Rx for a Sick System Leverage Health IT to Improve and Extend Care
Robert Pearl, MD, has a story about a follow-up conversation with his adult daughter after encouraging her to consult a physician about a seemingly minor problem she had been experiencing with one of her fingers. “She said she had taken my advice,” notes Pearl, who serves as CEO of The Permanente Medical Group. “I answered that I was happy to hear that, and asked her which doctor she had seen. She told me that she hadn’t actually made a visit, but instead had had a consultation via computer and that everything was fine.”
Addressing attendees of The 8th Annual Health Care Congress, December 5-6, Anaheim, California, Pearl deems the application of information technology in this and many other fashions a key antidote to disaster where the U.S. health care system is concerned. “Our current system resembles a 19th-century cottage industry,” he asserts. “It is fragmented, with a base of individual, unconnected physicians. It is one in which high volume, rather than the quality of care, is rewarded; everything other than claims is paper-based; and leadership is minimal at best.”What is the best way to incent physicians to engage with patients electronically?By contrast, Pearl notes, other market segments not only have embraced information technology on many levels, but also are leveraging it for the benefit of all constituents. He cites as an example the banking sector, whose infrastructure enables an individual arriving from the United States one evening at an airport in South America to utilize any automatic teller machine to immediately access his or her bank balance, as well as to withdraw cash.
“Compare that with the person who walks into an emergency room on a Saturday night with chest pains,” Pearl states. “Here, it would not be unusual for the hospital staff to be unable to review previous EKG readings from the doctor’s office until Monday (increasing health care costs and, potentially, endangering the patient). Why do we provide so much less to patients than banks do?”
Leveraging IT
Pearl believes that only a combination of tightly integrated information technology and widely delivered preventive services can prevent the U.S. medical system from becoming a two-tiered one in which the rich receive a high caliber of care and the remainder of the population, a radically different one. He concedes that although the health care currently accessible by the poor is better than that offered during the 19th century, the situation could become worse if it remains unaddressed.
“I'm talking about a system where the middle class gets less and less, [with] higher and higher deductibles, until there's rationing as the solution to the American health care crisis,” Pearl says. “Once that happens, we'll never go back. Today is the last great hope … for American medicine."
Pearl shares several examples of radical, positive changes that could be effected through the adoption of electronic health records (EHRs), naming a reduction in the volume of heart attacks and strokes suffered annually to the top of the list. Kaiser Permanente physicians, he says, exercise such preventive measures as administering beta-blockers and statins to patients whose condition warrants it. Kaiser’s EHR system is the lynchpin for coordinating these regimens.
Were EHRs and associated information technology harnessed to afford every American an identical extent of preventive services, Pearl asserts, there would be 200,000 fewer incidences of heart attacks and strokes in the United States annually, citing a study¹ that appeared in the June 2010 issue of the New England Journal of Medicine. The study found that the number of heart attacks occurring among Kaiser patients decreased by about 25% between 1999 and 2008, in part as a result of the preventive strategies and EHR usage Pearl describes.
A reduction in mortality rates among sepsis patients constitutes another example, according to Pearl. In many instances, he notes, young patients develop septic shock because a lack of access to their complete medical history prevents an emergency department physician from recognizing an unapparent condition that really requires aggressive treatment.
“Consider an infected kidney stone,” he elaborates. “With information technology, the information would be at hand, coordinating tests could be ordered immediately, the condition could be identified, and aggressive treatment could begin immediately rather than in a few days or even weeks—enough time to land the person in the ICU in a potentially life-threatening situation. With information technology, we’re looking at a 30% lower mortality rate, and cost savings in the tens of billions.”
Reducing Radmissions
Hospital readmissions, too, would decrease precipitously given a dose of EHRs and physicians’ use of mobile devices to manage care, Pearl contends. Kaiser has seen a 43% decrease in readmission rates because everyone caring for patients maintains access to the same information and updates it where applicable, he says.
Pearl also foresees video and e-mail as playing a role in health care delivery going forward, in turn bolstering the caliber of patient care and adding valuable layers of cost control. At Kaiser, dermatologists monitor the progress of teenagers whose acne is being treated with Accutane through teleconferences with the youngsters. Each conference requires just a few minutes of physician time, need not be scheduled weeks in advance, is more convenient for patients, and is sufficient to ensure that the treatment is working and the acknowledged side effect of depression is not setting in, Pearl claims.
As for e-mail, Kaiser now receives about five to six secure e-mails per year from the average patient. Were this mode of patient/provider communication to become widespread, the U.S. health care system could save several billion dollars, Pearl believes.
