Health care spending in 2008 — the most recent year for which we have complete data — once again exceeded the rate of growth of the gross domestic product (GDP). For the year Americans spent $2.3 trillion dollars for health care or $7,681 per person.
Health care accounted for 16.2 percent of GDP. This is an unsustainable rate of growth especially in light of the steady increase in numbers of uninsured and underinsured citizens. In this and subsequent columns I will examine specific proposals for reducing our nation’s health-care bill.
* Electronic medical records (EMR) have been widely hailed as a means for reducing costs and improving quality. Because EMR systems are expensive and involve lengthy training, few hospitals and fewer medical practices have installed comprehensive programs. Thus, in most locations, a high-tech medical system must depend upon bulky, dog-eared often illegible charts to preserve and to transmit information among multiple providers. Patients have little access to the information contained in these records. Opportunities for error, delay, and needless repetition of studies abound. A typical patient will have separate records in each clinic, medical office, hospital, and pharmacy where care has been provided.
Vanderbilt Medical Center offers an example of what EMR could do. History, physical examination, progress notes, diagnostic studies, and medications are entered into a tightly secured EMR. A physician or nurse can access a structured, legible record at each point of care, whether inpatient or outpatient. Illegible handwriting, which leads to many medical errors, becomes a thing of the past. Uncertainty about a patient’s current medications and allergies is immediately clarified. If an inappropriate medication is ordered, a pop-up message will highlight the issue. A consulting physician can quickly review laboratory studies and view prior scans and X-rays. The Vanderbilt system required years and millions of dollars to perfect.
President George W. Bush first proposed a universal EMR. The administration of President Obama has offered increased Medicare and Medicaid payments to physicians and hospitals who adopt EMR. For example, a physician’s office could receive up to $40,000 over a five-year period for utilizing EMR. Funds are tied to “meaningful use” of approved EMR. A system would have to:
* Meet federal and state laws regarding privacy.
* Permit patient access.
* Allow exchange of important clinical information among providers.
* Document progress in a standardized format.
* Warn of drug interactions.
* Transmit prescriptions to pharmacists.
* Remind patients and providers about immunizations, follow-ups, and clinical guidelines for monitoring chronic conditions.
Providers who do not use EMR by 2015 would see deductions in their Medicare and Medicaid payments. Up to $44 billion dollars have been allocated to subsidize EMR.
But would this ultimately lead to savings?
Consider an example: Mary is 55 years old and has high blood pressure, adult-onset diabetes, recent surgery for colon cancer, and depression. She has multiple allergies to drugs. In addition to follow-up visits with her surgeon, she sees on a regular basis an internist, an oncologist, a gastroenterologist and a psychiatrist in four different offices. She currently takes 10 prescription medications. In most settings at least five different charts in separate locations would document her care.
This scenario presents multiple chances for errors and omissions to occur. EMR would certainly decrease mistakes and related expenses in the care of Mary. Costs decrease further with the elimination of countless phone calls and hours of processing paperwork at each of her treatment sites. Each office could view her relevant clinical information swiftly and coordinate care with all providers.
Experiences of integrated health systems that have developed and used EMR for years tell us that savings and efficiency improve immediately and continuously.
Contact Clif Cleaveland at cleaveland1000@comcast.net.