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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Employer-driven "Electronic Health Records": A needed catalyst for healthcare IT?

Employer-driven "Electronic Health Records": A needed catalyst for healthcare IT?

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I've commented before on this Blog that much of the true innovation I see in the implementation of advanced information technology solutions in healthcare, particularly electronic health and medical records, is happening outside of the United States.  There are two reasons why this is so.  First, most healthcare in other countries is controlled and delivered through the public sector.  Decisions about, and investment in, healthcare information technology are made by regional or national government agencies.  Second, many nations are able to jump ahead of the U.S. because they are starting their healthcare industry transformations with a clean slate.  By not being burdened with the complexity of integrating a patchwork quilt of outdated legacy systems and the disparate silos of information locked up in those systems or on paper, they are able to use the most contemporary, and often commoditized technology, on the market.  The solutions they implement are not only more robust, but far easier for healthcare providers to use.  They also tend to be much less costly. 

I wouldn't proclaim that the solution to our healthcare IT woes in the U.S. is to abdicate to the government even though there is something to be said for centralized planning, command, and control as observed in other countries. Perhaps, however, there is another very powerful force for solving these problems that is a better fit with our American culture and way of life; Employers.  If you read the Wall Street Journal yesterday, you no doubt saw the article proclaiming an initiative by several of America's largest corporations to "provide digital health records to their employees and to store them in a multimillion-dollar-data warehouse linking hospitals, doctors and pharmacies. Their goal: to cut costs by having consumers coordinate their own health care among doctors and hospitals."  If we are ever going to reach President Bush's 2004 State of the Union promise of an electronic health record for most Americans within 10 years (now 8 years), this may be the way we get there. 

This certainly isn't the first time that major employers have banded together and flexed their muscles to stimulate needed changes in the healthcare industry.  The Leapfrog Group has been an effective change agent for hospital quality around a defined set of diseases and treatments.  Hospitals had little choice but to tow- the-line when major employers and payors in their markets sounded off.  I have no doubt that this newest initiative by employers to stimulate EHR/PHR adoption will help move things along in the United States.  I would, however, urge these major employers to make every effort to work closely with organized medicine and care providers in planning and implementing these systems and services so they work equally well and provide an investment return for everyone in the healthcare ecosystem; patients, providers, family members, employees, and employers. 

Next week I'll be attending the Health Industry Leaders Forum in Barcelona, Spain, where I'll have an opportunity to deliver an address and get an update on some of the most contemporary healthcare information technology projects in the region.  I'll provide a summary in my next Blog post. 

Bill Crounse, MD           Healthcare Industry Director           Microsoft Corporation 

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  • Systemic Change Required.

    One challenge we have here in the US is the fragmented nature of health care on both the payer and provider side and now we are compounding it with IT systems that really aren't compatible. Even if a patient has an online health care record via their employer it has to be integrated into their providers system as well. Will the providers need to have access to multiple employers data-bases as well as their own in-house systems?

    There is a tremendous push towards "consumer directed health care" in the hopes that the "market" will drive costs down. But since over 70% of all health care cots are incurred by 5% of the population we need to be more strategic in how we invest in technology. The other largest percentage is spent during end of life and who amongst us  wants to pull the plug a few days earlier on your parents?

    Heath care is not purchased in the same way that electronics are. At the point of purchase (the ER) will you look up the quality measures for the hospital where you parent was just admitted for a heart attack and request a transfer? Can you even get onto the panels of the top ranked doctors? Of course not we already know who the best docs are and their practices are full.

    Does your doctor or hospital know what your actual out of pocket cost (vs the bill) will be for services? If you knew would you change doc's or hospitals? Do health savings accounts take the cream of the healthy out of the insurance pool and leave the ill?

    The VA has a nation wide system that allows patients to enter their own comments and information right into their medical record. Many people don't realize that the VA has the most comprehensive EMR in the country and were the only health care provider in New Orleans to provide seamless care to their enrollees after Katrina.

    They are also  the highest quality provider according to all of the national quality measurement agencies.  Many people are suprised to discover that the Vets who get care in the systems vs those outside it.  http://www.washingtonmonthly.com/features/2005/0501.longman.html

    One huge differnce between the VA and other providers is that they have a vested financial interest in prevention. A provider isn't paid to prevent illness but to treat it and an insurance company has a vested interest in keeping current costs low vs saving Medicare money years from now. It is only when we take a systemic community wide approach to these issues that we can find ways to not only cut costs but improve people's health.

    Lest you think I am going to advocate for National Health Care I am not. Although interoperability and consumer involvement is crucial we are a long way from giving people the quality and costs date they need to control costs. The first step is to give them the legal rights to their own medical records in the same way that we own our own banking records and would never allow our employers access to them.

    One innovative solution drawn from the banking sector would be to develop "health record banks". In the same way that you can put your money into any bank in the country and easily move it around you should be able to control your own medical records and pick which "bank" you want to deposit it in. You could chose to disclose information to providers and the industry standards would allow them to easily access the information via clearinghouses. In an emergency situation providers could still have access to a limited set of data if needed.

    By combining a marekt based approcach with the best of technology (EMR's and health banks) with consumer empowerment and a still undeveloped link between prevention and cots we could see dramatic savings. Many of us are old enough to remember paper checks but the adoption of electronic transfers happened fairly quickly.  

    People's medical information has value and it rightfully belongs to us not to insurance companies or our employeers and we need innovative market driven solutions that bring employers, employees, payers (ultimately us) insurers and providers to the table in a collaborative manner.

  • Thanks for much for your comments.  I can't say I disagree with anything you said.  Employer-directed ERMs won't be the definitive answer to our healthcare woes in the U.S., but they will help stimulate the market and hopefully move us closer to where we need to go as a nation.  I like your idea of medical records banks.  At Microsoft, we have long envisioned medical records held securely "in the cloud", or should I say "clouds".  So long as the solution is secure, available when needed, cost-effective and interoperable, everyone will be better served.

    Bill Crounse, MD     Healthcare Industry Director      Microsoft

  • Great article.  My company is running into similar issues with our clients.  Healthcare organizations are demanding that their Independent Review Organizations and Hospital Peer Reviewers provide a way for them to transmit their records electronically and securely.  Its been a challenge to accommodate them, but we have done it by implementing a portal on our site called Peer Point.      

    We've been working closely with the hospitals, insurance companies, third party administrators, and self insurers to make sure that our system is exceeding privacy and quality standards and it has been a headache - but well worth it in the end.  We are now finding clients are coming to us just because we have implemented the portal and are able to share medical records electronically, unlike some of our competitors.

  • The most common type of mesothelioma is the pleural mesothelioma. The pleura is a thin membrane found between the lungs and the chest cavity. It provides a lubricated surface so that the lungs do not chafe against the chest walls. Thus, a pleural mesothelioma is often referred to as a "lung" cancer.

  • I have developed www.DYSmd.com, a website that is both a personal health record and health information service.  I believe it will be very helpful for both patients and physicians, since it is a place to keep an anonymous and complete medical chart that can be used by any doctor.

  • EMR/EHR is a technical (Information Technology) project/installation and should be treated as such and sold accordingly. Look for a nerd selling a solution and not a

    salesman selling a product. Make sure your data/database is industry standard (SQL Server; Oracle, etc.) and HL7 compliant. It’s all about the data. For more information visit Spring Medical.

  • Implementing EHR I think will definitely lead to better care..It  could improve the quality of care.EHR systems can help doctors deliver more timely and complete care for their patients.There are other more reasons why to move toward a system of electronic health records.

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