Mature Market Experts: more mature market news and stats more often: Electronic Medical Records -

“Hello, Supreme Pizza, Carmen speaking, how can I help you Dr. Applebaum?”

How do you know my name?

“Caller ID my friend, would you like the usual, vegetarian with extra onions delivered to 23 High Side Lane?”

That would be great. “Ok Dr. it will be there in 20 minutes and we’ll charge it to your credit card on file ok?” Sure, thank you, goodbye.

Every day we interact with sales or service organizations that have an enormous amount of information about us in their computers. They use this information to provide accurate, efficient and timely service. We’ve come to expect this and get frustrated when we deal with companies who are “still in the stone age” – sound like your doctor, perhaps?

Most physicians have computer systems to manage the billing for their practices, but less than 10 percent of America’s primary care physicians use computers to manage their patients’ medical information.

Several studies have measured the percent of patients who get appropriate care for common medical problems. Results vary, but are mostly in the 50-70 percent range (i.e. blood pressure control). Imagine if you got the right pizza on 60% of your orders, or FedEx delivered 30 percent of their packages to the wrong home, or if your bank’s ATM only gave you cash 50 percent of the time.

Obviously, these companies would be out of business in short order. All of these industries are motivated to satisfy their customers.

Our health care industry, in contrast, is paid to take care of sick people, not keep people healthy. For the most part, the “medical industrial complex” is more profitable when more people are sick, not healthy. Hence in America, we have Sick Care, not Health Care.

We would all appreciate not having to go over our entire medical history every time we meet another provider. We would also feel a lot safer if we knew that any emergency department could retrieve information about the medications we take, the allergies we have, and the tests we’ve recently endured. This would save huge sums of money and minimize redundant, uncomfortable and potentially dangerous procedures.

So how can we get American medicine on par with the trucking industry and pizza parlors? If we wait for major health care system reform we will continue to cut down thousands of trees creating millions of incomplete, inaccurate, eligible un-searchable medical records.

Rather, we should trust that a national system of comprehensive medical records will lead to improved outcomes and decreased costs. While the political landscape for health care system reform is a mine field, who can argue against improved information at your doctors fingertips?

Clearly the country that put a man on the moon in 8 years and won a World War in 5 is capable of building a data-base to manage all of its citizen’s medical information in a safe, secure, privacy insured system.

The federal government could stage several competitive design and management competitions and develop a plan in less than two years. It could be implemented in less than another two.

The only thing needed to digitize and thereby revolutionize American health care is leadership. So next time your Congressman asks your opinion on health care reform or a politician asks you for a contribution, ask them if they will help you control your blood pressure, or just promise you onions on you pizza.

Gary Applebaum, M.D., is a senior fellow at the Center for Medicine in the Public Interest and a team member of TR Mann Consulting. He is the former Executive Vice President and Chief Medical Officer of Erickson Retirement Communities.

Fellow Mature Market Experts, last week we agreed that we have a sick care system that rewards those who treat us rather than heal us or keep us healthy. So how do we convert a sick care system to a health care system?

Let’s go back to the beginning, “you get what you pay for”. We must devise a system where those who have superior outcomes and truly keep us healthy are rewarded, not those who simply provide care. Naturally this assumes we can measure outcomes and that’s where we have to start.

First and foremost America must put into place a comprehensive, secure, central database that would enable all of our medical information to be stored, organized and searched. Ultimately this would allow us to determine which providers are truly enhancing health and not just treating sickness.

Once we have quality information (see Tom’s previous post on this subject and Google) it could be made public and used by patients to seek superior care. This information would also be used by insurers to determine appropriate reimbursement. Clearly people who keep you healthier should get paid more! I’ve always said that it takes you five minutes to decide if you like your doctor and at least five years to know if he’s any good.

Last week I admitted a patient into a hospital whom I had never met. After taking her medical history and examining her I was pretty certain I knew the correct diagnosis. I felt she had a viral GI syndrome, but something did not sound right. Her recollection of certain key historical facts did not add up.

Since there was no easy way to check her medical history on the internet I spent 45 minutes tracking down her paper chart at another hospital. I found that she had been admitted there with a similar story but ultimately was found to have a flare of Crohn’s disease which was successfully treated with IV steroids. This dramatically changed my treatment plan and saved the patient some unneeded tests and treatments.

Naturally I was thrilled but I received the same payment from Medicare that I would have if I had not spent the extra time and effort. Physicians want to do the right thing and go the extra mile but as with all other professionals they need to be rewarded when they do so. Doctors are human too!

And as consumers we must also take responsibility to have a lifestyle that leads to health and not sickness. Despite the significant number of Americans without health insurance, the majority of us does have insurance and pay a very small part of the premiums. Most of the costs are paid by employers or the government in the case of Medicare and Medicaid. Generally speaking, people don’t value what they don’t pay for; and you have to wonder if people would take better care of themselves if their insurance rates reflected these efforts.

My grandmother always used to say “if you have your health, you have everything.” Well, we need to honestly look at our system of care and decide if we want to have our health or have the growing beast of our current sick care system. Fortunately it’s not about money, we’re spending plenty. It’s about the commitment to focus on long term outcomes rather than short term revenues.

Ultimately those of us who have committed to heal will be more professionally satisfied and will be better compensated because Americans will really get what they paid for and will sincerely appreciate it.

As a nation we spend about 16% of our annual income, our gross national product, on health care. That’s more than all other countries spend. Are we getting more health care for all the money we spend? Then again do we really want more health care?

Health care is a service just like tax accounting. Receiving the service may not feel very good but in the end if it’s done well we appreciate the outcome. In the case of our accountant we receive a well prepared, unlikely to be audited, tax return. Our health care providers perform tests, treatments and give advice but ultimately what we really want is good health, not health care. So are we getting what we pay for?

Unfortunately, despite the fact that we spend more on health care than anyone else, by many measures we are not any healthier. American’s life expectancy does not lead the world and because of obesity, smoking, alcohol, drug addiction and other lifestyle issues we are not the healthiest nation on earth. In fact, we currently rank 42^nd in life expectancy behind other less affluent, less developed countries.

Health for sale?

So does this mean the basic economic treatise of “you get what you pay for” doesn’t hold true for health care. Actually, it does, it’s just a matter of what you measure.

In America, physicians, hospitals, pharmaceutical companies, medical equipment suppliers, virtually everyone in the “health care food chain” all benefit financially when they do more to us or sell us more stuff. Sadly, they benefit financially when we are sick, not when they lead us to good health.

Think about it, when was the last time you sent a hospital a thank you card and a check because you were still healthy four years after they did your cardiac by-pass surgery? Did you send the company that provided you with the antibiotics for your cough an extra $10 this week because you were still feeling great? And most importantly did you give your family doctor a bonus at the end of the year because he got your blood pressure under control and you didn’t have a stroke?

In all of these cases they would be financially better off if you weren’t feeling well so they could get paid to take care of you again.

It may seem crass but the truth is we have a sick care system, not a health care system. For the most part everyone in the system gets paid more when we’re sick and less when we are healthy. And as sick care consumers we’re also at fault in that we continue to pay for products and services regardless of whether in the end they make us healthy.

So how do we convert a sick care system to a health care system? Well for the next several days, exercise, eat a healthy diet and enjoy a safe Labor Day Holiday . . . then return to Mature Market Experts for my prescription for our sick care system!