Stimulating Stimulus Will Fund $20 Billion in Health IT Projects - a Good Idea?

These are the kinds of stimulus that we should be funding. Our health care system has a lot of problems but certainly one is the redundant and archaic paper-based records and billings system. Nearly every discussion of how to reform health care, whether from the left or from the right, mentions information technology reform as a means for saving money (see below the fold). Therefore, it is good to see that a full $20 Billion has been approved in the House stimulus bill for Health Infrastructure Projects. From the story at Robert Wood Johnson Foundation:

Approved under the American Recovery and Reinvestment Act of 2009, the bill would provide incentive payments to Medicare and Medicaid providers who implement certified electronic health record technology.

In would provide funding for health information exchanges, standards development and conformance testing, and other aspects of health IT. The bill also would establish the Office of the National Coordinator for Health IT and strengthen privacy protections for individuals' personal health data. Additional provisions granted under the bill would extend federal support for broadband communications in underserved areas and establish a program to determine the effectiveness of select medical treatments. The Senate in early February is expected to consider a similar bill that calls for $23 billion in health IT spending (Ferris, Government Health IT, 1/29/09).

This will cut health care costs for Medicare and Medicaid. This will stimulate the economy because all these groups will need new electronic records systems. Those have to be made somewhere and they have to be installed, serviced, taught. In addition, the broadband communication expansion will allow rural health care providers access to these systems and provide the side benefit of giving regular folks access to broadband.

Part of me wants the entire stimulus to be put towards building roads and infrastructure. This is a bit more around the horn towards stimulus, but it is also something that won't go away. Once we drag the health care system into the digital age there won't be any going back. This paper from 2005 shows that full electronic records COULD save billions:

It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.

There are road blocks towards doing this correctly, but even if we do a half-ass job of implementing it the savings should push above $23 billion in about four years and should reach more than $20 billion/year in about six years.

So, what do you think is this a good use of stimulus funds?


Yes, I think so.

Having been immersed in the ER world checking my Uncle in to the Hospital 3 times in the past month, it seemed ridiculous to me that we had to give the same information over and over again. There was no continuity from one stay in the same hospital to the the next, much less from one doctor to the next. The long list of medications had to be entered each time and the chance of mistakes goes up each time.

It troubles me that personal health information could be easily abused so there has to be a firewall so thick no insurance company could ever touch it.

Really, this time we are going through is an opportunity to start doing things the smart way in all areas. Institutionalized stupidity needs to become a thing of the past.

What great timing, the other article I wanted to discuss.

Study Finds Most Hospital Patients Unable to Identify Their Physicians

A study in a recent issue of the Archives of Internal Medicine finds that patients at an academic medical center were often unable to identify their physicians by name or describe their physicians' roles in their care, suggesting a need for enhanced patient education, particularly for those who experience multiple handoffs during their hospital stay, the New York Times reports.

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

The hospital and many of the physicians here

have implemented electronic patient records. I thought it was a pain when the nurses and doctors were learning to use it. But now, life is much simpler for patients, particularly ones like my mother, who regularly sees several different specialists for several different conditions. The electronic records ensure that each doctor knows what medications she's on, and what the other doctors have been dealing with. I still keep a written record of both things, but this makes me comfortable that if something were to happen to her and I wasn't available to take her to the ER or doctor, they would have up to date records. (The physicians she sees share the records because they're all part of the same group.)

You're right, we should be spending stimulus money on this. Absolutely. I'm convinced that it has improved the quality of care my mother has received over the past year.

Think of the wasted:

  1. typing: how many receptionists have typed in my name, social security number, blah blah blah.
  2. information: as you say above, when people see multiple doctors or when they are treated in an emergency their records are not available. So, they treat without knowing.
  3. paper: how many reems of paper have I filled out in duplicate and/or triplicate over the years? How many times have I circled "NO" next to "Do you have any of these illnesses:"
  4. time: do you actually show up 15 minutes early to fill out the paperwork for the 50th time?
  5. lives: Well, look at information above. What happens when someone goes into the ER and is treated with something to which they have an allergic reaction?

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

According to what I've read, 31% of our health care costs

go toward administration and co-ordination between all the insurers and providers. That's money that could be better used paying for actual care.

Or as the Republicans would have it, more bonuses for CEO's and management and more trips to luxury spas and more money for lobbyists to spend buying their votes...and less care for those pesky folks who just have to get sick and ruin everything.

Stan Bozarth