President Bush and Congress have pledged to support an unprecedented rebuilding of the Gulf Coast communities that were devastated by Hurricanes Katrina and Rita. When it comes to healthcare, however, rebuilding should not mean simply replacing what was lost. Instead, we have the opportunity to create a model for the rest of the nation--a 21st century healthcare system.
A number of hospitals and countless doctors' offices, nursing homes, clinics and pharmacies were destroyed in Louisiana, Mississippi and Texas. As Joseph Cappiello, vice president of accreditation field operations for the Joint Commission on Accreditation of Healthcare Organizations, told the Associated Press: "Essentially the health infrastructure of New Orleans is gone--it no longer exists." Because of the scale of this calamity, the Crescent City and other communities in the region have the unenviable task of re-creating their healthcare systems.
A condition of federal assistance for this effort should be that robust information technology is integral to all health system designs. Although technology has revolutionized nearly every corner of our society, only 14% of physician practices have electronic medical records, according to a recent survey by the Medical Group Management Association. Hospital numbers are not much better. One of the primary obstacles to investment has been the cost to providers, because much of the financial return on investments in health IT--89% according to one study--accrues to those who pay the bills.
But on the Gulf Coast, the entire infrastructure is being rebuilt anyway, with the federal government largely paying the bills. We can build a smarter, safer and more efficient system, and probably save money in the process.
We should begin by making a personal health record available to every citizen in the affected areas. There is already a crash program under way to make these Web-based, patient-owned health records available to evacuees in shelters. With this system, health information won't be lost when people move to more-permanent housing.
Facilities must also have robust IT. There is no reason that any doctor's office should be rebuilt with big rooms for storing paper records or without broadband Internet access. Hospitals should be heavily wired and built with robust telemedicine capabilities so that rural populations can have better access to high-quality care. We should ensure that every provider who wants to switch to electronic medical records is assisted in doing so.
By integrally incorporating these technologies, we will be able to design healthcare facilities differently. In an electronically enabled health system, for example, we may need fewer hospital beds because lengths of stay are reduced and remote monitoring of patients from less intensive settings is available. Waiting rooms may be unnecessary as computers improve scheduling and reduce paperwork. With this sort of streamlining, building new, re-engineered facilities may actually prove cheaper than rebuilding what was lost.
The benefits of moving healthcare into the information age would be enormous for Gulf Coast residents. It could mean the end of those infuriating clipboards, of photocopying health insurance cards and being sent for duplicate tests. It could mean that a doctor or nurse seeing patients in an emergency room would always be armed with critical health information instead of asking what color the pills in the medicine cabinet are. Most poignantly, given recent events, residents of the Gulf Coast would never again have to worry about their entire medical histories being washed away.
Patients could communicate with their providers by e-mail and schedule appointments online if they wanted, and their chances of being harmed by a mistake or of missing important preventive care would drop. Meanwhile, doctors could see the number of claims rejected by health plans fall and the administrative burdens of coding and billing decrease as electronic medical records automatically generated bills to electronically send to health plans.
This revolution could have particular benefits for those living in poverty, provided we are sure to include their healthcare providers in these efforts. Low-income people move more often, are less likely to have stable relationships with providers and are more likely to have chronic diseases. There is no substitute for providing reliable health insurance, but at least with personal health records these individuals could consolidate their information and make it available to any authorized provider, making it far more likely that they will get appropriate and effective care.
I do not minimize the challenges in realizing this vision. It will require speedy, collaborative action by a number of stakeholders to ensure that privacy and security are iron-clad, that the right data are available when needed and authorized, and that physicians have the necessary support to make implementation and maintenance smooth. It will allow for changes in how medicine is practiced and accessed--changes that will take time to figure out. But these are not technological or even fiscal challenges. They are challenges of vision and leadership.
All of us are saddened by the tragedies that befell the residents of the Gulf Coast. But we might be able to turn calamity into opportunity if we can summon the initiative to build the future of healthcare rather than rebuild its past.
Rep. Patrick Kennedy (D-R.I.) is a member of the House Appropriations Committee's health subcommittee.