part, they can’t share data. As a result, an emergency room doctor in the Medstar Health System’s Georgetown Hospital might have difficulty accessing records on a VA patient who shows up after an automobile accident.
For more than 20 years, the private sector has tried to set standards to make these records interchangeable, interoperable and fully privacy protected. Efforts have never succeeded. The problem goes deeper than the simple need to move files between computers: the technical vocabulary doctors use differs from place to place and, as a result, two doctors might describe the same condition differently. What one doctor calls the “chest” another might call the “thoracic cavity.” It has become clear the government should set standards and get the ball rolling.
Over the last year, I’ve worked with Sens. Michael Enzi, Wyoming Republican, Hillary Clinton, New York Democrat, Ted Kennedy, Massachusetts Democrat, and others to pass Senate legislation to accelerate the process of implementing secure and interoperable electronic medical records.
I am pleased the House approved its own version of an electronic medical records bill last week and I believe Congress will be able to send President Bush a final version of the legislation by the end of the year.
The legislation gives the government the responsibility for helping to set standards, establishes a federal structure to oversee federal health information technology efforts, removes barriers in outdated laws, and includes some modest support for new information technology infrastructure. In addition, it will begin monitoring the quality of care so we can reward doctors and hospitals that provide the best care.
Bringing medicine into the information age will take serious work. But, when we provide secure, privacy protected, interoperable electronic medical records for all Americans who want them, we’ll save money, improve health, and, most importantly, save lives.
Bill Frist, Tennessee Republican, is Senate majority leader.