More, Better Information Key in Fixing Health Care

Primary care physicians and specialists often drop the ball in communicating with one another about patients they are treating, leaving patients or caregivers to try to close the loop on their own. And most physicians have no idea what anything costs.

Pharmacists are rarely better. They spend six years in school learning more about drugs than most doctors will ever know, then disappear to the back of the pharmacy to count pills. Pharmacies are convenient and accessible; their pharmacists are a vast untapped information source.

The introduction of electronic health records and electronic prescribing help but are only part of the solution.

We need health information exchanges, like the ones piloted by the Massachusetts eHealth Collaborative, to share patient data. We need secure, efficient platforms, such as RelayHealth, for doctor/patient messaging.

We need decision-support tools like SimulConsult to organize clinical findings to help diagnose rare diseases, sparing patients the misery of going from doctor to doctor in search of a name and treatment for their condition.

We need more patient communities such as Patients Like Me and treatment planning tools such as NexCura.

We should make better use of information from existing diagnostic tools. Advanced analysis software, for example, can mine digital data from inexpensive ultrasounds, reducing the need for expensive MRIs and PET scans. Other technologies can analyze ECGs collected for clinical trials, identifying cardiac safety problems early in drug development before the next Vioxx comes to market.

Using Information to Make Tough Choices

Better availability of information will improve quality and customer service, but it is by no means certain that the adoption of information technology will inevitably lead to big cost savings.

Some efficiency will be gained by eliminating transcription costs and reducing duplication of tests, but better information may actually lead to higher spending. After all, with more information about their conditions, patients may seek additional treatment.

Information can be used to hold down health care costs, but that requires political will.

In the United Kingdom, the ironically named NICE (National Institute for Health and Clinical Excellence) evaluates treatments based on data and decides if benefits outweigh costs. When the answer is no, as it often is, the National Health Service won't cover the treatment.

In Germany, whole classes of drugs are evaluated to determine whether on-patent products are more effective than generics. If not, branded products are reimbursed at the same (low) level as generics.

If we choose as a society to use information for hard decisions, costs will be contained. But the model will be different from the United Kingdom and Germany. We'll use incentives and cost sharing, not outright bans and price controls. Examples are emerging in the public and private sectors.

Within a decade there will be plenty of good information available, and we'll have learned to use it well. Then we'll finally be headed toward a health care system worthy of respect.

David E. Williams is a principal and co-founder of consulting firm MedPharma Partners and the author of the Health business blog.

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