• Is health care progress really happening?

    Matt Yglesias had a short post up yesterday that looked on the bright side of progress in health care:

    People are always very down on the health care sector, but I thought I might note that ever since I started my new insurance plan at Slate I’ve noticed that Kaiser Permanente is actually doing a lot of useful productivity enhancing stuff with information technology. Now Kaiser is a famous and famously “special” health insurer, but none of what I’m talking about is particularly related to their integrated care and health management focus. Instead it’s stuff like they have a pretty well-designed web interface that lets you book appointments with your doctor. You can also email your doctor if you have incidental questions. And you get copies of lab results emailed to you after you get a test done. The same website includes a lot of basic health information that you can play around with so you can try to self-diagnose if you’re feeling bad.

    I’m all for progress, and I understand the instinct to encourage it wherever we might see it. But I’ve made a career out of trying to improve information technology use in health care, and I’m telling you – there are days I despair. We see gains in small markets with early adoption, but getting widespread use of the stuff seems darn near impossible.

    Take Matt’s example. The stuff sounds like a no-brainer. Online access, mobile resources, what’s not to love? But these are things that a very small percentage of users are going to access. Moreover, I’ll wager that the people who need the most are the least likely to take advantage of the stuff.

    Besides, I’ve heard this before. When I was a medical student, electronic pens and easier order entry were all the rage. Then it was the Internet. Then it was laptop computers. Then it was Palm Pilots. Then it was smartphones. Now it’s tablets. But we ignore the unbelievable lack of infrastructure for the most basic needs of IT in medicine. It’s great that Kaiser can grant these bells and whistles to their patients, but when only about 20% of hospitals and 30% of office-based physicians have an electronic record at all, what progress are we actually making?

    The kind of thing Matt’s discussing makes for good press releases, but not for much in the way of proven outcomes. More of my thoughts on the issue here.


    • Hmm … I’d say it’s even worse than Aaron makes it out to be. IT is not completely irrelevant to significant productivity enhancement in health, but it is only a small part. The much bigger part is cultural, both on provider and patient sides of the equation. We have to generate more comparative effectiveness research and avail ourselves of more shared decision making. In other words, the real money is spent in what goes on in the exam and operating rooms (and, yes, the ancillary labs and imaging and so forth). What happens on the computer screen is a huge distraction, though, as I said, it can help support smarter, more efficient health care. But it is not itself smarter, more efficient health care.

    • I have never thought about this. This post really made me think about so many things in my life. I have read somewhere that Americans are using internet for choosing a better Health insurance. Fortunately I am British and I am very thankful to NHS. But your point of view is very interesting. Great post.

    • Have you seen this essay?
      Dave Chase is making a similar argument…it’s not the Computer itself that matters, it is the way the EHR system works with clinical care and can be easily and flexibly changed. That is a real challenge with some IT systems.

    • There is obviously some form of”progress” in the health care system. I don’t think IT progress is the root of the problem. I think it can help reduce cost and make the system more efficient but there are great economic problems with health care worldwide.

    • I’m wondering where comparative effectiveness research and shared decision-making were the actual path to smarter, more efficient health care.

      CE research, of course, ignores the fundamental question about cost. Its rise is just a symptom of the ongoing unwillingness of public payers and providers to engage in the discussion of whether what is done is worth the cost.

      Shared decision making sounds nice, but unless there’s a payment framework that forces tough allocative decisions into that discussion, its not going to make a difference either.