Transforming our healthcare system is one of the biggest challenges facing the U.S. today. In 2011, the first of 76 million baby boomers will turn 65, creating a dramatic and lasting impact on our ability to care for older Americans. The key to this transformation is technology, which can save untold billions of dollars and improve the quality of care.
Technology can help us better organize healthcare and create a system that is more rational, equitable and affordable. Millions of Americans do not have access to the medical expertise that exists because we don't apply information technology to the practice of medicine as we should.
It's always tempting to look to the future and think about what kinds of new technologies could be invented to improve the quality of care. And we do need to do that. But many of the technologies we need already exist. The challenge is to apply them.
As a nation, we have access to technology that seems limitless in its potential. Yet millions do not benefit from this know-how, because we do not adequately or routinely apply IT to the practice of medicine.
* More than 90% of the 30 billion annual medical transactions are conducted by phone, fax or stamped mail.
* Only one-third of hospitals have computerized order-entry systems-and fewer than 5% require their use.
* Only 5% of clinicians and 19% of provider organizations use electronic medical records.
* While we know that illegible penmanship is not a required course in medical schools, it is a popular elective. Yet fewer than 5% of physicians write electronic prescriptions. In 2003, Florida began requiring doctors to write more legibly. I think we often feel a little queasy when we see the mass-or maybe the mess-of handwritten notes from our own doctor and from others we have consulted. Can health providers actually make sense of all these things? Can anyone? I hope so. But it looks discouraging.
Happily, e-prescribing is included in the new Medicare law. This can produce enormous savings in pharmaceutical costs. It could mean:
* A reduction of administrative costs of about $4 per prescription for an estimated total savings of $13 billion annually.
* A reduction estimated at $10 per prescription for mail-order drugs, worth about $11 billion annually.
* Savings on formulary or generic drugs, estimated to be as much as $36 billion annually.
* Savings because of a reduction in prescription errors, a possible $36 billion.
* And untold billions of dollars saved in the decline of prescription fraud and abuse.
Better IT can foster better coordination and communication among doctors and nurses. It would help everyone get quicker access to information such as lab tests and X-ray results, help overcome memory overload and improve communication with patients.
I think of my own father, who has accumulated two sets of doctors, one in Florida and one in Pittsburgh. But his medical records don't travel with him. Just as we built the transcontinental railroad, using the same track gauge from one end of the country to the other, we need to build a national health information infrastructure.
We also have to figure out how to get the full benefits of other forms of IT that are available but not used in the delivery of healthcare. Informational databases with special reference to patients and their disorders could become routine. Physician consultation by telephone, fax, or e-mail is a remote delivery system waiting to be exploited-but barely is. We hardly think of them as technologies any longer. They are home appliances. Yet many physicians are reluctant to communicate this way.
Another form of technology, already in use in other industries, is radio frequency identification, or RFID. An RFID tag is a tiny chip with a transmitter that can be read by a hand-held device. Because it has 96 different variables, it is said that any given RFID system can be programmed to give a unique identifier to any object.
And this is a technology that is already being used-although in a limited way. Some retailers use RFID for what they call "item level tagging." For example, they put an RFID tag on a suit. Customers, before they pay for it, can go to a kiosk where an RFID reader will suggest a specific tie that would be especially attractive with that suit.
In healthcare, RFID can work in a similar way, perhaps when a patient has chronic condition or a physician needs to know a patient's medications. And in fact, it already is. The emergency room at the Regional Medical Center at Memphis (Tenn.) is using item-level RFID to keep track of patients. There seems to be no reason that we cannot tag patients-not to mention individual medications and other items.
We must keep in mind that technology is simply a means, not an end. The true goal, of course, is to make quality of care better, which will improve patients' lives. These wonderful devices we have now, and others waiting to be invented, must be used wisely, so that first-class healthcare is available, comprehensible and affordable.
So let's take these ideas and others and look ahead to a new vision for a healthy America in 2011-and beyond.
Bill Novelli is chief executive officer of AARP, Washington, which has 36 million members.