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A meaningful disruption of the U.S. health care systemby Brad M. Pruitt, M.D.
Palomar Pomerado Health Chief Medical Information Officer,
The mobile health (mHealth) revolution is now fueled by the federal government’s unprecedented Health Information Technology for Economic and Clinical Health (HITECH) Act to help health care providers transition from paper-based to electronic health records, which will ultimately report to a national health care database. With billions of federal dollars from legislative reforms and incentive programs at stake, hundreds of information technology, hardware, software and telecommunications companies smell the chum-filled waters.
The Chum is in the Water — and Everybody Smells the Money
As of January 2011, government programs were in motion assisting health care providers in converting from paper medical record systems to electronic health records. As part of the $155 billion allocated for health care from the American Recovery and Reinvestment Act of 2009, $25.8 billion was earmarked for the HITECH Act. The funds are being used to improve health care quality, safety and efficiency through the use of Health Information Technology (HIT) and electronic health records data. By one estimate, the government’s incentives to revamp the health care and medical technology sector could drive global HIT spending from $89 billion in 2010 up to $106 billion by 2014.
U.S. Health Care System Receives a “HIT”
At the bedrock of the federal government’s health care cost reduction strategy is the use of electronic health care data instead of paper medical records. Jamie Coffin, head of Dell’s health care business, explains the core of HIT: “The future of health care is that you should be able to go to any doctor, anywhere, and get access to your medical records.” In addition, cloud computing and wireless communication advances now give doctors and consumers access to electronic health records and clinical support tools in real-time at the point of decision. The widespread use of HIT and electronic health records will make it possible for health care providers to better manage patient care.
ViSi Mobile Device,
Given the abundance of wireless telecommunications, life science, medical research and information technology companies in the area, it is not surprising that San Diego has been dubbed the epicenter of the mHealth revolution with local firms leading the charge in pioneering such powerful medical technology.
For example, Palomar Pomerado Health developed a mobile application for tablet computers called MIAA, or Medical Information Anytime Anywhere, which provides clinicians access to electronic patient records and clinical decision making tools. Unlike traditional paper records, the MIAA displays real-time patient statistics by wirelessly receiving patient data from medical devices such as the ViSi Mobile™, a sport watch sized device developed by Sotera Wireless. The ViSi Mobile™ is worn on the wrist and continually collects and wirelessly sends patient vital sign data in real-time to the MIAA for analysis and cross-reference with the patient’s electronic health records.
For patients, this means that they can be monitored 100 percent of the time, regardless of whether they or their doctors are located within the hospital walls. This technology can predict and instantly detect patient degradation, trigger an immediate medical response and reduce the length of time a patient is cared for in the hospital as clinicians have the ability to continually monitor patient progress as they recover at home. Earlier patient discharge with home monitoring translates to lower costs for medical care, better patient outcomes and faster recovery times – with the added comfort of being at home rather than in the hospital.
A Meaningful Disruption
Electronic health records, in combination with mobile health devices and applications that are continuously on and connected to a network, are by definition a disruptive wave in health care delivery and management. Electronic health records provide benefits that paper records cannot, such as patient access to health information and resources, coordinated health care communication, personalized patient education and automated reminders for follow-up and preventive care.
The ultimate goal of the HITECH Act is to create a private and secure national electronic health information exchange system to achieve significant improvements in our nation’s health care quality at a lower cost. This is possible when providers enter patient data and orders electronically so a computer can analyze and apply algorithmic logic to the clinician's decision at the point of care. To achieve this goal, the HITECH Act provides the opportunity for health care professionals and hospitals to receive millions of dollars in incentive payments for implementing and using medical information technology with electronic health records.
President Barack Obama has compared the health care reformation efforts to past large-scale infrastructure achievements, citing examples such as Lincoln’s transcontinental railroad, Roosevelt’s Rural Electrification Administration and Eisenhower’s Interstate Highway System. The implementation of the HITECH Act will be rolled out in three phases.
Beginning in 2011, Stage 1 focuses on electronically capturing health information to track clinical conditions and communicating that information to coordinate patient care, implementing tools to facilitate disease and medication management and reporting clinical quality measures and public health information. In 2013, Stage 2 encourages the use of HIT for quality improvement at the point of care and the exchange of health information in structured formats, such as the electronic transmission of physician orders, prescriptions and diagnostic test results. In 2015, Stage 3 centers on improvements in quality, safety and efficiency for national priority health conditions, patient access to their own electronic health records with self-management tools and improving public health.
A Curve Bender?
Strong interest from patients and providers alike will drive the adoption of electronic health records and HIT to advance health care quality, outcomes, patient safety and compliance. Initial surveys conducted by the Department of Health and Human Services revealed that four-fifths of the nation’s hospitals and 41 percent of office-based physicians intend to take advantage of available incentive programs for electronic health records adoption. By February 2011, more than 21,000 providers initiated registration for the Medicare and Medicaid electronic health record incentive programs and more than 45,000 more providers have requested government information in regard to the daunting implementation of electronic health records.
The expected return on investment for the government’s HITECH incentives has been estimated at $337 billion over the 10-year implementation period, with savings of $80 billion each year thereafter. To begin extending the benefits of electronic health records and HIT to patients, the federal regulations mandate patient access to electronic health care records by 2016. Legislation further requires the electronic reporting of providers’ quality of care to the government for analysis that will enable patients to evaluate health care providers according to a national standard.
In the end, it is all about utilizing technology to achieve better health care outcomes at a lower cost, or to “bend-the-curve.” However, given the health challenges Americans face as a result of lifestyle, the question of whether HITECH spending would have been better spent on educating patients, new parents and grade-schoolers about proper nutrition, diet and exercise remains. With all the technology available we have the capability to analyze in real-time the effects of a Twinkie as it is digested and to automatically order an ambulance when the heart stops beating as a result of the accumulated effects of eating the Twinkie. If we figure out how to use technology to prevent the Twinkie eating, there may be hope on the horizon to improve our nation’s health.
Brad M. Pruitt, M.D. (Rady Full-Time MBA ’11) is an entrepreneur and consultant with experience in health care startups, medical devices, international business development, pharmaceutical clinical trials and academic research. Dr. Pruitt was the recipient of the Rady Fellowship Award and the Latham & Watkins-Wolfe Family Fellowship. He is the principal and managing director of Prucor in Del Mar, California and the moderator of The MD/MBA Group on LinkedIn. Pruitt is passionate about patient empowerment, innovation and the commercialization of mHealth platforms with seamless interoperability of medical devices and services that integrate electronic health records and health information technology for coordinated care solutions that disruptively transform health care delivery.