Trying To Soar With Feet Stuck In Mud
There are advances being made in healthcare that border on the stunning. Witness the gains made by Dr. Patrick Soon-Shiong (July 6, p. 30) as one example. Despite laudable gains in knowledge and therapeutics, our healthcare picture remains saddled by inefficiencies and an unsustainable cost structure. In that same issue of Modern Healthcare, an article about free-standing emergency centers lays bare some of our current healthcare delivery problems and inconsistencies.
Gains such as those by Soon-Shiong and others grounded in advances in genomics make clear the move toward more individualized care. Similar advances in individualized care through our exploding knowledge in epigenomics, proteomics, metabolomics and microbiomics, and the growing volume of data from patient-centric apps and devices will continue this trend at ever accelerating rates. How to ensure that all of this can be broadly offered to our fellow citizens without economic discrimination is nowhere answered.
Free-standing EDs provide some convenience to well-insured people. But to claim they answer, let alone advance, our country’s healthcare needs is simply disingenuous. They seek to siphon profits by virtue of a payment system that allows ED charges for services easily and more appropriately offered in other settings. All arguments supporting their claims of fulfilling needed services is laid false by their placement in only selected ZIP codes.
The point is that we lack the infrastructure to provide basic care to all while trajectories of waste exist alongside breakthrough knowledge and treatments. While I have no doubt that Soon-Shiong will enjoy success in creating a data repository whereby genetic markers for cancers can become a breakthrough for cancer treatment, it seems embarrassing that we cannot yet control even antibiotic use in an ambulatory setting.
Our current electronic health-record platforms seem to be everyone’s answer for the infrastructure mechanism that will address these problems in healthcare delivery. But their track record thus far is of a costly system that has yielded few measurable gains. They are costly not just financially but in provider time, workflow disruptions and satisfaction.
There is, however, a mechanism that can be the answer. This is an IT architecture that gathers clear, accurate data points at the point of care to drive accuracy and efficiency of care. In this architecture, the documentation elements of EHRs would be removed from billing and regulatory demands. Upon this simple, clear and accurate platform can be added data elements from genomics and the other fields and data from all those patient-centric devices. The data, accumulating exponentially, all serves to more precisely risk-stratify patients and formulate their functional status over any time horizon.
This system is easily constructed and would essentially be cost-free to providers. The basic dynamics move us away from the imposed complexity of current EHR platforms to a system that can truly drive healthcare while simultaneously decreasing provider time costs and lessening waste.
Dr. Joe Heit Chief of staff Centura-St. Anthony Hospital Lakewood, Colo.