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 By not being burdened with the complexity of integrating a patchwork quilt of outdated legacy systems and the disparate silos of information locked up in those systems or on paper, they are able to use the most contemporary, and often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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