Originally published in Medical Home News, June 2009 In the nearly two-decade quest for U.S. "health care reform," a strange sight occurred this May—President Barack Obama at the White House, surrounded by doctors and representatives of the insurance industry, hospitals, pharma- ceutical companies, and labor groups, all signing on to an agreement to reduce costs by roughly 1.5 percent per year industry-wide over the next 10 years. That may not sound like much, but due to the vastness of U.S. health care, the sum is expected to approach $2 trillion (although there has been some significant hedging on that figure since). A reduction of that size would nearly halve the percentage of gross domestic product spent on health care by 2020. Signees say they expect to achieve this goal by "coordinating care, reducing administrative costs and focusing on quality, efficiency and standardization." Hardly a concrete road map, and critics of the agreement cited the lack of specifics in questioning whether the financial goals would come to fruition. But on one thing everyone agrees: the U.S. health care system is broken. In hailing the deal, the President painted rising U.S. health care costs as an albatross around the neck of Americans. "Half of all personal bankruptcies stem from medical expenses," he said. "What is a growing crisis for the American people is also becoming an untenable burden for America's businesses. Rising health care costs are commanding more and more of the money that our companies could be using to innovate and to grow, making it harder for them to compete around the world." The U.S. spends more than any other nation on health care, with some of the worst results. The country ranks 41st in terms of life expectancy, for example, and some 50 million Americans have no health coverage at all. Today the cost of health care in the U.S. is already north of $2.25 trillion and heading toward 20 percent of gross domestic product. That burden is increasingly harmful to other public investments, such as education, that provide an infrastructure for future economic growth. So what's to be done about all this? Currently the cost and intensity of care varies dramatically across the United States, without much variation in the quality of results. Presumably the industry will work to identify those approaches that maximize cost to benefits and standardize on them. The Administration, of course, has been working on this issue since before inauguration day, and a central element of the Obama plan involves a sizable investment in the health care system's technology infrastructure. As much as $50 billion could be invested into the nation's health care technology, with electronic medical records the first priority, and doctors given a range of incentives to get on board. Health data is a huge and largely untapped asset for medicine, but there is much more to health care IT and its implications. Electronic medical records are just the beginning — what will really move health care forward in the United States is the way we use technology to provide more efficient care. It is estimated that 30–40 percent of visits to primary care doctors are people seeking information, reassurance, or just to better understand something they're concerned about. For the U.S. health care system to survive, these kinds of very simple consultations, and some forms of care delivery, must move away from the confines of the physician's office to online and in-home care. This is especially true when it comes to senior care, assisted living, and community nursing programs. In the same week as the industry announcement last May, Mr. Obama also praised the efforts of companies such as REI, Safeway and Microsoft in focusing on health rather than curing illness, and reducing expensive acute care in favor of more preventive measures. Microsoft, for example, has cut as many as 10,000 emergency room visits from its health care costs by encouraging physician house calls. Microsoft's "mobile medicine" program sends doctors to employees' homes to prevent costly emergency-room visits for problems such as coughs and skin wounds. According to Cecily Hall, the company's director of benefits, "We save a little over $200 every time we replace what would have been an emergency-room visit with a house call." Given that, think of the savings that can be achieved by something as simple as giving community workers mobile phones, Tablet PCs and other technologies to stay connected with patients. How about placing sensors and devices in the home so that nurses and doctors can call on patients remotely, staying in touch with them via email and even videoconferencing? These approaches can actually improve the amount of monitoring that patients receive, while at the same time creating efficiency for the doctors and nurses involved. With social networking and Web 2.0 technology, we can now also build solutions that enable patients to be more engaged in their own care. The evolution of these systems may one day help us redistribute health care resources. Microsoft took a step toward enabling these kinds of health care processes in October 2007, with the release of its comprehensive software platform for the health care industry, HealthVault. HealthVault provides a secure place for patients to store and share medical records, as well as a programming interface that will essentially "plug and play" with a wide variety of devices consumers bring into the home, such as glucometers, blood pressure cuffs, spirometers, smart scales, fitness devices and more. HealthVault provides a way to aggregate health information around each patient, making it available wherever the patient happens to be, and allowing a holistic picture of a person's health history to be shared among various practitioners. This can be especially helpful for a person with a complicated condition, such as diabetes, that requires input from a variety of professionals. HealthVault was also designed as a software "platform," meaning that technology companies in the health care industry, or providers themselves, can easily create new applications to use patient information in beneficial ways. Information is power, but Web technologies can also be used to streamline processes and reduce costs. For example, India has a surplus of radiologists. We are now able to use communication and collaboration technologies to allow these skilled professionals to interpret medical images from around the world. Such "tele-radiology" services not only redistribute the available pool of radiologists, but also improve service continuity across global time zones. This practice also shifts routine diagnostic tasks to a region where those skills are less expensive. Another example can be seen in work going on at Massachusetts General Hospital (MGH). Dr. Ronald Dixon, director of the Virtual Practice Project at MGH's Department of Medicine, is working with his colleagues on a kiosk solution that promises yet another approach to help redistribute and scale medical services. The kiosk under development is able to take a patient's medical history and vital signs. It may also provide simple blood tests like glucose and cholesterol. Results coming from a patient's encounter with the kiosk can be electronically forwarded to a nurse or physician for further evaluation and appropriate intervention. Researchers plan to pilot the kiosk solution later this year in the United Kingdom. These examples are really just scratching the surface of what's possible today. So when debating whether the cost containment measures announced this spring could actually happen, we must realize that health care reform in 2009 is a fundamentally different discussion than we had in the 1990s. Today we have mature technology to provide part of the solution, to create efficiency in running clinics and hospitals, to facilitate the actual delivery of care, and to give citizens new tools that can help them learn to lead healthier lives. Today we also have the will to invest in the health care system. At the highest level, we have come to see that the health care challenge is also an economic challenge, and as with so many other things, economic necessity can drive this evolution. The appearance at the White House this May of groups such as America's Health Insurance Plans, the American Medical Association, the American Hospital Association, the Service Employees International Union, and the Pharmaceutical Research and Manufacturers of America underscores a major shift that is occurring in the U.S. philosophy on health. In order to make it happen we have to reward providers for extracting costs out of the system, for preventive services, for meeting patients’ needs in ways other than simply having them come to the hospital or a physician's office. We need public policy that rewards innovation. By leveraging today’s tools and technologies, we can not only satisfy patients' need for information, but also deliver many medical services more efficiently by using settings outside of acute care hospitals such as the patient's own home. The end isn't simply getting health care to "go digital." It is really about the clinical and business processes that are enabled by this technology, and being very clear about the outcomes we hope to achieve. It’s not just about the technology, but how we use it. Ultimately, the efficiency and savings to be gained from these approaches should play a major role in turning around the health care conundrum both socially and economically, and improving the health of our citizens.
 | Dr. Bill Crounse, M.D.
Dr. Bill Crounse, M.D., is senior director, worldwide health for Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. Also, read Dr. Crounse's Healthcare Web log to get more insights into the latest technologies and trends in the healthcare industry. |
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