This morning I had the pleasure of meeting with US state and local government officials at our executive briefing center in Redmond. Although the briefing wasn’t confined to discussing information technology and healthcare alone, it should be no surprise that a frequent topic was health and healthcare reform.
I shared with the group some of my concerns related to US ARRA stimulus spending of $20 billion or more on health IT. I made an analogy to a recent misstep in Ontario, Canada. Much to the rightful ire of citizens in the region it has been disclosed that government spending on electronic records and health information exchanges in Ontario had exceeded one billion dollars, yet it seems that the province has very little to show for such spending. An ensuing investigation has revealed colossal mismanagement of government funds, bloated budgets, poor planning and even worse execution. How can we avoid that from happening in America (or anywhere else)? If a billion dollars had instead been spent actually providing care to citizens in Ontario, how much care would it buy?
For one billion dollars (one thousand million) you could purchase and administer a heck of a lot of flu vaccine. You could give prenatal care to more than ten million young women. You could offer visiting nurse services to millions of senior citizens. Ten thousand or more people could get a needed organ transplant.
Don’t get me wrong. I’m not suggesting that we shouldn’t spend money on electronic health records and health information exchanges. But I am strongly advocating that we must plan carefully for what it is we are trying to improve and be extremely prudent in how we spend.
America lags behind most of the rest of the industrialized world in the use of IT in healthcare. Seventy-five to eighty percent of American clinicians are still practicing with pen and paper. The health industry is woefully behind in its use of contemporary communication and collaboration technologies in clinical workflow, and I believe that little is more important for provisioning safe care than excellence in care team communication.
So, America has lot of catching up to do. But we also have an opportunity to learn from others on what not to do. We must first focus on what outcomes we want to achieve. We should be asking how we can leverage technology to make access to health information and medical services more efficient and do a better job delivering exactly the right amount of care, when and where it is most needed. There is no question that we can use electronic health data to improve care quality and safety. We can get a better grip on what adds value in health, and more importantly, what doesn’t. However, we cannot afford to waste even a single billion dollars on this, and certainly not twenty billion dollars or more. We must always ask the question, how many lives could we help if we spent the same amount of money delivering care?
It is time to get grounded before it is too late. It is time to bring our best and brightest to the table and dismiss special interests. It is time for more rational voices to be heard. It is time to ask what we are trying to improve before we set out to improve it. It is time to cast out technologies and processes that add little or no value, and embrace lower-cost, contemporary, flexible, commodity-based solutions and web services that actually improve workflow, make care more accessible, and contribute to lower cost, higher quality and safer care.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft