Friday, December 4, 2009

Yet more on Open Mobile Health Exchange

Karen Edwards-Crawford said:
Better access to patient's medical records would be a great improvement. There are times when I can't even get records from a facility that is only five mile away. What's up with that?

So many reasons why we can't routinely share data in the interests of the patient: legal, social, political, economic. Sometimes, just a failure of imagination! However, the technical barriers are mostly solved or nearly so. The real challenge is developing a social consensus that this is something we ought to do and agreement on how we should all behave so that patients (and their data) don't get abused. We've made great strides with sharing laboratory results for diabetes among providers (and the patient - a key ingredient!), but uptake by the healthcare industry is slow. Many of the key decision makers, especially on the insurance side, are wary. They are more worried about losing their franchise in the future altogether than improving quality and reducing costs now. They also want a "one-size-fits-all" solution that will solve all their operational issues at once. And, they believe their competitive advantage lies in cost-center control rather than quality improvement. So, they are holding out for a mandated solution that their competitors must do at the same time they do, that fixes all the ills of the health care system (not just one or two conditions, no matter how important), and that someone else will pay for. The net result is that they're leaving hundreds of millions of dollars on the table, doctors like Karen Edwards-Crawford are frustrated, patients get care they don't need and don't like, costs go up for everyone, and the government mandates more and more controls.

There is some good news. Some small insurers and provider groups around the country (like FirstCare in Texas) have figured out that they can see big benefits in the short run (this fiscal year) by making small targeted investments in intelligent, proven health information exchange programs for critical areas like diabetes. These payers and providers are positioning themselves to thrive no matter what comes out of reform legislation and no matter how long it takes to get the bugs out of massive comprehensive medial records programs. So, it feels like two steps back for every one step forward, but maybe we are inching towards a better place! It certainly has kept things interesting for solutions providers like Vermedx.

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