The entire PDF is well-worth reading, but here are some highlights:
. . . .I am sad to say that health care in America is a disorganized, weakly coordinated, inadequately linked, $2.3 trillion care infrastructure that is currently our country’s fastest growing industry. . . .
It is an industry that will not be reformed without intervention by public policymakers and purchasers. . . .
. . . .Major studies show huge inconsistencies in care delivery across this country. For example, diabetics consume over 32 percent of the total costs of Medicare, and reliable studies show that the U.S. health care infrastructure provides the right care for diabetics less than 10 percent of the time. . . .
We are missing critical linkages among clinicians and we are missing systematic, patient-focused care. One key element of the solution is to have vertically linked clinicians functioning in teams to deliver care, supported by a secure electronic medical record (EMR) that gives each clinician the relevant information about each patient in real time at the point of care. . . .
Another key element of the solution is to have special computer systems –- care registries –- that analyze data from the electronic medical record and give doctors and other clinicians reminders and prompts to recommend what the best scientific evidence and expert opinion would agree is necessary and optimal care for each patient. . . . 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. . . .
What Kaiser Permanente and other multi-specialty groups such as Group Health Cooperative, Intermountain Healthcare and Geisinger can accomplish is to set the gold standard with a sophisticated electronic medical record and a fully integrated system. But the rest of the health care system is not vertically integrated and does not have appropriately aligned financial incentives. However, as a country, we can decide to move towards virtual integration and to create payment structures that reward good care, rather than the quantity of services delivered.
Most American patients will need another pathway to computer supported care. That second pathway is possible. We don’t need algorithms for hundreds of diseases in order to transform care. We do need algorithms and support systems for the five chronic conditions (congestive heart failure, asthma, diabetes, coronary artery disease, and depression) and for the five percent of the total population who drive 50 percent of the care costs in this country. . . .
If we want care to get better for those patients, we need to insist that all chronic care patients with serious co-morbidities have their care supported by electronic care registries –- and that clinicians who choose not to interact with those registries should be financially affected by their decision.
What happens when care is fully supported by electronic panel support tools? The outcome improvements can be huge. We should set a national goal to decrease hospitalization for asthma patients by 50 percent. We should also reduce congestive heart failure crisis by 50 percent. We should reduce kidney failure by 50 percent.
The electronic medical record alone does not do the work. EMR is a great thing, but an EMR all by itself is not enough. The EMR must be supported by panel management tools that scan the data and give advice to clinicians about needed care. . . .
My advice for you today is this: Our nation’s current non-system — depending on siloed and separate paper medical records and providing perverse financial incentives that directly reward sub-optimal care and discourage efficiency –- will never reform itself. It will also never magically become a “system.”
We need to focus on the areas of the greatest potential – and we need to put computerized support systems in place as soon as that work can be done. . . .