Wednesday, December 23, 2009

Just finished a long comment on a health care discussion in LinkedIn: click here while you can.
That link won't last so I wanted to document my portion of the discussion which I think makes sense without the rest of the discussion. I've included a blockquote on the one section that I think you need to see to l make sense. Healthcare is something that we all need to work on since our government appears to be dropping the ball.

1) With regard to Electronic Health Records, I think that the lack of standards within the medical community is the biggest obstacle to its adoption. With the exception of my childrens' pediatricians, every doctor I visit is still recording health information on paper because the data entry aspect is not worthwhile to them. It's quick and easy to write out a variety of types of information on paper. Computer entry would result in too much time spent in order to pick the "right" box.

The Pediatricians on the other hand have measurable data points that they want to show to the parents and can easily using the software. Prescriptions are also easily entered and attached to the files so they can keep track of how much medicine is being assigned (not given, that's up to the parent) to the child. And this information leads to a perception of quality in the mommy networks that feed the pediatricians new patients.

Unfortunately until there is another way to measure health care beyond individual services, this will not change. Docs get paid for the service, not the data they record. And insurance companies will not pay for recording information, except as parts of pilot programs or where a Hospital is the insurer and they need the information for their own records.

I worked for an insurance company that was working on risk adjusted payment systems based on episodes of care. In the next generation of the software, we would have worked toward including additional information (such as lab results) to insure that the doctors were working within best practices, but the company decided to shut down the program because they could not figure out how to explain it to their core type of customer.

What healthcare needs is a total makeover. It should be turned into a system. That would certainly be nice. But it’s not going to happen. Let’s face it. There are too many political and social obstacles to deploy centralized planning throughout the entire healthcare industry.

So here’s a fallback position: Simply offer a parallel approach to what we have now. That would be a “public option” for healthcare delivery. It would be available to anyone who wants it. Unlike the existing approach to healthcare, users of The Public Healthcare System would not be able to visit care providers whenever they want. They would have to go through a triage process, entering their symptoms and other relevant information over the Internet or at a kiosk. And, of course, everything would be documented in an electronic health record.

These data would be evaluated by trained humans and/or intelligent software, to decide the most cost-effective course of action for each patient. Perhaps self-care is indicated and would therefore be guided. Or maybe some lab tests should be administered before the patient wastes a doctor visit just to get those tests requisitioned. Sometimes a nurse practitioner would be best positioned to handle the episode. Or the problem is beyond the scope of any primary care provider; so the patient should go directly to the appropriate specialist.

2) With regard to Health care, the "public option" parallel described by Joe W. is exactly the type of system that seems reasonable, but the political wings of the government would swoop down as "evil, socialized medicine". Removal of human elements, leads to a "harsher face" of health care that the majority of Americans would feel is substandard.

Professional services tend to be the last place for technology to penetrate. Even though we might use a kiosk to order our deli meats; the idea of giving basic health information to a machine before we could see a doctor or nurse would be a deal breaker.

I agree that triage is needed where health resources are limited, but the limiting nature of using triage when there is no perception of limited resources is not politically feasible.

"Unlike the existing approach to healthcare, users of The Public Healthcare System would not be able to visit care providers whenever they want." This would be the single largest sticking point. This is what HMOs tried to do. They failed. Miserably. People in the US feel that it is their right, to go to whoever they want and this is the core issue in the healthcare debate. Large insurance companies continuously make the statement that free choice of providers leads to higher premiums. This is simple and unfortunately true. Providers charge whatever the market will bear and when someone is sick they will pay just about anything to get better. The only market that was more predatory in my opinion was the funeral business. At least with regard the funerals, you actually can shop around before you need the services, even though most do not.

Standards of care and collection of data need to happen. We all agree on that. We just can't agree on what they should be. Yet.