Spending Obama’s billions – lessons for Australia?

Computerworld has published an interview with three health IT leaders canvassing their views on the smartest way to spend the US$20 billion set aside in the recent US economic stimulus bill for implementing a national electronic health record program.

Here are some salient quotes from the interviews:

“The country’s [technology] challenges are larger than that initial $17 billion installment, and that’s what I think it’s going to turn out to be, an installment for electronic medical records and for making the entire health care industry electronic. … it’s a significant amount of money and commitment on the part of any organization …. And I suspect when you get down to smaller individual physician practices, it will be a substantial cost and something that will need continued support from our government. I think it will require the paying model to be changed somewhat to help support that investment over time. There will consistently be need for maintenance.”

“….Health care organizations of all types … need to be able to share information in a variety of ways. Public health programs need to have a communitywide view…. So a patient first goes to a physician and then maybe a hospital, and then maybe to a specialty hospital or long-term care setting, and then back home with home care. We need to connect that continuum of care.

“Secondly, we need flexible approaches. Honestly, there’s no one technology architecture. There’s not one technology portfolio. There are big health systems, and small health systems, health care organizations that are payers and providers combined. There’s public health, which this bill addresses and sees the need for public health organizations to use IT to transform what they do. I think the bill does a nice job of not being too dictatorial. There’s money to support regional and subnational health information exchanges, but that money is available to the broad range of those exchanges out there. It doesn’t say you have to use this architecture or this solution set. That’s a positive thing.”

Should the EHRs be controlled by the patient or the health care organization?

We think in order for this to be successful, it needs to be patient driven, patient controlled. The reason is that if you look at what’s costing so much money in health care today, it’s chronic disease management. Chronic diseases are not something you go to the doctor and get fixed. They’re something you manage over time. To deploy tools that don’t have a patient-centric approach and expect, by automating the physician’s office alone, to see substantial improvements in the cost of care really isn’t that rational.”

What’s the greatest challenge going forward?

“The broader industry, because it’s not connected or integrated, really has an issue with how it gets paid. We pay for care. As long as the industry pays for care, you’re going to get care. Until we think progressively about how to incent physicians’ groups and hospitals around health … to incent people to [live] healthier lives so that care won’t be needed is a real mountain to climb in this industry. The broader industry focuses on the fact that you need to have care provided, so come into my office or let me put you into the hospital. Both of those events cost money these days. I’d prefer it where you don’t need to come into my office and I can get paid for an e-visit. What innovation that would be in this industry.”

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