President Obama’s HiTech Act, enacted right after he took office, should produce a major transformation in American health care when it gets going. Along with the health care reform legislation that was dragged kicking and screaming through Congress last spring, the Act could put the planets in alignment for real change in the way care is delivered and paid for, and the way patient outcomes are achieved.

The HiTech Act specifies that every American should have an EHR (electronic health record) by 2014, and receive continuity of care through a regional Health Information Exchange. It even provides coverage for Geek Squads to help providers with the transition to EHRs: finding vendors, deployment, and identifying specific ways to advance care in their own practices. A first set of rules for what constitutes “meaningful use” of these information technology tools has just been released. So things are getting moving to give both patients and providers the information to make better health care choices. But…

These programs always sound good. For example, one new federal program, Beacon, looks at health system change at a community level in a group of demonstration communities, The communities that have been chosen as Beacons have already achieved a high level of EHR adoption and want to find out how they can use the information these records generate to improve health care. The stakeholders in these communities will come together, identify goals, and unleash a range of strategies in service of these goals.

But the programs requires the coming together of four largely separate tribes of crusaders for improvements in health care:

1) Quality improvement fanatics who want fewer accidents and bad outcomes in hospitals
2) Payment reformers who want to change reimbursement from volume to value
3) Consumer energizers who want consumers to be more involved in their own care, and to be given better information
4) Health IT evangelists who want to unleash futuristic tools and applications

For any of this to work, all these tribes have to work together, combining their perspectives and tools.

Fifteen demonstration communities with baseline high EHR adoption rates have already been chosen as Beacons. They’ve already been working through questions such as What do you want your community to look like in three years? Which patients do you want to achieve what outcomes (for example, care coordination for asthmatic children using range of Health IT tools to prevent hospitalizations)? And how do you measure whether you are getting anywhere?

Geisinger, one of the Beacons, is working through the process to get its outcomes identified first, then measures, then tools, then sustainability of its goals. It is trying to extend its best practices outside its boundaries.

It’s a laudable goal to deploy information technology in service of specific payment reforms and clinical reforms. What are the odds that this will succeed, however? Many people have broken their picks on the hard rock of true health care reform.

This is my dilemma over the EHR debate: Why don’t I have full access to my own medical records? Try to go get access and see how far you’ll get. I discovered this several years ago when my insurance company denied coverage for a prescribed medication and I had to file several appeals. My appeals had to include the reasons why this, and only this medication was prescribed which meant getting the doctors’ notes and records to support his decision to prescribe it. (Something he had already submitted to them, by the way).

It took much screaming and gnashing of teeth to get anywhere with it. It seems that those notes are not for the patient; they’re for the doctor. I suspect this is a side effect of the practice of defensive medicine, but whatever the reason, I had to sign away my firstborn, the equity in my home and hold everyone harmless right down to Dick Cheney.

Okay, maybe not all the way to Cheney. But still absurd.

Now we’re in the middle of a national discussion and initiative about electronic health records (EHR), and what bothers me the most is that there has been no discussion of whether I ultimately control them. Note that EHRs are different from PHRs (Personal Health Records). Personal Health Records are the equivalent of a vaccination record — they are what your doctor gives you when you need to have evidence that you’ve done something. They can also include one’s own notes or resolutions or progress in certain areas, but PHRs are not official, and don’t represent one’s health history in any sort of official format.

Doc Searls has some ideas around this. Like me, he believes health records need to be centered on, and in the control of, the patient.

The patient needs to be the point of integration for his or her own data, and the point of origination about what gets done with it. Even if the patient’s primary care physician serves as a trusted originator of medical decisions, the patient needs to anchor the vector of his or her own care, for the simple reason that the patient is the one constant as he or she moves through various medical specialties and systems.

Doc even goes as far as to say that the patient should be the platform; that is, the origination point for all data and records flowing in and out to providers, insurers, hospitals, etc.

We don’t have the tools for that yet. Doc writes:

This requires classic VRM: tools of independence and engagement. That is, tools that enable the patient to be independent of any health care provider, yet better able to engage any provider.

In other words, while the answer needs to be systematic, it does not need to be A Big System (which I fear both BigCos and BigGovs whish to provide).

What concerns me the most is how that works for the poor, the ill, and the elderly, who do not have the same comfort level with electronic records as my generations and generations after me.

I see Doc’s answer as the best one, at least in theory. It’s how to put it into practice that boggles the mind. Are records stored in the cloud, released by the individual as requested? Is a patient’s entire history released, or only that which is relevant to the need? Who determines the need? What safeguards will exist to ensure that the records are seen only by those who the patient authorizes?

There are many more questions than answers. The good news: we are living in an age where data is being moved around in real time with regularity, discussions are unfolding and sparking innovation, and where development is growing at breakneck pace.

What we need isn’t here yet, but it will be, provided we can push past the usual politics and get to something that works.

Why is it that when discussing the need for health care reform, it seems to boil down to a simplistic formula on both sides of the debate? Over and over again, I hear the same tired arguments; namely, that any sort of reformation of our health care system will lead to socialism and the ruination of the American way of life or conversely, that health care reform must lead to a single-payer system controlled and administered by the federal government.

