Do you think the structure of our health care system needs to be changed? How so?
That’s an interesting question and certainly a challenge to answer succinctly. There is no question that costs are spiraling out of control, quality and errors are still an issue, and care is not as predictive and participatory as most would hope. Health care reform is a hugely complex issue, so I’d like to focus on just one component—implementing a nationwide electronic medical record (EMR)—and the essential role I think that plays in healthcare reform.
It comes as a surprise to most people that the standards-based connectivity developed for our modern world—for example, to allow secure online banking—is not already in use in the medical world. But, most physicians’ offices are still using paper records. And even if they have gone digital, they still can’t connect their records with the electronic system of another institution where we may be getting specialized care or connect to research going on in that area.
Most of our health care information has to be entered and re-entered for any new healthcare encounter we have with a new physician or in a different hospital, and not infrequently even within different departments at the same hospital. We are all familiar with the ever-present clipboard passed to us at each health encounter where we hurriedly recount from memory our complex medical history. This is not sustainable or efficient.
Many like to focus on the challenges of adopting a nationwide electronic medical record (dealing with the huge expense—especially for smaller physician practices, convincing and training healthcare providers on its proper use, security and safety of patient information, etc), but we are long overdue for truly investing resources in this area.
Researchers at Dartmouth University, for example, found that the U.S. wastes as much as $600 billion of the nearly $1.8 trillion spent on healthcare—most of which comes from disorganization, lack of information, and the unneeded tests, ineffective procedures, and simple human error that result. A nationwide electronic medical record would help to address many of these issues and is the first step, in my opinion, on the road to true healthcare reform.
What is the single most important issue meaningful healthcare reform needs to address?
In addition to hindering patient care, lack of accessible information also hampers the discovery and development of new therapies. For example, the absence of clinical data in electronic form slows the match-up of clinical profiles on thousands or tens of thousands of patients, with information about candidate therapies, so that correlations—and their significance—can be identified and applied rapidly.
A truly efficient and effective healthcare system seamlessly integrates and partners consumers/patients with healthcare providers, researchers, and even stakeholders in the biotech and pharmaceutical industry. Meaningful healthcare reform needs to recognize this and lay the foundation for a “learning healthcare system” where the discoveries and outcomes in the clinic inform the research questions, drug development, and diagnostics we explore in the lab.
Similarly, the discoveries from our basic research and clinical trials need to more quickly and efficiently be available to our healthcare providers and patients to make informed and personalized healthcare decisions.
Some organizations are already taking steps to make this vision a reality. For example, the National Cancer Institute’s cancer Biomedical Informatics Grid® (http://cabig.cancer.gov) and the BIG Health Consortium™ (www.bighealthconsortium.org) are providing tools and infrastructure, creating a constructive ecosystem, and working on a variety of projects to help streamline the way we do biomedical research and clinical care in this country. They are starting with cancer as a model (and quickly moving beyond that) to show how we CAN connect research to care and model a new approach in which clinical care, clinical research, and scientific discovery are linked to achieve personalized medicine and improved clinical outcomes.
As a part of this, these groups are working toward an oncology-extended electronic medical record—a necessary component of achieving the vision of a learning healthcare system in the cancer research community. I am hopeful that the best practices that arise for efforts like this will educate and inform those working in other areas.
Check back tomorrow for part two of Schulte’s interview.
As the national debate over health care reform rages, we’re asking Schweitzer Fellows and Fellows for Life — who are working directly with the populations whose needs are unmet under our current health care system — to weigh in.