Sunday, July 20, 2008

Healthcare and HIT Today

At a breakfast briefing held on July 17th, Karen Davis, President, of the Commonwealth Fund, announced that the “Commonwealth Fund Commission on a High Performance Health System” just updated the national scorecard on the U.S. health system. According to the report, the U.S. scored an average of 65 out of a possible 100 across 37 indicators of health outcomes, quality, access, efficiency, and equity—slightly below the overall score in the 2006 report.

According to James J. Mongan M.D. who chairs the 19 member commission and is CEO of Partners Healthcare in Boston, “It is apparent that overall, the healthcare system is performing unevenly and well below its potential.”

Cathy Schoen, Senior Vice President for the Commonwealth Fund stated how important it is to pursue strategies that take a whole system approach in order to improve access, quality, and efficiency all simultaneously.

In the broader picture the report points out that the country needs to have universal and well designed coverage for care, incentives need to be aligned to promote higher quality and more efficient care, design and organized care needs to be centered around the patient, goals need to meet and exceed benchmarks performance needs to be monitored, and national policies are essential to promote private-public collaboration and high performance.

Specifically, using health information systems to support efficient care is only a part of the overall debate on improving the healthcare system. However, as the report points out, the U.S. lags well behind leading countries that have made a system-wide commitment to invest in interoperable information technology.

Although U.S. physicians have increased their use of EMRs from 17% to 28% from 2001 to 2006, other countries such as the UK use EMRs in nine out of 10 primary practices, plus the fact that the Netherlands use EMRs in 98% of their practices. Furthermore, clinical data systems in these countries are more likely than those in the U.S. to have advanced functions that provide decision support and enable information to flow with patients across sites of care. At the current U.S. rate of dispersion, it would require more than 30 years to expand such tools to physicians.

As pointed out at the briefing, CMS is making several efforts to increase efficiency and accountability. For example On October 1, 2008, CMS will no longer pay for treatment needed to correct adverse drug events that could have been prevented during hospital stays. CMS estimates that it will save $20 million in direct outlays to hospitals.

The CMS Medical Home Demonstration coming in 2009 will provide family centered care to high-need Medicare beneficiaries. Care will be provided using evidence-based medicine, clinical decision support, and health IT will provide patients with enhance access to services.

CMS has an ongoing EHR Demonstration Project where Medicare will provide incentive payments in 12 communities nationwide to physicians who use EHRs. Financial incentives will be provided to as many as 1,200 small and medium size primary care physician practices over a 5 year period.

On Capitol Hill, the Senate Finance Committee held a hearing on July 17th to discuss the potential and limitations for HIT. Peter Orszag, Director, CBO, appearing before the Committee, said “the bottom line is that research indicates that in certain settings, health IT appears to facilitate reductions in health spending if other steps in the broader health care system are also taken to alter incentives to promote savings. By itself, however, the adoption of more health IT is generally not sufficient to produce significant cost savings.”

Richard Hillestad, Principle Researcher, Professor, RAND Graduate School told the Committee that HIT efficiency savings could reach approximately $80 billion per year at the 90% adoption level for hospitals and physicians. RAND estimates the costs to achieving these savings in 15 years would average about $8 billion per year or $120 billion total. During the 15 year adoption period, the cumulative net savings would be about $510 billion or approximately $34 billion per year.

Also appearing before the Committee, George C. Halvorson, Chairman and CEO Kaiser Foundation Health Plan Inc., and Kaiser Foundation Hospitals, pointed out that one of the solutions is to have special computer systems or care registries analyze data from electronic medical records. The registry would provide doctors and other clinicians with reminders and prompts, and provide recommendations on the best scientific evidence and expert opinions for individual cases. However, only a few places in this country will be able to achieve the full electronic medical record supported by an up-to-date care registry in the immediate future.