I’ve commented about the absence of any meaningful cost containment in the new health reform legislation. It’s not that I favor direct government command and control over spending. So what could the government do to promote efficiency? Very little, and yet quite a lot. After decades of talk and years of effort, it is time to give us integrated EHR. Not the type that the politicians and doctors are talking about, which is EHR for doctors only. We need EHR for managers. Think of EHR not merely as a medical decision making tool, but as a management decision making tool.
I cannot understate the importance of management-focused EHR. Without EHR, we cannot hope to measure either costs or quality. The lack of this basic information doomed physician hospital organizations and integrated delivery systems and is posing insurmountable obstacles to report cards, pay for performance, and accountable care organizations. The idea is so simple and yet no one wants to accept it: if you can’t measure something, you aren’t going to improve it.
The Obama administration is continuing the EHR initiative begun under Bush. But these EHRs are for doctors’ eyes only. And they will not contain the cost or outcome information required to make them effective as management tools. If we don’t fix this, we may as well give up on reforming healthcare delivery. We will have the same messed up fragmented system where no one is accountable to anyone for their costs or quality.
What will it take?
Integrated health records that link patient information across all providers. We are getting there, but not everyone is on board. EHR providers fear being driven out of business (this is a common worry when there is a standards battle.) More problematically, doctors don’t want the kind of transparency that EHR will bring.
Linking clinical and administrative data. We need risk adjusters to do proper quality measurement and this means making clinical data available to managers.
Outcomes data. The outcomes data currently available is shockingly limited. We can measure the quality of an automobile in a hundred different ways. Why can’t we get decent health outcomes data? It can be done, and there is some amazing ongoing research that points the way. Getting this information into EHRs should be job #1.
Won’t this all create concerns about privacy? I don’t think so. Employers and insurers can learn any evil tidbits they need to know from administrative claims data. There have been no privacy scandals thus far. Adding de-identified medical information to the mix wouldn’t threaten privacy, but how it would dramatically improve care delivery! I don’t see how we can reform healthcare delivery without it.