"The promise of [health IT] is that physicians will receive information in real-time that will lead to dramatic improvements in quality care. It will be like going from a horse-and-buggy to a bullet train: weeklong delays for patient records and comprehensive medication information will become a relic of the past as real-time clinically relevant information will be at a physician's fingertips while caring for patients."
-Steven Stack, M.D., Board Member, American Medical Association, Testimony to the House Energy and Commerce Subcommittee, June 4, 2008
Twelve days after Stack offered the above testimony to a Congressional subcommittee, my husband had three meetings in Germany in three towns that weren't exactly neighbors. He began the morning in Frankfurt. After the first meeting, he boarded a train and traveled an hour and 45 minutes to Düsseldorf. From there, he boarded another train line and in two-and-a-half hours he was in Hannover. Following the meeting there, he railed to Bremen in 59 minutes, where he conducted his last meeting of the day. In total, Robert covered 350 miles of Germany in 11 hours, which included three productive, in-person meetings in three towns (he then flew to Dublin on a low-cost, efficient airline that aims to compete with the fast trains -- RyanAir).
Biting the bullet (train)
Why is this relevant to the health information infrastructure? It's as Stack told Congress: We're now in a horse-and-buggy era of health IT. If we adopted a national health information infrastructure the way most of Europe has adopted fast trains, we'd be in the bullet-train era of health IT.
The better part of Western Europe has made the financial decision to bite the collective fiscal bullet, as it were, in allocating billions of Euros to fast transport because the region of 500 million people saw the investment as strategic infrastructure. Driven partly by economic development rationale, partly by the price of petrol and a greener environment, and partly by a vision for a democratic transport future, Germany and contiguous fellow European nations now enjoy the world's fastest rail network (except perhaps those in Japan and China). This has been accomplished through public-private partnerships.
It's the track, stupid
The limiting factor to speed isn't the trains themselves; it's the nature of the track. For example, over the past few years, the Eurostar that runs through the Channel Tunnel from London to Paris to Brussels could have gone faster on the first leg of the trip -- from London to the "Chunnel." However, the U.K. had not kept up with the new track technology adopted by Belgium, France and Germany. This has recently changed, and Eurostar's track between London and the south coast has been upgraded.
Now, refocus your lens back on the U.S. and consider the Acela Express -- Amtrak's express train that runs along the northeastern corridor of the U.S. between Washington, D.C., and Boston. The train could (read: could) exceed 150 mph, but Amtrak's tracks can't support that speed. And there hasn't been sufficient support in Congress to fund the upgrading of those tracks.
Just like the painful, long-overdue support for a national health information infrastructure.
The national resource known as infrastructure
I've been thinking about trains and tracks since I heard Richard Umbdenstock, the president and CEO of the American Hospital Association, talk in June at the annual meeting of the Healthcare Financial Management Association. He referred to health care as a "national resource." This got me meditating on the idea that a national health information infrastructure is a strategic national resource.
Congress has been crafting how to provide incentives for the adoption of health IT in the U.S. In the meantime, Congress has also been considering cutting funds to providers who treat Medicare patients. The unintended consequences, and perhaps irony, of cutting funding to health care providers, while we seek to promote the adoption of health IT by those same providers, should not be overlooked.
No improving outcomes without information flows
A new report published by PricewaterhouseCoopers' Health Research Institute, called "You Get What You Pay For: A Global Look at Balancing Demand, Quality and Efficiency in Healthcare Payment Reform", identifies health IT as the critical enabler to improving health outcomes.
PwC's research into the health systems of 20 countries, including the U.S., demonstrates that to better reward quality, information must be gathered, measured and acted on. Information flow among patients, payers and providers is used to ensure that incentives are appropriate and aligned.
And there is no information flow without an IT infrastructure.
Yet the flows of information in health care may be fated to the slow track beyond 2014 -- the year envisioned by President Bush as the goal for "electronic health records for all."
Hospitals' funding for EHRs may slow
Dave Garets, president and CEO of HIMSS, presented data to a group of health writers on June 30 drawn from the HIMSS Analytics database that represents over 5,000 nonfederal U.S. hospitals. The HIMSS data included EHR adoption trends as of Q1 2008.
Garets noted that too many hospitals had not yet reached a sufficient stage of EHR implementation to support any confidence that the majority of U.S. residents would be covered by an EHR system by 2014.
Furthermore, Garets noted the trend for hospitals to allocate more IT funding toward "revenue cycle" applications over the next few years. These investments will focus on hospitals' fiscal health -- such as consumer payments and receivables, customer service improvements, pre-registration and scheduling, bill paying via the web and claims attachments. This, Garets forecasted, would take money away from the clinical side of health IT -- further distancing U.S. residents from benefiting from those elusive EHRs.
The notion of nation
So I return to the notion of "nation" as the right scale for the health IT infrastructure in the U.S.
With the news that funding for the Office of the National Coordinator for Health IT will stay flat and Medicare funding will decline, we've really got to focus on that big picture while providers at the grassroots level are doing their best to care for patients and try as hard as they might to maintain their own fiscal health.
This calls for a massive public-private partnership on the scale of a new national railroad. The future viability of Medicare ... consumer empowerment, privacy and information security ... evidence-based medicine and rewarding quality ... all of these mega-issues are bound up in the national health infrastructure and the flow of information across it.
Individually, Germany, France, Belgium, Austria, and lately Italy, each decided to commit to a high-speed national rail system. The ICE trains that connect these countries together made the individual country investments exponentially more valuable.
Why can the largest Western European countries (U.K. excluded) come together, across diverse cultures and languages and social mores, to commit to and implement a high-tech, customer-centric continental-sized rail system, while a single nation can't prioritize a health information infrastructure?
Let's get rollin'.