There's a war out there, old friend

Most patients and their doctors have yet to realize that the future belongs to those with the best information. 

When it comes to getting paid for services, running a medical practice today often feels little different than fighting a battle. At this stage of the battle, using a WW II analogy, The doctors should be building radar towers. The analogy... in the Battle of Britain, it was not the numbers nor degree of effort of the combatants that primarily determined the outcome in 1940. The advantage for the Brits was determined by a small group of pilots armed with better information technology. The Brits did not have better pilots, and did not have more planes, they had better information! They had radar! 

So, to quote a movie line...  

…"There's a war out there, old friend, a world war.  And it's not about who's got the most bullets, it's about who controls the information.  What we see and hear, how we work, what we think, it's all about the information!"
--Cosmo to Martin Bishop, in Sneakers” - http://humanities.uchicago.edu/faculty/mitchell/glossary2004/information.htm  

A small group of patient-oriented physicians with better information technology could turn the tide on the current power-elite of our dysfunctional healthcare system. Otherwise, the current healthcare power-elite are further empowered to the extent they can continue to divert healthcare dollars away from providing reasonable care.

In order to bring the metaphor closer to home, just recognize that doctors can’t even take care of patients without information. Those who control the patients’ information, or have the best information, control the actions of patients and their doctors. This is why patients must have control of their health information. In nations where the focus has been on the patient, this has been accomplished with the result of higher quality healthcare at lower costs.

In the U.S., we are on a path where eventually, mega-billion dollar enterprises and/or the government are increasingly controlling healthcare information (and patient care). The information they have is terribly flawed because it is based almost solely on claims data. However, these power-elites have the only real data regarding patients. As a result, these entities are the ones “winning the war.” The losers are usually patients and their doctors. 

For patients and their doctors to win, they will have to roll up their sleeves and develop better information technology based on more than just providing claims data, and they must insist on having ownership-control of that information. Few doctors realize that the value of the information in their patient database will soon be far greater that the value of the system itself. Increasingly, enlightened physicians are willing to make the necessary investments today in order to reap tremendous benefits tomorrow. The key is to implement  electronic records that allow clinicians and their patients to own and improve the information within, and to be able to prove the superior results. 

Ideally, patients will be incentivized to increasingly take the initiative and seek the best information available to them regarding their issues (i.e. Personal Medical Home?), and see that their doctors have the most complete record of their personal health information (i.e. Personal Health Record or PHR?). Doctors would be wise to take the lead and show their patients how to best do this. This is best facilitated by being able to instantly deliver the most effective approaches to patient problems (i.e. Evidence Based Medicine?) 

For information technology to work for doctors and patients, the clinicians have to be able to turn a lot of data into true information. Doctors have to have the best tools to pool information (i.e. Interoperability and Registries) and do this in a fashion that has the intent of improving the well-being of patients. Clinicians must develop the means to have valid data-information to take to those paying for healthcare. Doctors must be positioned to show "payers" that their practices are delivering a superior service at a lower cost. As a result, doctors might even be in a position to limit their "participation" to only the "health plans" that adequately reward them for their efforts and focus on valid measures of patient well-being. Would it not be great if doctors could then decide what payers to allow to participate in their practices rather than the reverse? This is possible if clinicians work together and look for the common good. It will not happen if clinicians continue to do little more than criticize, and continue to produce gobblity-goop records. 

The industry/government approach, to date, has been extremely flawed. For example, there is a real risk with Stark Law Exemptions where hospitals and other, large corporate entities may now provide health information technologies to physicians.  This often has the result of further empowering the heavily-moneyed entities that tend to be in control of healthcare in this nation. Unfortunately, true healthcare reform will not be possible by putting the industry or the government in charge of the information. The patients must be in charge, and patients need trusted advocates to help them best manage their information. In a healthy system, this should be a physician of the patient's choosing. In the current environment in the U.S., the Stark Law Exemptions have sometimes encouraged just the opposite. Patients and their physicians are losing more control over patient health information.

Finally, ensuring that there is true information interoperability is the only way to keep things from turning very dark. This will only happen if physicians and other patient advocates step up and become information specialists and demand affordable interoperability. They must insist on interoperability standards that facilitate patient ownership of their information. That is not necessarily the goal of the healthcare industry and government initiatives currently in progress. Unfortunately, as long as the fee to a small practice averages $14,000 for an interface to the hospital (or other) systems, the industry efforts to promote interoperability are little more than a smoke screen to hide the fact that the desire is to thwart information sharing. If the industry can't control price gouging for interfaces, we will only have more of the same. The results, to date, has seen the creation of many, local, healthcare monopolies all across the country. The results have often been very profitable healthcare delivery systems (and their supporting information system vendors) with patients unable to get care or information.

The future well-being of U.S. healthcare will be largely determined by how well patients and their trusted physicians control and utilize information technology. The other approaches will result in more war games as the industry remains focused on chasing dollars instead of taking care of patients.

At SOAPware, we will continue to participate in initiatives to empower physicians deserving of their patient's trust.

So do you think insurance companies are basically fighting and winning a war with providers by out investing them on the technology side?