Information
Superhighways are Paths to Better Health Care
By John M. Eger,
San Diego Union-Tribune, Sunday, January 2, 1994
Forty to eighty billion dollars a year could be saved in existing health care costs using advanced communications technology. And even more if information technology were aggressively embraced by the health care industry.
It is not at all clear that the administration has given much thought to the inescapable connection between health care, and the role of advanced communications technology. But they should, for it would be good for consumers, telecommunications providers and the entire health care industry.
Health care is essentially a knowledge or information-intensive business, and the health care industry is heavily dependent on and comfortable with information technologies. But transforming health care delivery to increase efficiency affects not just the cost side of the equation. Health care, not unlike other uniquely American information products and services, represents one of America's greatest strengths in the new global information economy. Indeed, health care broadly defined could be one of our nation's greatest exports. That's the good news.
The bad news is that most of the emphasis on modern day medicine and health care has been on the cure, not on prevention. Consumers of health care are relatively uninformed; some might even say ignorant of their own bodies. This ignorance contributes greatly to the cost of health care and is a major barrier to shifting the emphasis from cure to prevention. But the biggest near term problem is that the systems used by hospitals, HMO's, physicians, and laboratories throughout the country are a hodgepodge with little standardization and with very little interoperability.
Until recently, the incentive for innovation in not only the delivery of health care, but the management of health care, has been wanting. Health care, like education, business and government, and all industries deeply affected by advances in telecommunications and by the onset of a global, interdependent economy, is long overdue for a paradigm shift in the way health care is defined, administered and ultimately delivered to the individual consumer.
The relationship between those who provide health care and those who receive it must and will undergo a major transformation for us to make the shift under "managed care." Telecommunications can and should play a central role in this new environment in three major areas: first, through creation of a "health care utility"; second, establishment of a sustained program of consumer education; and third, a vigorous re-examination and redefinition of "primary care."
According to the National Institute of Medicine: 30% of doctors can't get access to patients' records; 70% of hospital records are incomplete; 38% of time is spent by doctors writing up charts; 50% of time is spent by nurses writing up charts; yet at any given time, at least 22 people in hospitals depend on the accuracy of and need access to, the patients' records. Compounding the problem is the fact that there are four billion medical claims generated annually, appearing in more than 450 different forms. Most hospitals have their own formats for processing patient records and billing, and doctors use a standard form only 40 percent of the time.
There is no incentive for one health provider to tackle the problem of patient records, laboratory testing results, or standardized billing. However, through establishment of a kind of "health care utility," a private and public sector cooperative, if you will, a plan could be developed to: standardize patient information and harmonize billing and insurance; and establish a community-wide link between hospitals, clinics, physicians, laboratories and imaging centers serving the health care providers for the routine transfer of patient records and lab tests. This alone would significantly increase efficiency, productivity, cash flow and reduce fraud.
Another major component of a new agenda for health care is to create an educated health care consumer. According to a study done in San Diego not too long ago, more than half of the people who are clogging up the primary care physician's offices and the urgent care centers are not sick. These folks are not malingerers. They simply wake up in the morning, don't feel well, don't know what's wrong, and don't have anywhere to turn; so they go to the urgent care center or their doctor's office.
Through the use of interactive databases, informational television programming and other multimedia products, it should be relatively easy to begin the process of educating the consumer. Not everybody of course will have access to these tools for information distribution or be able to afford the information itself. On the other hand, some databases, for example relating to AIDS or venereal infections of various kinds, might be accessible as a matter of public right through publicly-funded facilities. Other health concerns such as hypertension might be sponsored or supported by one or more pharmaceutical companies having an interest in hypertension drugs. Such databases would allow users to seek information anonymously and at their own pace, and be referred to a physician or health care facility if that was their desire.
In the 500 channel environment, surely there will be opportunities for not only on-line information systems, but multimedia systems as well, which convey text, voice, and full motion video. Such programs might include not only health information, but as some videos are used now in doctors offices, serve to provide information and advice on an as-needed basis to someone about to enter surgery or need advice on post surgical care.
The end result of a sustained program to educate the health care community should result in a redefinition of "primary care," a troubling issue since there are not enough primary care physicians to go around. Indeed, according to a recent study, most physicians simply aren't interested in becoming primary care physicians -- not because they are among the lowest paid, but because it is not as professionally rewarding. We know, however, that through the use of telecommunications technology, this dilemma can be alleviated by making better use of licensed practical nurses and other health care practitioners.
Some telemedicine applications already exist in rural areas where telemedicine has been commonplace. However, most of the uses involve standard monitors and a video camera with a health care practitioner usually talking to a specialist in another remote area. Clearly we have moved well beyond this as more and more teleradiology is coming into play, and devices such as MedTel, which Dr. Michael DeBakey recently announced, should help. MedTel, which uses telephone, satellite, cable or microwave to link medical specialists in one location with a general practitioner in another, will use an electronic medical instrument such as an electronic stethoscope to gather data from the patient, then transmit the data to a specialist who can assist in interpreting information and treating patients. From his facility in Houston, DeBakey can reach patients almost anywhere, whether they be in Turkey, Russia, or Saudi Arabia.
On another level yet, given the convergence of broadband communications networks, high resolution imaging and development of virtual reality-based tools, it will be possible, indeed in some limited way is possible today, to provide more sophisticated diagnostic services and eventually treatment via telecommunications. In a sense, laparoscopy already makes good use of the genius of some of these new technologies. Given the potential of literally roaming through the human body using nanotechnologies designed for medical care, the tasks of even the most complex surgery can be divided among two or more doctors, at different locations, whereas in the past the incision that had to be made only allowed for one pair of human hands.
But telesurgery represents the outer limit of telemedicine as we envision it. Between now and that new future are a number of applications which should not only be anticipated, but explored. As the consumer becomes more educated and the means of accessing the health care system more "user friendly," it is not inconceivable that all of us will become our own "primary care" physician.
John M. Eger, Van Deerlin Professor of Communications and Public Policy at SDSU, is Chairman of Mayor Golding's City of the Future Advisory Committee.