Debate surrounding health information technology, particularly electronic health records (EHR), has become increasingly dominant among health care-related discussions around the Web. Forbes.com chatted with Geoff Brown, CIO at Inova Health System (a Virginia-based not-for-profit health care service provider system consisting of hospitals and other health care centers), about the significant role health IT could play “in improving medical care, cutting costs and speeding up treatment.”

The health-care industry is a study in contrasts. On one hand, it employs the best that medical science has to offer. On the other, it is one of the least automated sectors from an IT standpoint.

All of that is about to change, however, spurred as much by the federal government’s push for cost control and accountability in health care as the industry’s own need for modern information exchange. The task for implementing those changes will fall on CIOs at hospitals and clinics, as well as the companies that outsource records and information for doctor’s offices and outpatient facilities.

Read the interview with Geoff Brown about health IT and hospitals

Matthew Holt conducted and posted three interviews relevant to two sides of the current health IT/EHR debate about, to use Holt’s words, “whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there.” Holt spoke with Glen Tullman, CEO of Allscripts, Mark Leavitt, Chair of CCHIT, and Jonathan Bush, CEO of AthenaHealth during HIMSS09. Describing his take on the two sides of the debate highlighted in these three interivews, Holt explained:

The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker.

Below is Holt’s interview with “cat” Mark Leavitt:

Find all three interviews on The Health Care Blog

On the NOW! blog, and at Left in the West, Jason Rosenbaum discussed how rural Americans are among those more severly affected by health care inequities and other problems, focusing specifically on Montana residents:

We are far more likely to pay higher out-of-pocket medical costs and incur greater expenses for emergency room care, and we are 70% more likely to be underinsured, according to a research paper published in Health Affairs entitled “Out of Pocket Health Spending and the Rural Underserved.” As Lil Anderson, Jim Paquette, and Nicholas Wolter – all Montanan health care providers – explained in the Billings Gazette last week, one in five Montanas is uninsured, rising health care costs are squeezing even families that have health insurance, and Montana’s small businesses and by extension, our families, are suffering…
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Montanans are suffering in a large part because there is no meaningful competition in our state’s health care market. According to the American Medical Association [PDF], one insurer, Blue Cross Blue Shield of Montana, controls 75% of the market. With competition like that, no wonder prices are soaring even faster here than in other regions of the country!

Read Rosenbaum’s complete, original post

Children’s Defense Fund President Marian Wright Edelman explained how a public insurance plan option could ensure health care coverage for children:

It’s plain that our nation’s health insurance system is broken: 46 million people in America lack health coverage–nine million of them children–and the number of uninsured is growing during the current recession.
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Our health care system is crying out for reform, and our families and children are crying out for help. Reform must include a public health insurance plan option that competes with private insurers to extend comprehensive benefits through first-rate health care providers at an affordable price. Without this public plan choice, the health of our children will continue to be held hostage to profit-driven insurance companies.

A public health insurance plan option would encourage competition on the basis of cost and quality, not by avoiding the sick and denying care, as is the current practice. The plan will also keep costs down by negotiating bulk discounts from providers and drug companies through pooling on the model of the Veteran’s Administration. A public health insurance plan option could be available nationwide to people who want it and deliver services through private health providers as Medicare does. Those satisfied with their current insurance could keep it.

The editors of the ScienceBlog Effect Measure (senior public health scientists and practitioners) called the lack of universal health care in America “morally and fiscally bankrupt”:

The idea that if the United States joins the rest of developed nations and finally adopts a universal health care system it will bankrupt itself is not based in reality. The reality is that the US spends a larger proportion of its Gross Domestic Product (GDP) than any other developed nation. By far. Not even close. CDC has just documented it from data collected by the Organisation for Economic Co-operation and Development (OECD) in its 2008 health data yearbook (statistics and indicators for 30 countries). It suggests we are being bankrupted by our lack of a universal health care system:

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The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US is that we placed health care financing into the hands of the same folks who helped make our economic system such a disaster: private insurance companies, who are little more than disguised investment banks with the added incentive not to pay back their depositors (the premium payers). We don’t need health care reform with a public option. We need one with public financing by default, perhaps with a private option for those who wish to and can pay extra for it.

Also discussing health care costs, Ezra Klein commented on OMB Director Peter Orszag’s discussion of a new study about hospital readmissions from the New England Journal of Medicine:

The peg here is a New England Journal of Medicine study that found “that approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 30 days. The authors estimate rehospitalizations accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare in 2004.” Health policy experts tend to think that many of those rehospitalizations are unnecessary, and substantial money could be saved by preventing them. In particular, Orszag notes that “the study found that rehospitalization rates vary substantially by geographic area…”
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This gets to a point Orszag has made before: A lot of attention accrues to international health spending comparisons. France spends X and we spend Y. But given differences in culture, system structure, doctor payment, population health, and much else, there are a lot of confounding variables in such comparisons. There are also, however, massive differences between different states in America. South Dakota and Florida aren’t the same, of course. But they’re not that different. And if we could get Florida to spend more like South Dakota, that alone would be a huge improvement.

View a map of Medicare spending across the US from the CBO on Klein’s post

Related posts:

1. Blog Roundup: President Obama's budget plan for health care reform
2. Video blog roundup: Health care reform debate goes public
3. Blog Roundup: The Economic Stimulus Bills and Health Care
4. How to save $40 billion in health care costs
5. Blog roundup: Healthcare IT and Meaningful Use

This entry was posted on Monday, April 13th, 2009 at 2:34 pm and is filed under Cost, Disparities, HIT/Health Gaming, Innovation, Roundup, Technology. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.