Health Care Rx: New Technology and Creative New Ventures

In an October 11th interview, Senator Debbie Stabenow (D- Minnesota) noted we need to employ new technology to improve our health care system. In a letter I recently shared with the Senator, I emphasized that her comments were right on target and offered the following observations:

-- The health care sector has lagged behind all others in using leading edge technologies to improve operations- vested interests have really not worried too much about costs; these were just passed on to consumers, directly and indirectly.

-- We learned lessons years ago with the e-commerce revolution where companies replaced paper with electronic transactions. Moving from paper to electronic changes processes, creates new way of conducting business, and these are the real benefits. This point has been missed in much of today’s health care dialog.

-- U.S. hospitals are, by all measures, the most expensive in the world. About one-third of all private hospital expenses look like what you may expect in a hotel business – costs for check-in, room service, reservations, meals, cleaning and check out. Years ago I was involved in a major health care study which also reinforced the same points- not much has changed since. Hospital costs are the largest component of health care costs; administration and support costs are a major component of hospital costs- if we set the objective of reducing hospital costs by perhaps 5 percent and with proper incentives, we can achieve real measurable cost benefits. We are far behind the curve and should look at best practices elsewhere. In early 2009, I was invited to participate in an Israeli hospital management company which used Israeli logistics 'best practices' to optimize scheduling for all perioperative procedures to efficiently handle large patient volumes- these same new processes have excellent applications in US hospitals.

-- Within the Senate Finance Committee, the Electronic Health Records ("EHR") issue is being addressed - their April 29th report ("Description of Policy Options: Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs') as you know proposes measuring EHR use by physicians and hospitals with Medicare/Medicaid incentive and penalty payments. The concept of developing a ‘certified’ EHR technology is also proposed. The proposed timetable suggests a 2011 target for a fuzzy concept called 'meaningful EHR usage"- given the magnitude of today's health care challenges, we should all have real concern about the timetable here.

-- I view the April 29th report as a summary of policy options to help 'fix' the system. And there are many exciting technologies beyond EHR that can reshape today's health care system. What is disappointing is the fact this document has 48 pages with only 2 pages addressing 'Health IT' policy options. We really need to pursue some bolder options here if we are to address the depth of problems and capitalize on global best practices.

-- What would help today’s debate is a global benchmarking study to show how innovative publicly directed and funded health programs in countries are making a difference and could serve as a model here. Widely used telemedicine programs in the Scandinavian countries and elsewhere can reduce hospital and assisted living costs- the VA has made some progress here. What is a possible model for the US and what is the cost benefit? Japan years ago

deployed a smart card system to consolidate and streamline records for child care and pregnant women - what is cost benefit here, quality of health care implications and so on? The Israelis have employed advanced techniques to streamline all facets of their health care system. There are many other examples. We need to identify and create awareness on new possibilities here- many of these are 'tops-down', publicly driven options. We can improve our nation's health care system learning from the successful best practices of other global players

-- I believe the administration was caught off guard related to the 'public option' discussion, and is now being charged with developing a bureaucratic, possibly 'socialistic agenda, impacting the current structure with an uneven playing field- we know the arguments here. What could and should have been done in my view, is position the public option as a new vision health care option that would be the foundation for deploying innovative ways to offer, for example, regional telemedicine facilities to provide 'at home' services; focused EHR programs to address seniors as an example; and other national health initiatives. Objective here is to broaden the 'public option' policy from the current position to include " ...objective of serving as a model for developing innovative new health care platforms and service architectures to improve our nation's health care system". I still see opportunity to pursue this new direction though some lead time has been lost.

-- Also missing in today’s health care debate is the need to address health care emergency response and consequence management issues. Much of today's emergency response systems use traditional paper based technology- mandating new techniques, used in other countries, to streamline the processing of emergency care patients can save time, costs and lives and makes sense, yet seems to be ignored. I suggest your staff look over the issues related to the US National Grid (USNG) which is seeking to develop a uniform mapping standard to assist emergency responders- this is one of many challenges in today's disaster response structure. Understanding where assets are currently deployed within a health care network enables us to maximize operating efficiency and improve disaster response. These techniques are available, used in other countries yet not fully embraced in the U.S. When you view assets as medical staff, hospital beds, medical supplies, blood and others, the potential process improvement benefits of these technologies should be clear.