Doctors Often Block Information Technology Reforms
While information technology has "enormous potential" to revolutionize the American health care system, many health care providers have not embraced new advances, according to a panel of experts who spoke at an eHealth policy briefing last Friday in Washington, D.C. They said that technology such as the Internet could boost productivity and efficiency, in the U.S. health care system as well as reduce medical errors and costs. "This intersection of health care and technology ... is becoming more and more prominent," Sen. Bill Frist (R-Tenn.), who served as moderator of the briefing, said. Still, he added that "the wholesale penetration of information technology in health care ... has not yet taken place," pointing out that "physicians have been slow to reach out and evolve."
According to Dr. Joseph Scherger, chair of the Family Medicine Department at the University of California-Irvine Medical School, "The Internet has enormous potential to improve care, yet care delivery is untouched by it." He called information technology a "key" to reducing medical errors, which according to a 1999 Institute of Medicine report kill up to 98,000 patients a year. For example, he said that computerized physician order entry systems, which some hospitals have used to help eliminate medication errors, could reduce adverse drug events by more than 50%. "It is inexcusable that these technologies exist," but health care providers fail to adopt the new advances, Scherger said. He also pointed out that "government is paying for these mistakes" through Medicare and Medicaid, adding, "There must be a mandate for this technology for safety. That's really a major job of the government." In addition to reducing medical errors, Scherger said that technology could "make care more effective" and "timely" through computer-assisted diagnosis and reminder systems to inform patients when they require medical tests. He also said that by establishing "asynchronous" information-sharing systems "available 24 hours a day, seven days a week" through electronic messaging, hospitals and doctors could reduce delays and provide care with "much greater efficiency."
However, according to Dr. Mark Leavitt, founder and chair of Medscape, several barriers prevent physicians from adopting information technology systems. He pointed out that doctors who implement such systems often receive criticism from health plans and other doctors. "No good deed goes unpunished in the [U.S. health care system]," Leavitt said, adding, "The system does not reward quality. The system does not insist on safety. That's one of the things that has to change." In addition, he said that information technology systems -- including software, hardware, installation and training -- often cost up to $30,000 per physician, adding, "That's not capital that physician groups generally have." Leavitt also pointed out that doctors' attitudes toward technology, as well as technical issues, may prevent physicians from embracing new advances. While he admitted that the Internet has helped overcome some of the obstacles, Leavitt said that "financial and systemic barriers remain." Pointing out that the health care industry spends only 3.9% of its budget on information technology, he concluded, "We're going to have to rewire the motivations and the reimbursement system [in U.S. health care] so that the doctors get wired."
Dr. Mark Smith, president and CEO of the California HealthCare Foundation, acknowledged that eHealth could trigger a "revolution," prompting "dramatic changes" in the U.S. health care system. Still, he warned, "Like all revolutions, this one has some potentially dark sides," including the issues of patient privacy and quality of information on the Internet. "It's great that people are getting this information," Smith said, but he added, "The question ... is what do you get when you get it." He also addressed the role of not-for-profit groups in eHealth. Over the past five years, a "tsunami of innovation and development" has risen in health care, but according to Smith, the "tsunami of the venture capital that formed it has started to recede," leaving a number of "beached organisms." He said, "We're beginning to see some things that were great ideas, and are still great ideas, but it turns out were not perhaps profitable ideas, or at least not yet." In the future, Smith said that not-for-profit groups will have to "walk down the beach and look through some of the beached organisms and see which of them we may want to salvage." He concluded, "People have learned the hard way that just because it's a good idea ... doesn't necessary mean that you can find somebody to pay for it" (Josh Kotzman, California Healthline, 6/18). To view a Webcast of the briefing, sponsored by the Alliance for Health Reform and the Forum on Technology & Innovation, go to www.kaisernetwork.org/healthcast/alliance/ehealth/jun01.