Today’s Wall Street Journal has a fascinating piece on large employers (WalMart and Intel) moving to develop their own electronic health records for their workers — click here (I think it’s free).
Next week, the companies will announce their collaboration on a records standard to kick-start the plan. Later, about 10 employers are expected to chip in $1.5 million each to construct a data warehouse to store and update the e-records. Once in place, the combination would allow consumers and insurers to evaluate price and performance data from millions of employees. Eliminating duplicate tests and erroneous or lost information would also slash administrative overhead, which is estimated to account for 40% of medical costs. And electronic prescriptions alone could help prevent the 98,000 serious illnesses or deaths that result annually from prescription mistakes. …
The coalition expects to apply a combination of market pressure and incentives to get doctors and hospitals on board. The employers will insist that health-care providers adopt electronic records and prescribing as a condition of future business. Retailer Wal-Mart will apply its purchasing power to get bar codes on products intended for hospitals and clinics. All expect employees to pick doctors willing to use and update their records, though employee compliance is voluntary. According to the companies, the records will be the property of the employees, and the data will be mined by insurers and others only after the patients’ identity is stripped off. …
Coalition members believe that giving consumers control over their own records would help get around the technical and cost issues. But the idea of portable medical records and a massive repository still faces hurdles. Privacy advocates worry that digital records will be misused by employers and insurers to deny jobs or health-care coverage. The watchdog group Patient Privacy Rights Foundation urges employees to shun the approach until there are adequate protections. “The system is leaking information,” says Chairwoman Deborah C. Peel, a practicing psychiatrist. “Once out there, it’s like a Paris Hilton sex video. It’s [there] for the millennium.” …
“It has always seemed unusual to me that the medical record is seen as the property of the medical system,” adds Donald Berwick, chief executive of the Institute for Health Care Improvement, Cambridge, Mass. Tests are duplicated and information lost in the handoff between physicians or clinics. “The best integrator in the end is the patient,” Dr. Berwick says. …
So much to chew on! Here in Massachusetts, the MA eHealth Collaborative (MAeHC) has been working diligently for several years now — with $50M in Blue Cross funding — to develop a statewide eHealth system, starting in three pilot communities of North Adams, Brockton, and Newburyport. Is this new initiative a “disruptive” strategy that enhances or complicates MAeHC’s job?
Is this an example of what Intel’s former CEO meant when he suggested the health system should “shift left,” moving to simpler and more basic innovation strategies?
Does it make you feel warm and fuzzy to trust big companies with your electronic health records — especially WalMart, which in a memo last year outlined plans to make all their workers round up shopping carts in the parking lot as a way to encourage less healthy workers to leave their employment?
Bottom line — the existing medical system is on a slow, slow path (faster here in MA) to EHR adoption. Maybe this is the kick the system needs.
I think its pretty important to allow portability of the electronic health record, but doing it through employer sponsored records is a bit scary to me…also completely unnecessary given some of the services that are out there. One that I know of is http://www.chartbiopsy.com; they have an EMR system that’s designed specifically to allow different offices to communicate. It was originally designed primarily for local free clinics that end up sharing a lot of patients. I know about them both through volunteer work at these clinics and they asked me for feedback occasionally on the interface, although (unfortunately!) I don’t get any money from them. Anyhow, recently they’ve announced they’re going to start offering office accounts to regular medical practices. As its dirt cheap at $29/month, I don’t think you can claim that portable EHRs are some huge investment that only big employers can cover. Regardless, this seems like a far better solution anyway because if you leave your job you can still take your health record with you.
This comment is on the MAeHC Blog as well (www.maehc.org). Yesterday’s WSJ reported on a WalMart/Intel collaboration in digital health records. I don’t have a well-formed opinion yet on whether this is good news or bad news for the HIT adoption effort that many of us are engaged in, partly because the article didn’t provide a whole of detail on what this collaboration is actually doing. So let me proceed, but with caution. John McDonough asks whether this might be a “disruptive technology”. I don’t think so. He also asks whether this will complement the work of MAeHC and others involved in promotion HIT adoption. I do think so.
On the technology question, it’s not obvious what’s meant by “digital records for employees” and “portable electronic records.” Patients don’t document medical care, physicians do. And only 10-15% of physicians have EHRs, and most of the country’s 7,600 hospitals don’t have readily accessible data either, so unless this is really a program giving digital records to physicians – and then giving patients access to those records – I don’t see how patients will benefit much.
Perhaps the WalMart model will be based on models that are already out there for the two types of data that are already electronic: claims and prescriptions. Health insurers are well down the road toward providing claims-based PHRs for patients, and AHIP has even brokered a deal for portability of the data across health plans. Revolution Health is going to build a portal that allows patient access to health financial information and health education information. KatrinaHealth is a patient-centric digital record of prescription information. None of these incorporate any hospital or physician information (ie, what we typically think of as our medical records) for the same reason noted earlier, namely, the data isn’t accessible electronically.
So, I don’t think this is a “disruptive technology” from a technical or innovation perspective – I personally don’t believe that there’s a technology magic bullet out there (though we all keep wishing for one!). The main obstacles, as always, are structural (our health care delivery and financing system needs is broken) and cultural (providers are notoriously independent and resistant to change, and patients think they get the best care in the world, even though there’s tons of evidence that they don’t).
I also don’t think it’s a “shift left” a la Andy Grove. You can’t get data out until someone puts it in, so I don’t think there are any good shortcuts here. It also has to be good data – you can’t aggregate data that isn’t structured, so having physicians use word processors rather than real EHRs won’t facilitate data warehouses and will actually set them back 10-15 years. I agree that we don’t want to have complex technology be a barrier to adoption, but it needs to be sophisticated enough to deliver value.
I do think this WalMart effort might exert “disruptive pressure” which could push the agenda forward and be very helpful to efforts such as MAeHC. The problem in HIT is that there’s no compelling reason for physicians to adopt EHRs or for providers to link up their systems once they have them. Most efforts to date have focused on the supply-side (ie, providers) because there’s been no real pressure from the demand-side (patients and employers, and their proxies, the insurers). Pay-for-performance may be an indirect means of forcing technological transformation, but it’s indirect. By contrast, when working with their other supply chains, WalMart, GM, Intel, and others insist that their vendors set up electronic data interchange systems that allow real-time inventory management, order management, delivery tracking, etc. If employers start thinking of their health care supply chain in the same way – and require that their health care providers have EHRs and interoperability – they will fundamentally alter the pace of change by creating urgency, where none really exists today. Patients will be the main beneficiaries in the end.
I think it’s fair for all of us to be concerned about anything related to healthcare that WalMart is involved in, because their business success is based on cost-reduction, not on maintaining high quality products or service, and they apply this approach to their suppliers and to their employees alike. In that vein, I worry that there could be an element of coercion in their model as described. Will they derive revenue from selling the de-identified data from the warehouse? Will they ask patient permission to sell this data (HIPAA doesn’t require it)? Will they share the revenues with their employees? My fear is that the answers to these questions aren’t on the side of their employees. WalMart of course would argue that the data is theirs since they’re holding it, paying for it, and de-identifying it (I guess possession is 9/10 of the law, or something like that). Yet another reason that we should move away from our system of employer-sponsored health benefits, but I’ll wait for John to open up that can of worms……