Could Health IT Revolutionize US Healthcare?

I interviewed former Congresswoman, Nancy Johnson (R-Connecticut), about her views on health information technology (IT). Ms. Johnson has been a longtime supporter of health IT initiatives, and introduced the health IT legislation that led to the establishment of the Office of the National Coordinator for Health Information Technology. She has fought for broad adoption of health IT to reduce medical errors and improve care quality. I first met Ms. Johnson at the Partnership to Fight Chronic Disease conference in Washington, DC, and I was so intrigued with her perspectives that I arranged a follow-up interview at Baker Donelson's office where she is a member of the Firm's Federal Public Policy Group.

Dr. Val: Tell me a little bit about the health IT landscape and which initiatives are the most important in improving quality and decreasing costs.

Ms. Johnson: We've made great strides over the past 2 years to raise awareness of the importance of health IT and the acceptance of its centrality by doctors, but it's still a long way from being a system that organizes and delivers care. The private sector understands (better than the medical community) the value that technology can bring to any information-intensive business. The unique thing about medicine is that it's not just about information management, it's about people and their intimate details, so we have to have standards in place to protect that information. We are currently working on these standards, but not at the speed industry would like - so they are creating digital products with interoperability in mind.

This is kind of like Pell Mell development - a lot is going on, but it's not well coordinated. The good news is that we're seeing far more activity in the interoperability standards arena than we did even 2 years ago. Technology will make all the difference in the degree to which we can focus on care management issues and quality issues and then hold the system accountable for delivering that kind of health.

Dr. Val: What do you think about medical devices that help people "age in place?" Are home monitoring devices a valuable addition to a system that helps people stay out of the hospital?

Ms. Johnson: Absolutely. Early intervention is the secret to controlling costs. So any technology that helps us to identify and intervene early in a disease process is extremely valuable. These devices do something equally important in controlling costs: they involve the patient in their own care. Physicians have told me that patients become more vigilant in caring for themselves when they can see their results - for example, when they can see a graph of their glucose levels responding to a low carb diet, they adhere to the diet more vigorously. So these devices that give patients immediate feedback can help to modify behavior.

Prevention (and getting patients involved in their health) is the only solution to our healthcare crisis that doesn't involve limiting access to care. All other countries limit access - Canada does it by controlling the number of physicians that they train and they're now heading into a physician shortage crisis that makes ours pale in comparison. Patient education and early intervention are critical in solving our healthcare problems. We need to build preventive thinking into our healthcare system - such as insurance plans that offer free preventive care and financial penalties for those who don't get it.

We must have people tend to their preventive care as seriously as they would change their baby's diapers.

Dr. Val: What would the ideal IT system look like?

Ms. Johnson: It would offer continuously updated evidence-based guidelines at the point of care for physicians. It would give patients clear information about what they should expect. It would enable physician social networks to promote learning and experience sharing with one another. It would promote continuous improvement of care practices, and track outcomes and results to continue refining healthcare delivery. Patients should be given check lists and preventive health guidelines, and be asked to provide feedback on any complications or unanticipated events.

If we could aggregrate deidentified patient information we would gain powerful insight into adverse drug events (or unanticipated positive effects) at the very earliest stages. It could be useful in identifying and monitoring epidemics or even terrorist incidents. This could advance medical science faster than ever before. Until we have all this information at our finger tips, we can't imagine all the potential applications.

Dr. Val: Are you describing a centralized, national EMR?

Ms. Johnson: Not necessarily. But if systems are interoperable, it could function as one. I imagine it as a series of banks run by local administrators, but with the capability of sharing certain deidentified data with one another.

Dr. Val: Do you think the government should design this information system?

Ms. Johnson: No. You don't want the government doing it alone. As much as I love the government and have been working in it for decades, it's simply not good at updating and modernizing systems. You have to have a public-private partnership in this. The government should be involved to protect the public interest, and the private sector should be involved so that the system can be innovative, nimble, and easily updated.

Technology will bring us extraordinary new capabilities to manage our health, prevent illness, minimize the impact of disease on our lives, improve the ability of physicians to evaluate our state of health, allow us to integrate advances in medicine in a timely fashion, and quantify the impact of new inventions and procedures. All this, and IT will help us to promote prevention and control costs associated with acute care.

We have a high quality system now, but because it's so disorganized, the patient doesn't receive the quality they should. The incredible advances in technology that we have created should be available to all who need it. Unfortunately that's not the case now.

If you look at Canada's use of the specialist and specialist equipment along the US's border with Canada, it says a lot about government run healthcare.

Dr. Val: You've mentioned previously that you have major concerns about approaching healthcare reform from a purely access angle - that the first step we need to take is to make sure that everyone has insurance. You said that the first step should be to streamline the system so that when people are given insurance, they'll have a healthcare provider to go to. Tell me more about that.

Ms. Johnson: A perfect example is the CHIP program. Everyone wanted kids to have health insurance - but CHIP was designed to pay providers at about the same rate as Medicaid, so no one would accept it. In some states it pays 40 cents on the dollar of costs. This blind attitude of "we'll open up these systems to the uninsured" is not solving the real problem. Unless you also reform the system, giving people access to it doesn't help anyone. We must do the things necessary to provide appropriate, efficient care that's not duplicative or wasteful. You can only accomplish that with technology.