However, he cautions, the transformation will not be automatic. "It won’t happen, unless we're able to change the structure, change the financing, and put in place leadership structure to make it so.”Julie Ritzer Ross is a contributing writer for HealthCXO.
Addressing attendees of The 8th Annual Health Care Congress, December 5-6, Anaheim, California, Pearl deems the application of information technology in this and many other fashions a key antidote to disaster where the U.S. health care system is concerned. “Our current system resembles a 19th-century cottage industry,” he asserts. “It is fragmented, with a base of individual, unconnected physicians. It is one in which high volume, rather than the quality of care, is rewarded; everything other than claims is paper-based; and leadership is minimal at best.”What is the best way to incent physicians to engage with patients electronically?By contrast, Pearl notes, other market segments not only have embraced information technology on many levels, but also are leveraging it for the benefit of all constituents. He cites as an example the banking sector, whose infrastructure enables an individual arriving from the United States one evening at an airport in South America to utilize any automatic teller machine to immediately access his or her bank balance, as well as to withdraw cash.
“Compare that with the person who walks into an emergency room on a Saturday night with chest pains,” Pearl states. “Here, it would not be unusual for the hospital staff to be unable to review previous EKG readings from the doctor’s office until Monday (increasing health care costs and, potentially, endangering the patient). Why do we provide so much less to patients than banks do?”
Leveraging IT
Pearl believes that only a combination of tightly integrated information technology and widely delivered preventive services can prevent the U.S. medical system from becoming a two-tiered one in which the rich receive a high caliber of care and the remainder of the population, a radically different one. He concedes that although the health care currently accessible by the poor is better than that offered during the 19th century, the situation could become worse if it remains unaddressed.
“I'm talking about a system where the middle class gets less and less, [with] higher and higher deductibles, until there's rationing as the solution to the American health care crisis,” Pearl says. “Once that happens, we'll never go back. Today is the last great hope … for American medicine."
Pearl shares several examples of radical, positive changes that could be effected through the adoption of electronic health records (EHRs), naming a reduction in the volume of heart attacks and strokes suffered annually to the top of the list. Kaiser Permanente physicians, he says, exercise such preventive measures as administering beta-blockers and statins to patients whose condition warrants it. Kaiser’s EHR system is the lynchpin for coordinating these regimens.
Were EHRs and associated information technology harnessed to afford every American an identical extent of preventive services, Pearl asserts, there would be 200,000 fewer incidences of heart attacks and strokes in the United States annually, citing a study¹ that appeared in the June 2010 issue of the New England Journal of Medicine. The study found that the number of heart attacks occurring among Kaiser patients decreased by about 25% between 1999 and 2008, in part as a result of the preventive strategies and EHR usage Pearl describes.
A reduction in mortality rates among sepsis patients constitutes another example, according to Pearl. In many instances, he notes, young patients develop septic shock because a lack of access to their complete medical history prevents an emergency department physician from recognizing an unapparent condition that really requires aggressive treatment.
“Consider an infected kidney stone,” he elaborates. “With information technology, the information would be at hand, coordinating tests could be ordered immediately, the condition could be identified, and aggressive treatment could begin immediately rather than in a few days or even weeks—enough time to land the person in the ICU in a potentially life-threatening situation. With information technology, we’re looking at a 30% lower mortality rate, and cost savings in the tens of billions.”
Reducing Radmissions
Hospital readmissions, too, would decrease precipitously given a dose of EHRs and physicians’ use of mobile devices to manage care, Pearl contends. Kaiser has seen a 43% decrease in readmission rates because everyone caring for patients maintains access to the same information and updates it where applicable, he says.
Pearl also foresees video and e-mail as playing a role in health care delivery going forward, in turn bolstering the caliber of patient care and adding valuable layers of cost control. At Kaiser, dermatologists monitor the progress of teenagers whose acne is being treated with Accutane through teleconferences with the youngsters. Each conference requires just a few minutes of physician time, need not be scheduled weeks in advance, is more convenient for patients, and is sufficient to ensure that the treatment is working and the acknowledged side effect of depression is not setting in, Pearl claims.
As for e-mail, Kaiser now receives about five to six secure e-mails per year from the average patient. Were this mode of patient/provider communication to become widespread, the U.S. health care system could save several billion dollars, Pearl believes.
However, he cautions, the transformation will not be automatic. "It won’t happen, unless we're able to change the structure, change the financing, and put in place leadership structure to make it so.”Julie Ritzer Ross is a contributing writer for HealthCXO.