Conventional wisdom would indicate that the cost of health and medical care will go down as a result of the push by government to implement electronic health and medical records (EHR / EMR). One can certainly understand that as a result of tremendous gains in the use of emerging standards for sharing health and medical records. The Clinical Document Architecture and HL7 has helped entrepreneurs ride the band wagon to invest in cost effective platforms for hospitals and their provider members making it easy to share information between providers and to efficiently administer medical care. In addition, the use of portable devices at many care facilities has brought significant gains in the flow of clinical information between physicians and healthcare technicians. How is it then that a recent study shows that the United States still ranks 22nd out of 27 high-income nations (US Ranks...) when analyzed for its efficiency of turning dollars spent into extending lives? Some politicians would argue that the high cost of care is due to the far superior R&D and resulting healthcare services provided in the United States as compared to elsewhere in the world. That is certainly evident in the leading edge medications and minimally evasive surgery tools and techniques which are no doubt second to none. However, there can be no excuse for such gains when the healthcare economy of the country has been moving towards a growing dichotomy of haves and have not's. It is certainly counter-intuitive that over the last 30 years access to health care for the elderly has improved so drastically while fees for services by practitioners has been reduced. Many practitioners have countered the drop in their disbursements of Medicare and insurance carriers by administering more and more unnecessary procedures. Some have even dropped their membership with carriers and are charging cash fees to patients that can afford to pay for the services. Carriers are now countering with limitations on the administering of certain health services. In addition malpractice insurers have increased their fees to counter that trend. So, in essence we could be riding a death spiral that result only in havoc in the largest industrial country in the world.
The solution can only lie in a conscious effort to review all the policies surrounding the administration of healthcare and to built efficiency into it. Why for example should a hospital pass on the cost of compliance with the Health Information Portability and Accountability Act (HIPAA) to the patient when such cost is unrelated to the care needed by the patient (Hospitals Waste...). Improving the standards and procedures by which providers handle personal health information should result in a net reduction in the cost of that healthcare and not an increase. That is where messaging and document standards can certainly make a difference. Securing and providing the means for auditing records should be something that is known to those building the Healthcare portals and government agencies performing the audit should have adequate tools for doing those audits before the healthcare portal goes live.
Another area were some gains have been made in many states is to cap the cost of malpractice so that the fees that practitioners are paying for their insurance does not unexpectedly rise as a result of a single incident. Over the last 10 years, we have witnessed a considerable reduction in the rise of insurance premium rates for automobiles in California simply as a result of those caps. Obviously, a small percentage of malpractice can cause irreversible damage to patients and their families. In those cases, one cannot argue against large monetary judgments. Seizing the practitioners license from practicing is punishment enough to remove the risk of further malpractice. Instead of penalizing insurance carrier for mistakes of a few practitioners, what if states provide public/private partnerships that would pay for such damages to patients.
From time to time, one needs to look at the list of thousands and thousands of medical conditions which are now being standardized by Health & Human Services at the federal and state levels and the correct prescription for those conditions and ailments. These standards are being deployed under the new ICD-10 nomenclature. The motive for it at the federal Center for Medicare and Medicaid is to reduce fraud. But, there is a tremendous cost in overhead by state agencies and healthcare payers alike in ensuring that patients are getting the correct prescription for the conditions they have and the cost of administering that overhead should not add to the burden of administering the overall healthcare cost. The jury is out on this one, but one can certainly create economies of scale by grouping and simplifying low risk conditions and procedures while paying more attention to more complicated conditions such as cancer or type 1 diabetes. Payers should build triggers into their automated systems that would allow more complex conditions to be under further review or better yet to reduce the number of services which require pre-authorization by driving the cost of basic medical care down to negligible rates. That way, one can even expect to see basic medical care be covered by single-payer (there I said it), while physicians and practitioners focus on complicated medical conditions.
Finally, and this is were something has definitely gone wrong in is the lack of competition that federal and state regulations have created for payers and providers alike. Insurance agencies and providers should be able to market their services beyond their regions to gain some economies of scale. With the advent of tele-medicine and real time communications between patient and practitioners, government must remove the burden to the practitioner who wants to practice across regional boundaries. If you want a small clinic that provides excellent cardiac diagnosis capabilities in Chicago to build its own EHR / EMR capability, in addition to the incentives that have been provided by the Center for Medicare and Medicaid for funding those endeavors, why not make it even more appealing by allowing that clinic to practice its medicine in rural Iowa or Arkansas.
Yes, EHR / EMR can definitely reduce the cost of healthcare, but that is not a foregone conclusion. What is needed also is policymakers that can augment technology gains with changes in programs and changes in regulations that would make those gains more possible.