Pogue: What about the interoperability problem? Every software company selling these systems puts the data in a different format.
Blumenthal: We’re doing a lot in this office to try to minimize that problem. We’re gonna be helping states to create interoperability capability, capabilities to link records, to link institutions.
And we’re developing standards at the national level to make it possible for records to talk to each other. And then we’re also gonna be certifying records, to give physicians and hospitals some guidance about the capabilities of those records, so that they’ll know in advance whether or not the records are gonna be able to talk to each other.
These [standards discussions] are open processes. This will all be a very open and transparent process.
Q: You briefed us before about the recently revised Dutch healthcare system. Lately, you’ve been working on a new care provider proposal that would create added value to the system. Tell us about it.
Uildriks: The concept is called SOS Doctors, and it is borrowed from a successful program in France, SOS Médecins. Arnold Verhoeven, a Dutch citizen who now lives in France, learned that there, one can call for a doctor to visit at home, anytime, 24/7. He wants to improve the quality of care here, and he is convinced this would be an important improvement. We were asked to analyze the financial impact an initiative like this would have on healthcare costs, and present it to government and physician representatives.
Q: How do the government and the healthcare system in the Netherlands view this idea?
Uildriks: They are concerned a service like this will raise healthcare costs, because people will be calling all the time. And, of course, utilization will increase.
Ng: Physicians are worried, too. The National Association of General Practitioners (GPs) is worried about the quality of care, because they claim that the SOS Doctor will not have a personal relationship with the patient or have access to the patient’s record. Of course, when a person goes to the emergency room the specialist does not know the patient or have the patient’s records, either.
How would care professionals like to use these devices?
Note the minuscule use of these devices for patient records and imaging compared to the desire for such usage. The hardware situation is one of many examples of how the move toward EHR remains in its early stages.
We made a mistake in the print version of our client magazine, and are using this opportunity to set the record straight. In “The Rise and Risk of Medical Tourism,” we misidentified the International Medical Travel Association (IMTA) as a provider of medical tourism certification. The organization we meant to identify was in fact the Medical Tourism Association (MTA).
There are important distinctions between groups active in the medical tourism industry, and it’s easy to mistake one from another. In addition to the Medical Tourism Association and the International Medical Travel Association, there is also an Indian Medical Tourism Association, among many other similar naming conventions. There are important distinctions among these groups, which points to the challenge of knowing the differences between them all and what that means to the medical consumer–let alone using them effectively to inform quality care decisions.
Medical tourism has gotten a lot of ink. International healthcare expert Lisa Beichl explains how it is now becoming more accepted:
A $250,000 heart surgery in the United States costs approximately US$15,000 in India, including airfare and accommodations. As a result, a number of major U.S. insurance agencies and provider companies are offering coverage for a range of medical procedures performed internationally. It is easy to imagine how this could lay the foundation for a growing treatment alternative and possibly, depending on variables such as the future of Medicare and the concept of universal coverage, a sea change in the U.S. healthcare industry.
Going abroad for inexpensive medical care sounds like a great solution upon first inspection, but there are possible perils:
Important factors such as hospital reporting, medical residency requirements, the use of evidence-based medical guidelines, and even pharmaceutical nomenclature vary worldwide, and so a critical component remains unsolved: how to standardize the way patients, providers, and payers assess and manage the risks associated with this new medical frontier.
The social networking news may be getting the headlines, but the support for e-prescribing may have more immediate benefit. Milliman principal Susan Pantely published an article about the benefits of e-prescribing earlier this year. e-Prescribing has a number of efficiency and quality implications and can enable better access to necessary prescriptions for patients and better management of prescriptions for providers.
The latest post at The Health Care Blog features an article by Bruce Pyenson, Kate Fitch, and Sara Goldberg about their recent healthcare reform report, “Imagining 16% to 12%,” which provides an actuarial yardstick for health reform proposals and efficiency targets for the US healthcare system.
As the business of healthcare becomes more global, best practices will increasingly migrate around the world. A recent example of this trend has emerged in Austrailia, where hospitals are using the Milliman Care Guidelines via handheld devices in order to improve outcomes, reduce unnecessary care, and optimize length of stay. In the words of Milliman Principal Scott Harris:
“The tool helps avoid delays in care, can reduce underuse, overuse and misuse of medical resources, provides planning tools to anticipate patient needs and includes patient education tools…One of the key outcomes we have shown is that using these tools can appropriately shorten patient length of stay in hospital. This not only improves the patient experience, but reduces the possibility of hospital acquired infections and can place the patient at a more suitable care setting.”
Mr. Schreiner is what’s known in the health care world as a “medical tourist.” No longer covered under his former employer’s insurance and too young to qualify for Medicare, Mr. Schreiner has a private health insurance policy with a steep $10,000 deductible. Not wanting to spend all of that on the $14,000 his operation would have cost stateside, he paid only $3,900 in hospital and doctor’s bills in Costa Rica.
The concept may be compelling, but there are risks. Health consumers are still limited in their ability to compare quality of care in different countries, though sound evidence is emerging. Lisa Beichl, international healthcare expert with the Milliman Care Guidelines, discusses this dynamic in a recent issue of Health Perspectives.