EHRs and the Science of Care: This Generation’s Moon Shot?

This post was originally posted by me on the EHR Guy’s blog on Oct. 7th, and I’m reposting here for the record.

Remember 1999? Folks were promoting the Human Genome Project as the generational equivalent of the lunar landing and Columbus discovering America. Over the long term, they will likely be right, but the event itself was largely symbolic. Now we’re undergoing another major event, with little to no symbolism (certainly not enough), even though the very short-term benefits are potentially earth-shattering. I’m speaking to the potential for ARRA/HITECH in the improvement of medical care, which should be heralded as this generation’s moon shot.

Sure, I know what you’re thinking: there is perhaps no safer bet than shorting the success of HIT initiatives. Once again, it would be easy to predict failure at trying to fix a such a complex, non-adaptive  system. However, the simple difference here is that never before has anyone been able to answer the fundamental economic question of “who will pay for EHRs?” , and few have decided to pay, because it’s never been exactly clear who would stand the most to gain.

Here is what I think has been the crux of the problem as far as who could gain: For the most part, when we talk about medical records, we’re speaking to the continuity of care they can enable, which may work as a rather fuzzy, feel-good mantra, but what is too often overlooked is the science of care a national system of EHRs will enable. 

And so far, the results we are seeing indicate that even a partial success will produce stunning results. I imagine payers will be kicking themselves in years to comes asking, “Why didn’t we do this sooner?”

Exhibit A: Kaiser Colorado.  Kaiser’s Collaborative Cardiac Care Service (CCCS) “uses an electronic medical record and patient-tracking software to document all interactions with patients, track patient appointments, and collect data for evaluation of both short and long-term outcomes.” Studying over 10,000 patients has demonstrated that their integrated CCCS system has reduced mortalities associated with Coronary Arterry Disease (CAD) by a whopping 76%! Newer data suggests EHRs systems that regularly communicate with patients are highly effective at maintaining target lipid levels. Studies such as these strongly suggests that, as part of a coordinated care program, a nationwide system of EHRs may will be as historic as the lunar landing (and certainly no less difficult), but with direct and immediate benefits of millions of lives and hundreds of billions of dollars saved. As noted by David Blumenthal, the national coordinator of HIT, said earlier this month, “One thing we haven’t done is apply the scientific method in the practice of healthcare and medicine.” We as a nation have gone too long researching the mechanism of disease with far too little time spent researching the best practices in the delivery of care.

Other collaboration technology studies are beginning to show equally impressive results. A third party survey of Syndicom’s (a client) case-based physician collaboration communities have found that 90% of spine surgeons using these case collaboration tools feel they improve their ability to practice surgery and make recommendations. Within Syndicom’s community alone (over 1,000 spine surgeons), we’re talking about thousands, perhaps tens of thousands of patients with improved outcomes, reduced pain, and reduced costs on our health care system. Collaboration has been a cornerstone of medicine for centuries (think grand rounds and tumor boards), yet we are just beginning to see the benefits of web-based collaboration.

If HITECH succeeds only partially in increasing medical collaboration and communities, the $20 billion spent will be a bargain. In a nation where total medical and social costs attributed to CAD alone tops $475 Billion and affects 80 million Americans, the cost savings and life improvement potential is nothing short of spectacular for implementing a nationwide Kaiser-like CCCS system. When ten percent of patients account for 80% of all health care costs and 75% of those costs are related to chronic diseases such as CAD, the effective management of these diseases through effective health information is more beneficial than even the greatest blockbuster drug at reducing time in the hospital for high cost treatments and mortality. Savings of $50 Billion per year in CAD patients alone for a nationwide, connected EMRS is not unrealistic.

Studies such as those above suggest that we’ve been thinking about HIT the wrong way. If these technologies can improve patient outcomes so dramatically, shouldn’t they be considered part of the standard of care? Networked communication tools can improve treatments and protocols across the disease spectrum. If your cardiologist found a treatment that increased survival by 76% in all CAD patients over a 2 year period, could he be found negligent for denying the use of it? Would Medicare reimburse it? Absolutely! When you think of HIT as a method for improving treatment outcomes, it really makes perfect sense that the majority of ARRA/HITECH is funded as a CMS remibursement. The HIT portion of ARRA is a one time (hopefully) Medicare reimbursement for a systemic treatment that’s long overdue.

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