A Letter to President-Elect Obama on HIT
November 5th, 2008
Dear President-Elect Obama,
Congratulations on your historic win. As we emerge from the first decade of the 21st century, I agree with your campaign message that there is great opportunity for change and the ability to harness new ways of looking at existing problems to propel us forward as never before. As President, you will have many complicated issues to address and manage, both foreign and domestic, more so than perhaps any incoming President in the history of this great nation.
Despite a lengthy campaign that covered so many issues, I am still left with this huge question, “How will we manage healthcare going into the 21st century?” Having practiced emergency medicine for 17 years, I know the shortcomings of our employer-based healthcare insurance system and our inability to address the under-insured.
Having also been in the health IT field for many years as a CMIO, I have also know the challenges of implementation cost and difficulties with EMR adoption from an organizational and clinician perspective. In my more recent role as a vendor, I speak daily with customers who have spent millions deploying transactional systems yet cannot get the data they need for quality improvement, cost analysis and business intelligence.
During the campaign you talked about improving healthcare; about using IT to improve efficiencies with healthcare delivery; about how to control costs, improve access, and focus on quality. All of these are necessary, but wholly insufficient. The real challenge today is to not fall into the same old “business as usual” healthcare policy approach, and ultimately pave a “new” cowpath replete with 20th century approaches and solutions.
When you look at other westernized countries like Canada, the Netherlands, and Sweden–these nations spend significantly less on healthcare delivery, have higher quality outcomes and provide better access than the US. While there may be lessons to learn from these successes, solving the number one public health problem of chronic disease remains elusive, even for these leaders in healthcare delivery.
Chronic disease utilizes 70-80% of all healthcare expenses in the US today and in large part, this statistic holds true worldwide as well. Our current episodic approach to care of chronic disease is not only expensive, but fails to provide optimum “health”. The World Health Organization predicts that a single disease–Type 2 Diabetes–alone, has the capability to bankrupt national economies over the next 25 years.
No proposed plan has as yet been able to harness the energy of the consumer, as patient, as caregiver, as investigator of medical illness and therapies. Our current century old method of delivering healthcare is focused solely on the provider and episodic care, relegating the consumer to passive participant. Asking the consumer to simply “pay more” as a proxy for active engagement in their health is not sufficient, especially in a world of increasing numbers of under-insured. To solve this and other healthcare challenges, we must engage and enable consumers in the management of their health.
What fundamental change in how we manage health in the 21st century and technology in large part will create that transformation? Imagine America, for once, leading the world in this transformative approach with the consumer-as-patient at the center of healthcare delivery and quality, particularly for those with chronic illness.
Technology exists today that allows consumers to get, store, and share their personal health data, and information on their family members as authorized. Every consumer should automatically be given this information electronically–without having to ask–from the local pharmacy, doctor’s office, diagnostic center, health plan, or inpatient stay. Having all personal health data in one place is just the start to helping consumers-as-patients understand more about their health.
Add to that the capability of this technology platform to capture data from home devices such as a glucometer, sprirometer, weight scale, an implanted cardiac device, blood pressure machines–and suddenly you have the building blocks of something never before possible. Now take this information collected in “real time”, in the patient’s home or wherever the patient happens to be, and instantaneously relay it to a case manager, a nurse, a doctor and now you have the amazing ability to manage health in REAL TIME, averting worsening symptoms before they progress to the point of an emergency department visit or hospitalization. “Real Time” intervention to forestall exacerbations of chronic disease CAN occur TODAY using these types of technologies. This patient centered technology enabled “real time” approach as the cornerstone of our healthcare delivery system will fundamentally and forever change the way we enable health and manage chronic disease.
So how much will this cost? That depends on how it is done. How much did the Internet cost? Billions of course, but it barely registered because it was done in the usual course of business. And so can this.
During your campaign you demonstrated that you understand the value of new media and how to harness that power. You have used that knowledge more effectively than any other leader today Why not use that knowledge to inspire consumers to manage their health? You are in the unique position as our 44th President to fundamentally and forever change the way we manage health and particularly chronic disease in America. At this moment, perhaps only you have the opportunity to set the standard for the world to follow.
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