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The field of healthcare information technology is gathering momentum, poised to shift the care-giving paradigm. It plays a supporting role to a broader shift in healthcare to evidence-based medicine, which uses such scientific techniques and models as risk-benefit analysis to help physicians make decisions about what treatments best fit patients’ needs. Critics worry that the practice depersonalizes care, but Green says that it gives doctors better tools for practicing medicine. The Obama administration has showed support for evidence-based healthcare and earmarked stimulus money for research on its effectiveness. Green says that currently only 30 to 40 percent of healthcare is based on evidence — the rest is guesswork. “We can do better than that,” she says.
What are the principle issues in the healthcare industry right now?
When people talk about problems with healthcare, they are talking about it in three dimensions, all of which are interrelated. The first is the cost of healthcare and the fact that those costs are growing faster than the cost of living. The second problem is access. We have 47 million uninsured in the United States and many more people who are underinsured. Medical debt is the leading cause of personal bankruptcy. It is hard even for people with insurance to get appropriate care because of their location, cultural barriers or long waits to see their physicians. Third is the issue of quality, which is divided into several pieces: misuse, or medical errors; underuse, which is care that should be given to a patient based on accepted, evidence-based medical practice, but is not; and overuse. We know there are many unnecessary procedures and tests that are done and, in fact, may be contraindicated.
Adding to the complexity is that the healthcare system is highly fragmented. No one part of the system controls the whole process of care. Healthcare is delivered in many different places; for the same episode of illness, many different individuals and facilities may be involved.
“We know there is a huge variation in care based on location, but geography should not be the determining factor for care. Moving to evidence-based systems is one of the most critical things to be done if we are going to have a more effective healthcare system.”
Healthcare is a growth industry. What area of growth is especially interesting right now?
There is huge growth in information technology. There are already several organizations using healthcare IT very effectively to make better diagnostic and treatment decisions that are based on the latest evidence, and integrate care across providers. The result is better quality and lower costs. But these systems are the exceptions. For most organizations, there are many obstacles to creating these type of integrated, IT-supported systems, including issues of interoperability of different existing electronic medical record systems and financial and cultural barriers to installing and using such systems. However, companies like Microsoft, Google, Siemens, Intel and GE are all heavily invested in creating the capabilities needed to move to integrated, evidence-based care. This is creating a revolution in healthcare delivery. It’s just a matter of time before standards for personal health records are established and IT systems will prevail in connecting physicians, hospitals and other health facilities more effectively.
How is healthcare IT emerging as both a challenge and as a solution?
It is very hard for physicians to keep up with the prodigious amounts of research produced in any given area of healthcare. They don’t always have access to information about the latest treatments, drugs and procedures. Some of the best hospital IT systems have developed extensive learning systems that constantly update information from journals, peer institutions and their own institution about what treatments work best and when. These systems can develop standardized protocols that are very useful for the bulk of patients by creating better outcomes and using resources more effectively.
One of the challenges in doing this is that people raise the specter of taking decision-making out of the hands of physicians. That is nonsense. It is actually equipping doctors with the tools they need to make better decisions, not taking authority out of their hands. No one is talking about a computer making decisions. Many other industries have computer-based decision support systems for operations. One prominent example is the airline industry, which depends heavily on computer-based systems. Flying is much safer now than in the past. Healthcare is one of the most complex and dynamic professions of all. You can argue that it, more than any other industry, can benefit from the use of evidence-based decision support systems.
Intermountain Healthcare, which is based in Salt Lake City, and the Mayo Clinic are two providers that use these kinds of systems very successfully. However, it is too easy to scare patients or physicians into believing that developing and using data on the comparative effectiveness of healthcare treatments is tantamount to a government takeover of decision making for healthcare. That is what has happened to some extent.
Are you optimistic that the healthcare industry can successfully make the transition to these IT systems?
The government can do things to incentivize and help fund that transition, but ultimately this has to happen at the institutional level. I am optimistic that there is already broad recognition across the healthcare community that these things have to be done, and there have been some efforts already. One of the reasons we haven’t advanced as much in IT as other countries is that there hasn’t been enough money to put it in place. It will be an evolution over a long period of time.