Parente: We Could Have Health IT Up and Running in One Year
This is Steve Parente in an AEI report:
On its current trajectory, health IT policy is expensive, slow, and likely to be ineffective. In contrast, a market-based approach where incentives align to expand IT functionality for industry and consumers should become the new goal for health IT.
The current system will move down a path with many hurdles to surmount, including too much reliance on bribes for an interoperability ideal that may never be fully embraced by the provider community. In contrast, the policy prescriptions outlined [here] are pragmatic, based on proven unsubsidized success in the financial services industry, and they could be implemented as part of the routine cost of doing business in the health care industry. This alternate, market-based path can quickly create the health IT platform necessary for transparency in outcomes and performance information for patients, providers, and insurers, private and public alike.
There is quite a lot of nonsense written about health IT. This is one of the few sensible treatments of the subject.
Wow, where to begin? How many financial firms run labs with all sorts of disparate instruments that generate data? How many financial firms have many disparate point of care devices in hundreds of runs that generate data? How many financial firms have to operate under FDA regs (Sarbanes-Oxley is close, but not there)? How many financial firms are dealing with exponential growth of data? How many financial firms…
This is just silly.
Does this guy even understand how big a SINGLE MRI file is? And how many thousands (millions?) of customer transactions it would take to be equivalent data load? Nonsense, Nonsense, Nonsense. I have to get a coffee.
Sorry mdb can’t handle this. I thought it was a good paper.
We already have one of the most wired health systems in the world. It isn’t clear that real-time records are needed (or cost effective) for any but the more complex cases, and in many cases those already exist.
As the GAO has pointed out, the VA’s claims about its electronic records system have never been independently validated. What we do know is that at least some of the physicians stuck with the VA system rail against the amount of useless information it generates.
Real time records may not be needed, but then you must maintain 2 systems – paper and electronic. This raises several issues – what happens when they inevitably get out of sync, the costs for maintaining 2 systems, training employees on 2 systems, etc. Hybrid systems are usual the worst way to go, a pure paper is usually better.
The VA system has many faults, not the least of which is MUMPS or M ( http://en.wikipedia.org/wiki/MUMPS ). Object Relational Databases are blazing fast with transactions, but extracting and analyzing data sets is EXTREMELY slow. Also the last I worked with it, it was very limited (much like the VA) in what it does. So if all you want to do is log data, by all means the VA system is a great choice. If on the other hand you want to do something with the data, well you might want to reconsider…
It is a compelling paper, although I always get grumpy when I see a proposal to go “beyond repeal and replace” that still incorporates the notion of “exchanges”. What the heck is the point of repealing and replacing Obamacare if you’re still going to have exchanges up and running in 2014?
I’m not sure Prof. Parente’s proposal is really market-based: It incorporates exchanges, licensing three “financial-services hub equivalents,” and a state-issued “insurance exchange identity card” for every resident. (I wouldn’t like to be the politician who tells the citizenry that everybody has to carry one.)
I think there are also a number of fundamental differences between banking and medical care. First, banks have to work with each other, day in and day out. They have to borrow and lend money to each other continuously, and their currency is issued by the Federal Reserve System. The “bias” to be interoperable is deeply seated, and unavoidable.
Second, banks settle each credit-card transation individually. The bank doesn’t decide how much to pay Macy’s for my new shirt: I do. Health insurers do not pay individual transactions, despite the fee-for-service nature of most medicine today. Instead, they collect transactions into “panels” and decide how much to pay for the panel. It’s as if my bank gathered all the data from all its cardholders’ purchases at Macy’s last month and then told Macy’s that the balance was too high, so it was adjusting downward.
Third, there is the question of centralizing information. The government care what I buy with my credit card. However, the government is very interested in what medical treatments I consume. (Remember President Obama’s statement that if there is a red pill and a blue pill that do the same thing but the red one is cheaper, you can have that one?) The citizens are very aware of the risk of the governmnent illegally using this data to ration treatment, and will resist mightily.
Fourth, the best IT in the world doesn’t change the “silo mentality”. One of the anti-fraud techniques described by Prof. Parente is predictive modelling, whereby an attempted transaction that appears suspicious triggers an immediate phone call to the merchant or customer. (This has happened to me.) Again, I wouldn’t like to be the bureaucrat who tells Dr. Marcus Welby that his patient’s health card will result in him receiving an immediate phone call if he prescribes a treatment that is outside the norm.
Nevertheless, the paper is a valuable contribution, because health IT is pretty unacceptable today.
Computers are Digital (precise), Medicine and biology are Analog (imprecise). I’ve been reading pieces like Parente’s for over 25 years and though I believe there is much to hope for, we are yet another 25 years away from any meaningful benefit from healthcare IT.
This isn’t that it’s not important to pursue, to the contrary it’s critical, just that the benefits are less clear and require abundantly more IT sophistication that we currently have available at the provider end.
One more thing, in looking toward the financial system for hope and aspiration, one must remember that despite all the data, they failed to call the current crisis. A healthy skepticism is in order