Wednesday, January 13, 2010

Health Reform Passes. Now, The Real Work Begins.

Well, as I'm sure you're well aware, Health Reform has passed both Houses of Congress. The House of Representatives passed their version on November 7th, 2009 with a vote of 220-215. The Senate passed their version of the health care bill on December 24th, 2009 with a clear 60-39 party-line vote. A clear victory for health-reform advocates (and a nice Christmas gift for those advocates whom celebrate the holiday), the battle is far from over.

Step 1 of the battle was passing the bill. Step 2 now is compromising the two forms and agreeing on the bill's provisions, which is no small task. A number of provisions will be hammered out: 1) national versus state health exchanges (no more public option), 2) definition of, and possible taxing of, "Cadillac" health plans, and 3) how to pay for this health care overhaul. Democrats are focusing on some provisions appealing to all consumers, such as: 1) the cutoff age for children to be on their parents' health plan moved to 26, 2) eliminated co-payments for preventive services, and 3) no more denying coverage to children under the age of 18 with preexisting conditions. However, that doesn't mean Republicans are done fighting. As stated by Minority Leader Mitch McConnell (R-KY), "My colleagues [Republicans] and I will work to stop this bill from becoming law."

I think Adam Zyglis' (from the Buffalo News) Charlie Brown cartoon (above) says it all for our next steps. How far will the compromises go and what will our final version of health care reform look like? Will it be enough?

Health Efficiency

It's a fact. The United States is not a "leader" in health information technology. But we are trying to say "goodbye" to our old ways of paper records (see photo). We may be able to learn a lot of Denmark, a country that started using electronic health records (EHRs) a year ago. Telemedicine is also greatly utilized in Denmark (an example of Telemedicine can be found here). If the US wants to focus on efficiency in our health care system (we do), then perhaps we should follow our Scandinavian friends' example (Sweden and Norway are also using EHRs).

To quote the 2008 report by the Healthcare Information and Management Systems Society (HIMSS), "healthcare information technology (IT) is a sleeping giant." On top of that, healthcare IT is significantly behind most other sectors (e.g. banking and telecommunications). The report also mentions that Denmark was able to save roughly $120 million per year by using electronic medical records. The Commonwealth Fund will also be publishing a study later this month, which concludes the Danish information system is the most efficient in the world.

US policymakers are studying the Danish system and seeing if it is possible to follow their example as we overhaul our current healthcare system. Although it is used in some US hospitals and clinics, EHRs only exist in the minority of hospitals--about 10%, or about 17% of physicians use EHRs. Compatibility across and within systems needs significant improvement in the US though. However, last week, two large health systems and users of EHRs--Kaiser Permanente and the Department of Veterans' Affairs--announced communication is possible across the two systems (hooray!).

Of course, electronic health records (EHR) aren't without some concerns. Privacy is one of them. Even though the majority of physicians think EHRS will save time and money while improving patient care, many are still worried about possible security breaches. This is one area HIT policymakers will have to focus on while moving forward with the United States' journey to advanced HIT and EHR.

What do you think about the United States and its expanding role into electronic health records using health information technology? I must say that I, for one, am looking forward to the day that I do not have to fill out my prior medical history (AGAIN) at every doctor's appointment I ever make. Have it all in one electronic record would sure be nice.