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.


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