What can Boeing teach Rhode Island’s hospitals about quality and efficiency? Does the world of air traffic safety hold lessons applicable to medical errors? And what are some health care organizations doing already that the rest could emulate?
Those are some of the questions tackled at the 2005 Frontiers of Health Care Conference, sponsored by U.S. Rep. Patrick J. Kennedy and hosted by Brown University on Monday.
Last year, at the first “Frontiers” conference, Kennedy and former U.S. House Speaker Newt Gingrich made headlines by coming together to advocate for prompt adoption of information technology in health care, including electronic medical records and e-prescriptions.
Much has happened since then, locally and nationally. Aided by a $5-million federal grant, Rhode Island has launched a five-year project to develop a statewide health care information exchange system. Area hospitals, especially the Lifespan network, have made major investments in computerization, and made some units paperless. And President Bush has set a goal of giving most Americans electronic health records by 2014.
Last month, to speed the pace of health care IT adoption, Kennedy and U.S. Rep. Tim Murphy (R-Penn.) introduced the 21st Century Health Information Act, which would provide financial support and incentives to develop community-based health information networks.
That bill is still pending, but on Monday, while the “Frontiers” conference was taking place, U.S. Health and Human Services Secretary Michael Leavitt unveiled a new public-private collaboration to advance health care IT, as well as requests for proposals focused on privacy concerns, standards harmonization, and a scalable national network prototype.
The federal government will spend $86.5 million on health IT programs in fiscal 2005, and President Bush has requested $125 million for fiscal 2006.
In this context, the focus of Kennedy’s conference was no longer to sell providers on IT, but to discuss how to adopt it effectively, with the motto “Don’t reinvent the wheel.” The idea was that while IT may be new for most health care providers, there are plenty of examples to learn from, both from health care trailblazers, and from other industries.
So the audience heard from local experts, such as the head of Rhode Island Hospital’s medical intensive care unit and the heads of the Rhode Island Quality Institute and Quality Partners of Rhode Island, but also from leaders from Raytheon, the Defense Information Systems Agency, the Federal Aviation Administration, and Boeing.
Woven into every talk was the notion that technology is not a goal unto itself, but a tool to vastly improve quality and safety and reduce costs. Today’s health care system, Kennedy said, is not designed “to get the best possible outcomes for patients at the lowest possible cost.” Treatment protocols proven to save lives and promote health are often not followed, while unnecessary procedures are common. And poorly designed systems and paperwork create “rampant” inefficiencies, Kennedy said, costing $1,059 per person in 1999.
The system needs to change to provide “the right care for the right people at the right time,” Kennedy said, and that requires health care technology, combined with the “right knowledge and culture” and “the right incentives and information.”
Technology can also help save costs, Kennedy said, by identifying “high-value” providers – those who provide the right care and avoid unnecessary procedures.
Elizabeth B. Gilbertson, director of strategic planning for the HEREIU Fund, a Las Vegas hospitality workers union’s trust fund, spoke about how the union, which manages its own health benefits, used claims data to do just that.
The union’s plan covers 120,000 people – mostly low-income immigrants, including 43 percent Latinos – at an annual cost of $235 million, Gilbertson said. It has about 1,800 doctors in its network, and in 2003, it started evaluating their “treatment patterns” for different diagnoses and patient types, on the notion that 85 percent of health care is driven by either what doctors do themselves, or what they order to be done.
The study found that for ear infections, for example, doctors ordered treatments ranging from $46 to $412, and acute bronchitis treatments ranged from $89 to $771. Treating a urinary-tract infection could cost $81 to $779, and knee surgery could go from $2,727 to $9,383.
To some extent, it’s normal for different patients to get different treatments depending on their general health and other circumstances, Gilbertson said. But the study looked at patterns, and how likely different doctors were to fall into the lower, middle and upper ranges.
Ultimately, the HEREIU Fund fired 50 doctors. Simultaneously, it created a “gold star” program to reward doctors who provided recommended care, such as regular cervical cancer screenings, mammograms and diabetic retinal exams, putting a star next to those doctors’ names in the provider listings and allowing them to earn bonuses of up to 10 percent.
In the first year, Gilbertson said, the program saved $17 million, and health costs, which had been expected to rise by about 12 percent per year, only rose by 1 percent. In the second year, which ended last April, costs rose by 7.6 percent, she said.
David M. Cutler, a Harvard University economist, said technology has the potential to make big improvements in health care, especially in reducing errors and improving quality. But actually saving money – that will only happen in the long run, it won’t necessarily benefit those who are making the big investments, he said.
Cutler noted how HealthPartners, in Minnesota, made a “phenomenal improvement” in diabetes treatment and outcomes through an intensive effort with doctors. But at first it lost money, and the eventual savings were small, because “five or ten years down the road… the patients are rarely in the same health plan they used to be in.”
The way to get around this, Cutler said, is to collaborate.
“You need a regional system,” he said. “And you need shared goals, for example, a 70-percent cut in hospital admissions due to medication error, or that a significant number of doctors will be open on weekends.”
Without collaboration, Cutler said, “I’m afraid that because health care is so fragmented, people are going to do all these things and discover that no one thing in health care can make a big difference.”
