Health-Care I.T. – A Modest Prescription to Remedy Health Care’s Ills

When Dr. Paul Ellwood invented the health maintenance organization in 1970, he wanted to improve care through competition and a focus on preventative medicine. Unfortunately, it didn’t work out that way. Managers at the time used HMOs to cut costs. And in spite of those efforts, climbing health-care costs are a famous fact. In 1960, health care made up 5 percent of the gross domestic product. By 2000, it hit 13 percent, according to the government.

Now Ellwood, among the most important voices in American health care during the past three decades, believes there’s only one way to fix the nation’s health-care system: Embrace computers. “Computers are our best and only chance of getting around the problems we’ve got,” says Ellwood, who was a consultant to President Clinton during his failed attempt at massive reform in the ’90s.

Late last year, Ellwood and his band of reformers known as The Jackson Hole Group convened for the first time in six years to take another stab at reform, this time with an IT bent. The timing?the economy is in recession and medical bills keep rising?was not happenstance.

Neither was the heavy IT focus. Ellwood wants to use IT where he sees others abusing it. He is troubled by a new generation of CRM-driven health-care policies that let policyholders set their level of coverage?in effect letting healthy people pay less and putting more of the cost burden on the sick. (For more on this, see “CIOs at the Heart of Health-Care Change,” at www.cio.com/printlinks.) That is, in effect, rationing, and Ellwood says it’s the “dumbest idea around. The whole idea of insurance is that you’re supposed to pool the risk to help pay for the sick.”

Instead, The Jackson Hole Group (which supports universal health care) now wants to use IT to create “personal health journals”?a voluntary system of electronic medical records that would contain an individual’s entire medical history. The key is that the patient would control his records. Not the doctor or the hospital or the insurance provider.

Those journals would be standard, open and not cooptable by proprietary technology (for example, one hospital wouldn’t force its patients to adopt that hospital’s standard and henceforth be “locked in” to that hospital because of the format of the records). They would be Web-enabled and viewable from a doctor’s handheld or an insurance company’s office.

Ellwood envisions a new Institution for Medical Practice and Technology implementing the journals first through Veterans Administration hospitals.

There’s more to Ellwood’s plan than these patient journals, however. He wants to accelerate the development of clinical care apps, like physician order-entry for prescriptions or electronic film transactions, so that patients get better care and the resulting reduction in errors can lower malpractice claims.

Ellwood knows there are barriers to this latest plan?privacy being a big one. Huge up-front technical investments are another. But Ellwood also feels that a big barrier?doctors’ complaints about data entry?is gone. “You can get data in quickly now, and it’s routine and systematic. The discipline of IT systems will actually create disciplines and efficiencies in health care,” he says.

Ellwood believes this plan can fare better than the HMO. He adds: “We have the power to make the health-care system more ’progressive,’ instead of letting it remain stuck in its traditional guild-like ways.”