HIT and the practice of medicine in Texas

Posted on July 13, 2009 by Steve Fox and Vadim Schick

While we anxiously await ONC's preliminary definition of "meaningful use" (due to be published on Thursday of this week), let us consider the future of American healthcare through the prism of recent industry analysis and new developments in Texas.

The New York Times Bits blog had a posting today about "an ambitious experiment" at the Cook Children's Health Care System in Ft. Worth, Texas.  Cook Children's is implementing a new EHR technology system (see details after the jump) which the administration hopes "will help the clinic improve care management and curb costs."  This outcome-oriented approach is also consistent with the payment and reimbursement structure at the clinic: "a capitated payment -- a set annual payment for each patient, instead of the standard fee-for-service system of American health care."

This development reminded me of Atul Gawande's fascinating article in The New Yorker last month about the bottom line-driven culture of hospitals and medical practices in McAllen, TX, which, according to his analysis, may lead to significantly higher cost of health care, while showing no real improvement in the quality of care.  The article contrasts the McAllen model with an outcome-oriented, collaborative model of practice of medicine in such healthcare enterprises as the Mayo Clinic in Minnesota and Grand Junction in Colorado, which produce better quality of care while significantly lowering costs.

According to the the Bits blog:

[Cook Children's] plans to install Web-based electronic health records and data integration technology at its 60 offices and clinics throughout Texas. It is also offering personal health records, controlled by the families of its young patients, that can follow them throughout their lifetimes.

The Web-based health records will be supplied by AthenaHealth, while the data integration software and personal health records will come from Microsoft.

The most intriguing thing Cook Children’s has planned is probably its prototype Innovation Clinic. It will be a small physician office, with two or three doctors. Small practices are the biggest challenge for electronic health-record adoption, since they cannot afford full-time technical helpers. The 2,000 to 3,000 patients will be from Medicaid families — lower-income homes where chronic health problems are most common.

The clinic, said Ryan Champlin, vice president of operations for Cook Children’s, will emphasize family engagement and preventive care.

Is outcome-oriented practice of medicine the answer to some of the major problems of the U.S. healthcare system? Will the final health reform bill, if passed, incentivize or address these issues?  While the answers to such questions remain uncertain, it is clear that health IT will play a crucial role in the future of healthcare in the U.S., and is absolutely essential to the collaborative medicine model adopted by providers like Cook Children's.

Atul Gawande, "The Cost Conundrum," The New Yorker (June 1, 2009).
"Electronic Health Records: A Texas Model," The Bits Blog (July 13, 2009).
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Nationwide EHR adoption critical to health care reform

Posted on June 10, 2009 by Steve Fox and Vadim Schick

Sen. Edward Kennedy (D-MA) revealed the first draft of the healthcare reform bill, the "Affordable Health Choices Act."  Competing versions of the healthcare reform legislation are expected shortly from senior House Democrats, including Energy and Commerce Committee Chairman Henry Waxman (D-CA), and Sen. Baucus (D-MT), chairman of the Senate Finance Committee.  According to the Los Angeles Times, while the various drafts will differ significantly, congressional Democrats agree on three broad goals for the new healthcare framework:

  • Improving the quality of care for everyone by encouraging doctors, hospitals and others to adopt the best, most effective courses of treatment.
  • Curbing the explosive growth in costs by prodding the medical system to make more cost-effective decisions and to increase efficiency by moving to computerized medical records.
  • Expanding coverage to those who do not have health insurance.

Sen. Kennedy's bill does not provide additional funding for adoption of EHR systems, but, according to Piper Jaffrey senior research analyst Sean Wieland interviewed today by Healthcare IT News, "the use of the data generated from these yet-to-be-installed systems is a central theme throughout [Kennedy's] 615-page bill." 

Wieland continued:

The language in the bill is a dramatic shift towards a pay-for-performance reimbursement model ... Public and private health plans will be required to provide incentives for the provision of high quality healthcare, including the implementation of case/disease management, promotion of the medical home model, prevention of hospital re-admissions, promotion of patient safety and reduced medical errors through the use of best practices and evidence-based medicine and additional incentives for the use of health information technology.

The first public hearing on the draft bill are scheduled for tomorrow, June 11, 2009, with mark-ups beginning on June 16, 2009. 

In general, healthcare reform is going to be the blockbuster debate not only of this year, but perhaps of the entire Obama Presidency.  There is much disagreement about the proposed solutions among Democrats, while Republicans will almost certainly oppose any effort as unnecessarily government intervention.  Washington Post provides an excellent summary of the history of healthcare reform in the last 16 years.  The Post article ends with a quote from - appropriately - Hillary Clinton's pollster Geoff Garin:  

Compared to any other time in the last 30 or 40 years, there's a better chance of success than ever before. But this is going to be like a Indiana Jones movie, where we kind of slip through a lot of narrow escapes.

"A healthcare reform bill will affect nearly everyone", Los Angeles Times (June 10, 2009).
"IT central to health reform draft bill released Tuesday", Healthcare IT News (June 10, 2009).
"On Health Care, Congress Must Navigate Tricky Political Terrain", Washington Post (June 10, 2009).
 

 
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