The Paradox
It’s the great American health-care paradox. Yes, we have excellent doctors, hospitals, and technology, but the cost of our care vastly outstrips that of countries that provide universal coverage, and we leave millions uninsured. Although we clearly lead the world in many areas, such as advances in transformational personalized medicine, in other ways our health-care quality is not obviously better than that of other countries.
Why is our health system so expensive? Reformers have focused on therapeutic and diagnostic innovations as cost drivers but paid little attention to inefficiencies in the care delivery process — where significant financial savings and quality enhancements are ripe for the picking.
Improving the Delivery of Health Care
Take, for example, the case of Duke Medical Center which organically developed a new protocol of care for patients with congestive heart failure — a chronic, life-threatening, and expensive disease. Duke created teams of those who help patients manage their condition, from nurse coordinators to cardiologists. Although the teams decided that visits to expensive cardiologists should be vastly increased, the program quickly reduced costs by 40 percent. They did it by making people healthier so they entered the hospital less often and by shortening the duration of their stays when they did.
In the private sector, savings of this scale would be applauded, rewarded, and emulated. But due to the difficulty in re-engineering the process of care, Duke’s important innovation has barely been replicated at all.
This kind of radical protocol revision can be supported by health informatics, the intersection of health care and information science.
An around-the-clock remote patient-monitoring system for the critically ill called eICU is a perfect example. The eICU center, operated by UMass Memorial Health Care, relies extensively on health-informatics systems to support critical-care nurses at four hospitals within the Massachusetts health system. Critical care involves incredibly complex life-or-death decisions which are often made with little time for reflection. This rigorous patient-monitoring service alerts clinicians to subtle but potentially significant changes in a patient’s condition; uses health informatics to analyze patient data; and makes evidence-based care recommendations allowing ICU bedside staff to intervene with prompt and optimal care. An examination of over 6,000 patient records revealed that the UMass eICU program reduced the average length of a hospital stay by four days, saved 309 lives in 2007 alone, and saved an average of $5,000 per patient.
A Step in the Right Direction
We desperately need innovative methods for eliminating budget-busting inefficiencies today. The current effort to implement electronic medical records (EMRs) nationwide is a step in the right direction. However, a new study comparing 3,000 hospitals at different levels of EMR implementation verifies that simply converting patient records to a digital format does little in terms of improving health-care quality and lowering cost.
To achieve true quality gains, EMRs must contain intelligent and robust data derived from the point of care and then funneled into a nationwide health-information exchange infrastructure. That would enable us to learn from collective patient and clinician experiences and deliver care more efficiently. Just as having access to a patient’s entire health history can help a doctor determine optimal treatment, access to a nationwide records database could help identify and treat system-wide weaknesses and inefficiencies.
The Department of Veterans Affairs (VA) health-care system has utilized EMRs for several years and can provide a model. System-wide EMR data is analyzed through the Veterans Health Information Systems and Technology Architecture (VistA) to improve care. Before the VA began analyzing and tracking its performance electronically, rates of screening for breast and cervical cancers were 50 percent and 17 percent. After performance was measured, they raised screening rates to 88 percent and 87 percent.
The decisions we make today will impact the lives of future generations. If health-care spending continues to climb at current rates, then by 2040, health-care expenditures will consume 30 percent of our gross domestic product. This unacceptable future would greatly compromise our children’s ability to spend their incomes on necessities, such as our grandchildren’s educations. The future of quality health care in America demands improved methods for delivering that care. Doable reforms are out there; we simply need to reach for them.
– Dr. Regina E. Herzlinger is a professor at Harvard Business School and author of Who Killed Health Care? (McGraw- Hill). Dr. Eric Silfen is the chief medical officer and senior vice president, Philips Healthcare.