Let’s start with this: health care reform is not an either/or proposition with extremes as options. What we have right now is a system that is unfair, uneven, overpriced, and is crippling any possible true economic growth in this country.

If we are to have a real debate over how to reform health care, let’s start by exploding the myths about it coming from both sides of the aisle.

Myth #1: Universal access to health care is the same thing as single-payer health care

Of course this isn’t true. Having access to health care is a human right and a civic responsibility. Note carefully: I did not say having access to government-paid health care. Nor did I say access to employer-paid health care. What I said was that access to health care is a human right, and it is. I don’t know a conservative, liberal, libertarian, or independent alive who would see someone bleeding in the street and leave them there without at least calling an ambulance so they could get medical care and attention. Why? Because as human beings, all politics aside, we understand that when we are ill or injured, we need professional health care providers to intervene and help us heal. That isn’t political; it’s human. The issue has never centered around whether the sick or injured should be cared for; it has centered around who pays for that care.

We live in a nation where access to health care services is selective. If one is employed by an employer who still offers health insurance, there is access. If one is independently wealthy, whether insured or not, there is access. However, those who are unemployed or unable to work do not have access to providers or medications, particularly the group that I call the “unemployed middle class”, of which I am one.

Creating a pathway for everyone to have access to health care should be something every conservative embraces, because it could take the primary burden away from business and place it on the individual, if it’s structured properly and fairly.

Myth #2: Health care reform will destroy capitalism

This one always amazes me. On the payer side of the equation, if the responsibility shifts from employer to individuals with cost containment measures in place to limit out-of-pocket costs, we have not suddenly become a nation of socialists. Anyone who really believes that should have a close look at what socialism is before saying such a thing. Regulating health care is not the same as public ownership or administration.

Myth #3: Health care reform can be achieved without tort reform

Ask any health care provider and they’ll tell you that it cannot. The ones who win now are the lawyers. Malpractice insurance is crippling providers and hospitals, and services are rendered with attention to the lawsuit rather than the patient. Tort reform has to be at the center of any reform effort, and shouldn’t be ignored or minimized by either party.

Myth #4: Electronic Health Records (EHR) will streamline health care

This is a myth right now, because all proposals on the table do not require an open standard for records portability. There is a real danger that if this is not done properly, it will cost American taxpayers far more than it will save. Congress, take heed. This cannot be ignored or made into a political issue.

Myth #5: Health care should be managed by individual states

This is the least effective and most discriminatory way to manage health care, and most importantly, it places an undue burden on states offering broader access than the minimum. Right now, each state sets their own criteria for access to health care reform, subject to very broad federal standards. Those criteria include how pre-existing conditions are treated, who can get insurance, brackets for determining who is eligible for Medicaid, and expansion of current COBRA requirements. As a result, one can be covered for pre-existing conditions in Minnesota but not in California. It follows that Minnesota’s population will include many who, driven by the need for affordable health care, migrate to that state because they are able to get it there.

We are a nation of people who need to deal with the very real possibility that our economy will stagnate and die if we do not wrestle with the question of health care reform, accept that it will require an investment of taxpayer dollars, and begin to talk about the best ways to accomplish what must be done.

Health care reform must be a national standard. Access has to be universal and yes, required for every United States citizen. Reforming health care means that businesses, particularly small businesses, will be able to survive and thrive as the foundation of a new, more solid and secure economy. Survival of small business is a closely-held conservative value that should serve as the foundation of a place to agree on health care reform, rather than a reason not to reform it at all.

Heads up!

I’ve been working on the transition to electronic health records in the state of Arizona for years.  Gov. Janet Napolitano mandated the initiative when she first was elected, and there have been working groups trying to solve the enormously complex logistical problems surrounding standards, continuity of care, legalities, privacy, etc during all this time. Now there’s an organization formed to bring all the players together, and that organization  is holding its annual summit in early March. You will notice that the focus has broadened to the Western States in general. Actually, this is an initiative that should know no borders.  But as I’ve written before, this can be done right, or it can be done in a way that makes things worse for the providers. So if you are in the area, come join us. Here are the deets:

Arizona Health-e Connection (AzHeC), the Arizona Health Information and Management Systems Society Chapter (AzHIMSS,) and the Arizona Health Information Management Association (AzHIMA) invite you to join us at our

Western States Health-e Connection Summit & Trade Show – March 2nd and  3rd, 2009 at the Phoenix Convention Center, Phoenix, Arizona

Both the Summit & Trade Show will focus on current advancements, trends and challenges in health information technology and exchange.  This year’s Summit expands beyond Arizona to encompass the Western States, resulting in an expanded trade show and a more in-depth Summit session schedule. (See the Agenda via the link below). The stand-alone Trade Show highlights include an expanded exhibit hall with over 35 health care and information technology vendors as well as unlimited networking opportunities with key regional health care professionals.

2009 Western States Health-e Connection Summit & Trade Show Website
http://guest.cvent.com/EVENTS/Info/Summary.aspx?e=4e58d8dc-371d-48c2-a20b-07bfa2dd4746