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Billions of dollars are at stake. It’s time for leading physician organizations and forward-thinking employer groups to collaborate.
Editor’s note: This article is the fourth in an ongoing series by James McGauley, M.D., on the idea of a Coordinated Medical Record system, which literally produces a single comprehensive medical record for every patient. The record contains all of the patient’s clinical and financial healthcare information over space and time. The credit card industry is the model. This type of information system will do more to increase the quality and decrease the cost of healthcare simultaneously than any other single initiative.
In a previous article, I described how a Coordinated Medical Record system could significantly reduce the pain, suffering and multibillion-dollar costs of the healthcare industry’s information-related problems — misdiagnoses, inappropriate medications, duplicate tests, billing issues, quality reporting requirements, medical-legal issues and fraud. Fragmentation of information is the underlying cause of all of these problems and coordination of information is the solution.
Establishing a Coordinated Medical Record system is obviously a major undertaking. It is essentially a complete reshaping of the healthcare industry’s information infrastructure. The necessary technology is available, but tech does not solve problems, people do. So, the question is, who wants this type of information system and who can make it happen?
Patients. In the several years that I have been working on and talking about a Coordinated Medical Record system, I have never come across a single person who has openly stated that the concept of a Coordinated Medical Record, as I describe it, is a bad idea.
Some people ask about data access and privacy safeguards, but most people immediately home in on the system’s ability to eliminate the need to rely on memory, repetition and guesswork at the time of every healthcare encounter. Frequently, people launch right into their own personal stories about how missing, conflicting or inaccurate information has caused some clinical or financial problem for them or a family member.
Physicians. I have never met a physician who would not like to have access to Coordinated Medical Records. Frontline internists and family physicians, specialists, emergency department docs, hospitalists, radiologists, anesthesiologists and even pathologists know how access to comprehensive and reliable patient records would improve their lives and the lives of their patients.
No physician wants to miss a diagnosis, prescribe a wrong medication or duplicate a test without a reasonable cause. But there is no way to avoid these problems without real-time access to the specific information that is needed to proactively prevent these problems.
The problems caused by fragmented medical records were understandable when everything was on paper, but they should not continue to exist for patients and physicians in the digital age.
Physicians. Because physicians generate at least 80% of all healthcare activity, they are technically responsible for most of the industry’s information-related problems. By default, they are the only ones who can fix these problems. Physicians are the ones who have to use a Coordinated Medical Record system in order for anyone to appreciate its benefits.
Employers. Employers are the ultimate sources of most healthcare dollars. They sit alone at the top of the healthcare industry’s financial food chain. Using their collective financial power and influence, employers have the ability to impel major changes in the healthcare industry, including a reshaping of its information infrastructure.
Employers have the collective power to influence the way insurance premiums and healthcare tax dollars are spent. A reallocation of a portion of that money could fully fund a Coordinated Medical Record system, which would both improve the quality of healthcare and produce documentable multibillion-dollar savings — a pretty good return on investment.
The $35 billion that were spent on incentivizing the purchase of more than 2,000 fragmented electronic medical record (EMR) products came from our tax dollars, and they have not produced significant quality or cost benefits. Collectively, employers are the only ones who can prevent these types of problems from recurring.
During our pilot projects, we put some local employers who were concerned about healthcare costs in the same room with our pilot physicians. The two groups bonded rather quickly around their common goals: their concern for the health and well-being of their shared patients/employees and their desire that healthcare costs be transparent, equitable and justifiable.
The healthcare industry’s information-related problems were discussed as if they were a fairly straightforward business school case study. A successful business just doesn’t spend 30% of its operating budget on hundreds of different internal information systems and services that don’t talk to each other, and thereby directly cause billions of dollars’ worth of company losses.
It didn’t take much discussion for the employers to realize that physicians, using a Coordinated Medical Record system, could improve care quality and decrease costs in ways that were unattainable for insurance companies, hospital systems and companies that simply negotiate discounted physician fees.
Physicians and employers have compatible goals and complementary strengths. Each one has the capacity to exert their particular influence at different pressure points in the healthcare industry.
We formed these employer-physician coalitions in three geographically separate healthcare communities. The interactions were nearly identical in all three. They all demonstrated a broad appeal for the concept of a Coordinated Medical Record system, and they all highlighted the potential for direct employer-physician alliances to effect major changes in the healthcare industry and possibly even completely change the power dynamics.
Although we formed these coalitions in individual healthcare communities with local physicians and local employers, the model and the format are easily reproducible on a national scale.
There are dozens of physician organizations — like the Medical Group Management Association, the American College of Physicians and the American Academy of Family Physicians — who could be sitting down at a table with their counterparts from the dozens of employer organizations that are focused on healthcare issues — like Haven, the Amazon-Berkshire Hathaway-JPMorgan Chase project, the Leapfrog Group, the National Business Group on Health, the National Transformation Alliance and the National Federation of Independent Businesses — to discuss the concept of a Coordinated Medical Record system.
Based on my experiences, it is very likely that a meeting that included a representative from each of these groups would at least be interesting and possibly even productive.
Coordinated Medical Record system technology is available. If such a system is ever to become a reality in either individual regional healthcare communities or on a national scale, the driving forces are likely to be employer-physician coalitions. In a subsequent article, I’ll describe what our pilot projects taught us about the logistics of deploying a Coordinated Medical Record system.
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