Over the next decade, U.S. Health and Human Services Secretary Tommy Thompson wants America to develop an electronic database of health care records that physicians, hospitals, and patients can instantly access anywhere in the country. For tech-savvy Americans, such a database may sound like a relatively straightforward endeavor. In fact, this project is extraordinarily complex and expensive (some estimates put the price tag at over $10 billion). It’s also necessary if health care is to improve.
To pull it together, the Bush administration is looking to people like Leonard J. Betley, president of the Richard M. Fairbanks Foundation in Indiana, who’s helped blaze the electronic trail in his state.
“Getting the right information to the right person at the right time sounds easy, and it is being done in manufacturing and in other industries,” says Betley, “but in health care, it’s a huge problem.” One hurdle is the competition that exists among for-profit entities. “Our experience here shows that local hospitals are loath to put money into anything that will help a competitor,” Betley explains. “It’s very difficult to get them to go beyond their own immediate needs without another player involved. That other player is going to have to be a nonprofit. Nonprofits are the oil in the engine that makes something like this possible.”
The Fairbanks Foundation, established in 1986 by the founder of Fairbanks Communications, focuses its grantmaking on the Indianapolis area and looks for projects that provide market-based solutions to social problems. This funding strategy drives the foundation’s grantmaking in the area of health care. In 2003, it gave $60,000 to the Central Indiana Corporate Partnership, a forum of chief executives trying to spur economic development in the region. The money was earmarked to help launch a new nonprofit that would wire together health care providers—first in Central Indiana, but eventually in the entire state—by creating a common, secure infrastructure they could access. Fairbanks followed its initial grant with another $250,000 grant this year.
The newly formed nonprofit, the Indiana Health Information Exchange (IHIE), could become an organizational model for other regions of the country trying to launch uniform, computerized health information networks. If that happens, patients will get better care, and may even pay less for it.
“The fragmentation of patient information is not only costly, but quite dangerous,” says Dr. Thomas Inui, vice chairman of the IHIE board. “There’s a critical need for effective information-sharing, to monitor potential drug interactions, allergies, and all sorts of historical data that might affect a physician’s treatment decisions. Indiana can be a pioneer in this area.”
In emergency health care, where every minute counts, getting to medical records quickly saves lives. But one Stanford University study showed that 81 percent of the time physicians lacked the necessary information to make informed medical decisions. With an electronic medical system, possibly accessed with the help of a patient ID card, medical records could be obtained in seconds.
Less urgent care would also benefit. With medical information online, patients need not fill out time-consuming forms when seeing a new physician. Tests would not have to be duplicated because of a lack of coordination between doctors. And pharmacists would not have to decipher, and possibly misunderstand, doctors’ notoriously bad handwriting. Yet only 13 percent of hospitals and at most 28 percent of physician practices nationwide had electronic health record systems in 2002, according to the federal department of HHS.
Some consider the current situation outrageous. As Secretary Thompson told a congressional subcommittee in July, veterinarians have more electronic medical information on pets available to them than most doctors have on human patients.
“We can alert individuals to have their dogs come in for shots,” Thompson said, “but what about our children? Don’t you think it’s about time to have our children be able to have this kind of reminder?”
Thompson added that computer networks had enabled him to get cash and see his account balance from ATMs in Bangkok and Moscow, but unlike the financial sector, hospitals are not efficient communicators. “Right now in America, we have upwards of 98,000 people die each year from medical mistakes,” Thompson concluded. “Most of those can be changed and completely stopped by new technology.”
Thompson estimated that a good health information system could save the country $131 billion a year—about 10 percent of annual health care spending. To speed the transition, the Bush administration has appointed a national coordinator for health information technology and announced it will give $50 million in “seed funding” for five states to establish electronic networks.
Thompson cites Indiana, and particularly Indianapolis, as being “far ahead” of the rest of the country in “developing synchronized communications systems that can talk to one another.” President Bush has also praised Indianapolis for doing “a fantastic job of implementing and employing information technology.” In a recent speech on medical technology, the President said the challenge is first to have other regions of the country replicate what Indianapolis is doing and then “get communities hooked up with communities so there’s a whole nationwide network.”
With public-private cooperation, Indianapolis already has a working network in which five hospital systems and ten emergency departments are connected by computers. When a patient arrives in an emergency room, a physician can call up the patient’s previous lab tests, x-rays, medications, allergies, and other information within 30 seconds. And if all goes well, by the end of this year Medicare patients in Indiana will be able to log on to an Internet site and print out all their recent medical tests and diagnoses.
Nonprofits are needed to not only mediate between competing private health systems but also to ensure the public that medical records are being protected and not exploited. “Privacy is vitally important, and that’s where the nonprofits really help,” says IHIE chief executive Dr. J. Marc Overhage. “To have this move forward you need the assurance that there isn’t a for-profit company looking to sell your medical information to the highest bidder.”
In that regard, Betley has been an invaluable overseer, not just in his role at the Fairbanks Foundation, but as chairman of the Regenstrief Institute, a pioneering nonprofit that has invested more than $30 million over the past 30 years into research and development of what it calls “medical informatics.”
While much has already been accomplished, Betley says much more still needs to be done, at a cost of millions of dollars, to fully wire Indiana for health care. When that happens, the investments of Indiana nonprofits will pay dividends far beyond this Midwestern state. They will provide an electronic road map for health care nationwide.
“We want the best health care system in the world for our patients, at the best price,” said Bush after showering Indianapolis with praise. “It can be and will be achieved.” Bush’s new national coordinator for Health Information Technology, Dr. David Brailer, summed up the opportunity this way at Washington summit in July: “Ultimately, this is not about technology—this is something fundamental about how healthcare is given.”
Mark O'Keefe is editor of Religion News Service.