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The Dark Side

If ever a field cried out for the intelligent application of information technology, American health care is it:

• Walk into any physician's office today, and you will be asked to fill out the same privacy forms repeatedly.
  
  
• Make an appointment with a new physician, and you will be asked to complete a medical history form that you've filled out countless times before.
  
  
• Shop around for health insurance, and you will have to come up with the same recitation of past illnesses, drugs prescribed, and the names and phone numbers of the people who treated you, most of which you've forgotten.
  
  
• Go home following surgery, and you'll be treated to a blizzard of bills and insurance claims that even accountants don't fully understand.
  
  
• Call up your friendly health plan for help, and, if you're lucky, you'll speak to a real human being after 15 minutes of mind-numbing recorded messages.

That's just for the patient. Talk to any harried health care provider today, and you'll get an earful on stratospheric administrative overhead costs and less time to spend treating patients. The field is a veritable jungle of impenetrable forms, regulations, miscommunication and unnecessary duplication, much of it due to a lack of quick and easy access to relevant, accurate information.

And we haven't even touched on medical error and quality of care.

It's not that steps aren't being taken to improve efficiency and quality of care through information technology. After a slow start, billions of dollars are being invested in medical informatics and related technologies by hospitals, health plans and other organizations looking to get a leg up on the competition in the medical arms race. California-based Kaiser Permanente alone, with over eight million health plan members, is sinking almost $2 billion in an automated medical record system.

Kaiser isn't doing it because it's a cool thing to do. They're doing it to make money and improve the quality of care.

So why isn't everyone jumping on this bandwagon? We have the technology, we know how to create more efficient systems, we know how to reduce medical error, improve quality, and lower the hassle factor. Why did the health care industry invest just two percent of its revenues in information technology over the past decade, compared to a 10 percent rate for other information-intensive industries - and still manage to spend as much as $125 billion annually on unnecessary paperwork?

It's the Dark Side.

You know, the Darth Vader world of Big Brother peering into your medical history and denying you care, systems being hacked by merciless data pirates who fence confidential information to unscrupulous companies, email confidences being exposed, company data on cost and quality being misinterpreted and used unfairly - that sort of thing.

Well, there's some truth there. Privacy counts. Ya' got to be careful.

But there's another Dark Side we don't talk about as much, and that's the dark side of corporate greed. This is the world of proprietary data systems, slick technology, market share and our seemingly unlimited desire to make obscene amounts of money through competitive advantage.

The Dark Side of government control and loss of privacy is often a straw man for the Dark Side of greed and self-interest. Why invest in a public medical informatics infrastructure when your private investment gives you a financial leg up?

It's a challenge to persuade a health plan or hospital system that has invested millions of dollars in a proprietary information system to use a standard electronic medical record that can merge private system data into a much larger public system and then apply it to improving care for everyone across systems. The public arguments of efficiency, quality and cost (being able to instantly bring up the treatment history of a patient from another system who suddenly shows up in your system, etc.) are invariably trumped by a perceived loss of competitive advantage and control.

The fact of the matter is that while patients and providers are buried in a morass of administrative inefficiency, some people are making a ton of money. They feel your pain, but not enough to share it.

The one thing that would move things forward is a federal mandate for a universal medical record and the standards and regulations that would promulgate it in a fair manner with complete protection of patient and provider privacy. The Institute of Medicine is moving in the right direction by developing a standardized medical record, a model of which is expected sometime in 2004.

While we wait for that - and from the model to actual national implementation could well take a lifetime - photocopy reams of your HIPAA agreement and medical record forms and hand them out ever so discretely as you trip darkly through the system.