From cramped offices in a quiet corner of Boston's Brigham and Women's Hospital, a team of Harvard Medical School researchers is perfecting its model for rewiring the healthcare delivery system.
Members of Harvard's Decision Systems Group envision a system unfettered by geographic or physical boundaries, in which a hospital's radiology network would consist of top doctors at several academic medical centers.
They imagine a day when patients will be "introduced" to network specialists through pictures, voice-overs and detailed profiles available on the World Wide Web.
They see the potential to slash an easy 10% from the nation's $1 trillion healthcare price tag by eliminating time-consuming information gathering and distribution efforts.
The team's model bears little resemblance to popular healthcare integration strategies involving mergers and other risk-sharing arrangements. It doesn't require hospitals to purchase primary-care physicians, nor does it rely on the creation of physician-hospital organizations.
In the researchers' view, contracts among providers and insurers represent a tiny piece of the solution.
"What we're talking about is radically different," said David B. Friend, M.D., a visiting scientist with Decision Systems Group's production division and global director of healthcare consulting in the Boston office of Watson Wyatt Worldwide. "The key is (creating) a new, efficient system," he said.
Using the 1970s gasoline shortage as an analogy, Friend said most healthcare consultants are focusing on the wrong problem.
"They're all evaluating the gas station...not how many miles a gallon did you get," he said. That thinking has resulted in a proliferation of "preferred-provider gas stations" and "managed gas stations," all of which are trying to ration the "gas."
According to Friend, if people bought solely on cost, "everyone would be driving a Yugo." In his view, healthcare executives shouldn't be focused on rationing care to drive down costs. They should be figuring out how to get more miles to the gallon. "The future of healthcare is making the engine more fuel-efficient," he said.
Under a partnership agreement, Watson Wyatt and the 25-member Decision Systems Group are developing software and integration technology to help hospitals become fuel-efficient "virtual healthcare systems." In a virtual system, each provider-from the hospital to the home health agency to the durable medical equipment company-is connected to the others through computer systems, eliminating wasteful paper trails. Ownership changes and reorganization are byproducts of integration, but improved information flow is what really generates efficiency.
"We essentially are the orchestrators who allow this coming together to happen," said Robert A. Greenes, M.D., director of Decision Systems Group, a "medical informatics" research and development laboratory.
For proprietary reasons, Greenes can't reveal details of how the lab integrates different hardware and software technologies used by members of a healthcare network. Simply speaking, researchers employ existing architecture to build databases and combine them. "We don't have to start from scratch and build everything in its entirety," he said.
Since its creation 18 years ago, the lab has focused on improving medical decisionmaking and cost-effectiveness through information technology, Greenes said. The virtual healthcare integration project provides the latest, expanding venue for information-based healthcare integration.
The lab operates on a $3 million annual budget funded through government grants and contracts, including funding from the National Library of Medicine and work for the Defense Department. Its 2-year-old multimedia production division, the Innovation Center for Information Technology in the Enterprise, or InCITE, has a $1 million budget that's expected to grow as new clients sign on.
Greenes and his team have developed several healthcare-related products, including a computer tool that helps healthcare managers make organizational and financial decisions and an interactive program that teaches kids about effects of drugs on the brain.
And Friend is working with an undisclosed airline that sees the potential to reweave the healthcare delivery system. It sees an opportunity to break into the healthcare delivery business using its experience in information systems, risk assumption, billing and customer relations. Hospitals no longer have a corner on healthcare delivery and need to recognize airlines, banks, hotels and manufacturers as potential competitors, Friend noted. Hospitals "are not necessarily the people named in the will to inherit this business," he said.
The group at Brigham has received numerous calls and visits from healthcare providers across the country who've gotten wind of their latest work for Partners HealthCare System, said Jonathan L. Schaffer, M.D., an associate director of InCITE. Eight months ago, the lab entered a contract with the Boston-based parent of Brigham and Women's Hospital to provide information strategies that will increase the system's efficiency and sharpen its competitive edge. The lab's first effort, a doctor directory containing the biographies of Partners' 4,000 specialists, will be rolled out systemwide April 1 and eventually could be made available to the public.
The objective is to ensure that Partners' approximately 550 primary-care physicians are "as efficient and as effective as they can be," said John Glaser, vice president and chief information officer of the two-hospital system.
Say a primary-care physician needs to refer a patient to a breast cancer specialist. With a few clicks of a mouse, the system allows a doctor to pull up a list of specialists, their pictures and individual profiles. The system provides details on doctors' degrees, residencies, fellowships, clinical interests and languages. Need a specialist who speaks Chinese? No problem.
Luke Sato, M.D., an associate director of InCITE, said the data collected for the project include specialists' fees and the insurance plans they accept. "But we're deliberately not broadcasting those things," he said. A Partners committee selected the information to be included in the profiles, he said.
Even without that data, Friend believes the system will provide patients with a level of comfort they can't get by paging through a directory of physician names and addresses. Eventually, it could be updated with video and audio clips of physicians talking about their clinical interests and experience, he said.
With the proper tools, doctors will spend less time pushing paper and have more time to "think and process," Friend added.
To some degree, the referral system also represents a competitive response to marketplace changes, Glaser said. He compares it to the application of computer technology to the banking industry. In banking today, "I better have an ATM (network) if I expect to compete," he said.