Q. …We’ve got the most inefficient health care system imaginable. We’re still using paper. We’re still filing things in triplicate. Nurses can’t read the prescriptions that doctors — that doctors have written out. Why wouldn’t we want to put that on — put that on an electronic medical record that will reduce error rates, reduce our long-term costs of health care, and create jobs right now?
A. Because there’s no plan. Candidate Obama quite reasonably proposed a policy, not a plan; and you don’t think the Bush administration prepared one, do you? The near-disaster of health IT in England, and the few American examples of success, strongly warn against throwing money at the problem before it’s all thought out. You have to solve tricky privacy issues and bring the different stakeholders on board – doctors, nurses, pharmacists, health managers, and above all patients. In this vital planning stage, you don’t need that much funding and can’t spend bucketfuls usefully. The recession will probably be long, leaving time to put the real money in a later recovery budget. A coherent health IT plan is very important, but it’s not a good way to “create jobs right now”.
The House stimulus bill left $2bn for health IT, which looks plenty for now. The Senate raised it to $5bn (here, spreadsheet line 433) so the issue will have to be addressed in conference. My suggestion: shift the $3bn difference to restore the funding for public health prevention. RBC’s very own public health expert Harold Pollack has the arguments here, supported in a petition by
500 670 of his fellow professionals. These are ready-to-roll programmes with rapid payoffs in both jobs and the welfare of Americans. Looking ahead they will lower the huge long-term financial burden of treating HIV and other diseases. Every case of HIV prevented saves on average $618,000; much of it to taxpayers.
But not if the parley delays the passage of the bill by one day.
Update – 11 February
You read about “$20bn” for health IT in the Senate bill. Most of this looks to me (but I may be wrong) like hot air about grants to physicians etc from 2011, which will no doubt be changed in either direction. What the text does is set up the programme: there are 126 pages (pp 264 – 390) confirming the Office of National Health IT coordinator (established by Bush in 2004 as a figleaf for inaction), creating policy and advisory committees, standard-setting and grant-awarding processes, and so on. The newly promoted national health IT tsarik is given 12 months (p. 278) to appoint a chief privacy officer, clear proof that they have no idea of the storms about to hit. This repeats exactly the trajectory of the English NHS IT project: treat privacy as a technical problem you can solve with technical fixes, not the central policy dilemma of the whole thing.
Update 2 – 12 February
To be quite fair, there does exist a 115-page document from June 2008, grandly entitled “The ONC-Coordinated Federal health IT Strategic Plan 2008-2012”.
Judge for yourself, but it looks to me like those pretty charts produced in the heyday of the SDI and the Second Iraq war: Powerpoint exercises in wishful thinking.
Milestone 2.4.5: By 2011, there will be established accreditation criteria and processes for all models for the exchange of health information, as appropriate.
That is, in two year’s time, they hope to have sort-of decided how the health IT network is supposed to work.
I also liked the combination of these objectives:
1.3.6 End 2009: Consensus about the components of a certified PHR [personal health record].
1.3.4 End 2010: Majority of [PHR] products are certified.
1.1.2 End 2010: Best practices used to develop standards and certification criteria [on confidentiality, privacy, and security.]
It’s taken five years in England for one contracted provider (iSoft) to not quite roll out a PHR suite starting with much clearer criteria than this.
There is precisely one idea for overcoming resistance by physicians to having their working lives turned upside down:
1.3.1: Remove business obstacles for provider use of EHRs.- Physicians using certified EHRs are eligible for malpractice credit.
Needs more work, don’t you think?
Update 3 – 12 February
The Finns who got it right.
Update 4 – 13 February
They did it! Health IT stays at $2bn, and $1bn back for prevention. Who says bloggers do not wield secret power?