Gadgets are the real American obsession. In no other country do people have such a transcendent belief in technology as the salvation for all of its problems. Where would we be without our camera cell phones, two-way messagers, Blackberrys, wireless laptops, iPods, global-positioning systems, HDTVs, digital camcorders, satellite dishes and dashboard DVDs?
And that's just personal electronics. In business, the military and government, faith in things digital is supreme.
At recent healthcare conferences the ballrooms have been humming with hardware. Cell phones, pagers and instant messagers are ringing or vibrating incessantly. Notes are being punched into hand-helds. Every speaker is hard-wired to a PC.
At one event I attended a speaker was so flummoxed by the failure of his PowerPoint presentation that he kept several hundred people waiting for 20 minutes while a technician fixed the glitch. Everyone in the audience had precisely the same slides in paper form and the speaker had a hard copy of his talk, but without PowerPoint the poor man was unable to proceed.
The speaker was a living (I think) example of how the purpose of a technology is secondary to breakthroughs in computing power and microcircuitry. This may go far toward explaining a critical conundrum in our healthcare universe. How is it that the U.S. can lead the world in medical devices and healthcare spending yet achieve such poor outcomes compared with countries that spend far less? As reporter Cinda Becker details in her most interesting special report (p. 26), we often develop and export great technology but use it inefficiently here. We replace the old with the new before realizing significant return on investment. CT leads to PET to combination PET/CT without any evaluation of the best uses of the earlier incarnations.
One of the reasons for the spending-outcomes dichotomy is that the U.S. has failed to buy the technology that streamlines care and reduces medical errors. Other countries have invested far more in electronic medical records and computerized physician order-entry systems that move patients through the system quickly and safely. Those systems also help track patients with chronic conditions, who account for the majority of health spending. In our special report, Becker profiles Thailand's Bumrungrad Hospital, which manages to treat 1 million patients per year, seeing patients three times faster than in the U.S. The key difference is that the hospital implemented a fully integrated IT system, replete with EMRs, digital radiology and bar codes on everything.
President Bush has asked for a national electronic medical record system by 2014. There have been notable efforts in recent months to adopt standards for such a system. Other countries have already invested significant government funds and pushed harder on the healthcare system to work together to achieve a common IT system. Our government, meanwhile, offers little in the way of help to get this process moving. Imagine if President John F. Kennedy had promised to land a man on the moon within a decade and then said we should find someone else to pay for it.
A modest proposal: Allow the CMS to negotiate prices with pharmaceutical companies for the new Medicare prescription drug benefit. Use the savings to help fund information technology that will save hundreds of thousands of lives, thus saving additional billions of dollars in future health spending.
Another: Hospitals that haven't adopted EMRs and electronic ordering systems should stop building new facilities and buying latest-generation imaging equipment and use the savings to get into the IT game.