Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, April 15, 2009

The Mess That is the US Health System.

Dr. George Halvorson is chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. His health system provides health services to well over 10 million people and is the most advanced user of Health IT in the world.

He is also a very unhappy man as far as the performance of the overall US Health System.

Kaiser's Halvorson gives sobering speech at HIMSS

By Joseph Conn / HITS staff writer

Posted: April 6, 2009 - 5:59 am EDT

George Halvorson hardly smiled even when he told jokes during his keynote speech to several thousand attendees at the 2009 Healthcare Information and Management System Society convention in Chicago and his several thousand listeners rarely laughed during what amounted to be a sobering, Dutch uncle lecture on the state of healthcare in America.

Halvorson, the chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, revealed little new, but added another powerful voice from the healthcare industry to what has been an old chorus describing the ills of the industry.

Halvorson’s bullet points were familiar to anyone who has followed the news in the past decade; only the numbers were freshly updated for Monday’s audience. The U.S. spends some $2.5 trillion per year on healthcare.

The nation is on path toward spending 20% of its gross domestic product on healthcare.

One of the “great tragedies” of spending so much on our “nonsystem” of care is the nation is still leaving 50 million of its people uninsured and 20 million underinsured, Halvorson said.

For those who have insurance that does cover the cost of their care, providers are paid through “a piecework, very primitive” system in which providers charge for individual units of care “and not the entire package,” Halvorson said. “We have 18,000 billing codes for procedures, and there is not one billing code for a cure,” he said. “Not one code for health.”

Citing studies from three separate sources—the Commonwealth Fund, Milliman and Dartmouth Atlas researcher John Wennberg, each showing extreme variability the quality, appropriateness and cost of care—Halvorson said, “each of those studies concluded if we got healthcare right, we could save half a trillion dollars a year,” enough to pay for universal coverage.

More here (registration required)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090406/REG/304069929

He has been making it clear at the HIMSS conference, which happened last week, that he sees Health IT as basic to achieving health reform and making the system even survivable!

He also does not like paper records much.

Paper records are 'incomplete, inaccurate and inaccessible'

April 07, 2009 | Richard Pizzi, Contributing Editor

CHICAGO – There is a great deal of resistance to healthcare reform because industry players make so much money from the current system, said George Halvorson, chairman and CEO of the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.

Speaking Monday at HIMSS09, Halvorson said the current fee-for-service payment model generates $2.5 trillion worth of revenue, but merely sells "pieces of care" to consumers because the system is not efficient.

Healthcare is the fastest growing segment of the U.S. economy, moving toward 20 percent of the Gross Domestic Product, but Halvorson said the United States is on a dangerous path and must lower the costs of the system and improve outcomes.

"We need to fix the delivery of healthcare and move to full (health insurance) coverage," he said.

Halvorson affirmed that only a "systematic" approach to changing U.S. healthcare would succeed. He called for an emphasis on best practices, an increase in coordination between caregivers and a more consistent follow-through on patients.

Halvorson said there is tremendous inconsistency in the quality of healthcare in the United States, citing a study by Dartmouth professor Jack Wennberg that revealed a 40 percent variation by region in cardiac care.

"We need computers to get (systematic reform) done," Halvorson said. "Physicians don't have enough information to do their jobs right. Paper records are incomplete, inaccurate and inaccessible."

Kaiser is a completely electronic healthcare system, Halvorson said. The California-based system has electronic health records for more than 10 million patients.

More here:

http://www.healthcareitnews.com/news/paper-records-are-incomplete-inaccurate-and-inaccessible

The comments are also reported here:

http://www.fiercehealthit.com/story/halvorson-we-need-truly-reform-healthcare/2009-04-06

Halvorson: 'We need to truly reform healthcare'

April 6, 2009 — 12:59pm ET | By Dan Bowman

Dr Halvorson’s and Kaiser’s efforts in Health IT have been reviewed in the last week in Business Week.

How Kaiser Permanente Went Paperless

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved

When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run.

Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014.

Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July.

Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

E-Health Records Can Lead to Better Care

As Wiesenthal's lakeside workouts can attest, getting there hasn't been easy. Among those responsible for Kaiser's efforts are CEO George Halvorson, CIO Phil Fasano, and Louise Liang, senior vice-president for quality and clinical systems support. But Wiesenthal has been working on this project longer than just about anyone. A trained pediatrician specializing in infectious diseases, Wiesenthal is associate executive director at the Permanente Federation, an umbrella organization that oversees Kaiser's doctors.

Early efforts began more than 40 years ago and the path to electronic medical records has involved numerous detours, including a $400 million-plus project Kaiser developed with IBM (IBM) that was scrapped in 2003. Along the way, Kaiser has spent $4 billion and encountered disgruntled doctors, system outages, and a temporary decrease in productivity as physicians get accustomed to the new system.

Kaiser officials and patients say the overhaul was worth the headaches and costs, and industry experts say the upgrade has resulted in a higher quality of care in some cases. A 2002 report from a nonprofit organization called the National Committee for Quality Assurance indicated that in Northern California, Kaiser Permanente had reduced death from heart disease so significantly among the region's then-3 million members that it no longer was the leading cause of death in that population, though it remained so in the general population. The report gave partial credit to Kaiser's databases, reports, and tracking and reminder systems.

In 2008, health-care spending in the U.S. reached $2.4 trillion. As much as 30% of that spending goes to ineffective or redundant care, according to studies published between 2002 and 2004 by doctors Elliott Fisher and John E. Wennberg at Dartmouth. Digital health records can improve care by reducing the incidence of medical errors and eliminating duplicative procedures. For instance, electronically stored results of such tests as an MRI or CT scan can be more readily accessible to a wider range of care providers—say, a doctor in an emergency room in a city far from a patient's regular physician—reducing the need for a repeated procedure. As records are integrated with a pharmacy, a doctor or nurse can tell whether a patient hasn't filled a prescription.

Much more here:

http://www.businessweek.com/technology/content/apr2009/tc2009047_562738.htm

Kaiser has also been in the news for managing patient privacy very sensibly.

Octomom Records Breach a Lesson in Patient Privacy

John Commins, for HealthLeaders Media, April 6, 2009

Kaiser Permanente should be commended for quickly firing or disciplining 23 employees for unauthorized viewing of the personal medical files of Nadya Suleman, aka, Octomom.

The privacy breach at Kaiser Permanente Bellflower Medical Center in Los Angeles County—where the eight children were born on Jan. 27—occurred in mid-March. Suleman was immediately notified. Kaiser confirmed the breach to the public after several media outlets raised the issue. The case is now under investigation by the California Department of Public Health for possible HIPAA violations.

Kaiser's quick, unequivocal response and willingness to take responsibility for its employees' lapses in judgment will serve the health system well in the long run. Kaiser has sent a message to its employees, patients, and the public that spying on the health records of patients will not be tolerated.

So far, nothing more sinister than simply curiosity appears to have motivated the breach, Kaiser spokesman Jim Anderson says. There is no indication that any information in the files was sold to the media, or used for other nefarious purposes like identity theft.

Kaiser uses an electronic record system that allows the health system to track access to medical files. That's how the snoopers were caught. Anderson says Kaiser already had a training program in place at Bellflower well before Suleman's admission that stresses to the hospital's 5,000 employees the importance of patient confidentiality and the consequences for those who violate that trust.

More here:

http://www.healthleadersmedia.com/content/230986/topic/WS_HLM2_HR/Octomom-Records-Breach-a-Lesson-in-Patient-Privacy.html

What we have here is a health system that cares for the equivalent of ½ of the Australian population showing – through a major investment in Health IT and very considerable leadership at a clinical level both improved economic efficiency and much improved clinical outcomes.

Kaiser (and Dr Halvorson) has demonstrated Health IT really works and more has shown where Health IT can contribute to major Health System Reform.

I wonder when we will bother to take any notice of the obvious success.

David.

1 comment:

Anonymous said...

Interesting.
Betfair creates a problem - it's easy to fake your identity with them since they provide poor identity and age validation mechanisms.
Now they want the Federal Government to help them solve their problems by allowing them access to Government information repositories, including Medicare.
Wouldn't the simpler solution be for the Government to prosecute Betfair under a range of legislation for failure to provide proper identity validation as part of their business model and then close them down?
I'm sure any number of gambling support groups would be much happier with that option.