Presidencies end with criticism, but begin with advice.
President-elect Barack Obama began Wednesday receiving national intelligence briefings and met this morning with an ad hoc committee of financial advisers. So, were not jumping the gun by surveying a sample of healthcare leaders about their expectations as well as their advice for an Obama administration in promoting healthcare IT.
Matt King is a physician and chief medical officer of Clinica Adelante, a community health center in the Phoenix area. He is the chairman and director of WorldVistA, a not-for-profit organization promoting the use outside the Veterans Affairs Department of an open-source version of its public domain VistA clinical IT system. King recalled that both Obama and his defeated challenger, Sen. John McCain (R-Ariz.), included healthcare information technology as part of their plans for healthcare reform.
I know that President Obama noted healthcare as one of his top four priorities, King said. The real question is going to be how much is going to be in the budget, given the weak economy. Extending healthcare would have to include a fairly aggressive transition to healthcare IT. Assuming nothing catastrophic happens to the economy, I think its going to be a funding priority. I think theyre pretty interested in innovations.
King said WorldVistA leaders are very happy with the Health-e Information Technology Act of 2008, a piece of pending legislation sponsored by Rep. Pete Stark (D-Calif.), the chairman of the House Ways and Means Health Subcommittee, that calls for the Office of the National Coordinator for Health Information Technology to coordinate the development of an open-source software system for healthcare as a low-cost alternative for safety net providers. It specifically mentions VistA as a possible model.
I think its going to be a good four years for open source, King said.
King said that to demonstrate the power of VistA in his WorldVistA presentations, he uses a chart originally published in 2007 in the Washington Post showing inflation in per capita healthcare spending for VA beneficiaries compared with those same numbers for Medicare and all healthcare recipients between 1996 and 2004. The chart shows almost a flat line for cost increases of less than 1% for VA patients over the period, but a 45-degree angle for Medicare beneficiaries, whose costs increased nearly 45% over the period, and a line nearly as steep for the average person, whose costs went up nearly 40%.
It is pretty jaw-dropping, King said.
Don McCanne is a San Juan Capistrano, Calif., physician and a senior health policy fellow with Physicians for a National Health Program, which advocates for single-payer, universal healthcare coverage.
McCanne said, I think that we do need to use IT much more, EMRs and integrated IT systems. As an organization, We havent really pushed IT mainly because its been used in the debate over healthcare reform as a money saver. It probably wont be that. It probably will improve quality, reduce errors and improve some efficiencies. But the other concern we have is the privacy issue, I think thats a problem that they really havent addressed. Once you convert peoples healthcare information into electronics, its very vulnerable. Weve got to secure that information more effectively than what weve done. Youre going to need oversight.
Paul Tang is vice president and chief medical information officer of the Palo Alto (Calif.) Medical Foundation and has worked on several federal administration IT advisory committees. Tangs advice falls into three buckets.
First, Obama needs to find a way to ensure universal health insurance coverage to address disparities and alleviate injustices; second, reform the payment structure to create financial incentives for preventive health and wellness, and third, promote adoption of interoperable healthcare IT as a prerequisite enabler to delivering high quality, cost-effective healthcare.
As for achieving universal coverage, I have to leave that to Obama, Tang said. I think his approach is probably a good one. Lets not tear down the employer-based model, but hell have these pools that people will pay into if they dont have employer-based coverage.
Tang said the government needs to leverage its roles as the largest payer and healthcare regulator to develop reimbursement mechanisms to pay for health, not just treatment, through what he describes as person-centered health partnerships with healthcare providers.
I believe the current direction of medical homes is too tethered to the (current) medical model, he said. I think patients should have much more of a role than the traditional medical model that relies more heavily on physicians in their offices. People should be more self-reliant. There is a need to provide patients with the data, knowledge and tools they need to step up to that partnership, he said.
Personal health records will have your health data, but it would need to be an integrated PHR with your provider. The tools could be as simple as what can help me follow my blood pressure or my glucose, Tang said.
Given the limited resources available after dealing with the financial crisis, of his three top priorities, Tang said working on adoption of interoperable health IT, or electronic health records and PHRs, may be the lowest cost option. It also may be the easiest to accomplish compared to the other two, and would be an enabler to tackle the other two later, he said.
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