The economic stimulus package working its way through Congress includes $20 billion to foster the use of information technology in health care. That could improve care and even cut costs.
Computers and information technology have a large and growing role in health care. Expanding that, however, offers tantalizing opportunities - particularly in the area of medical records.
Most medical records are still kept on paper, which limits their utility. If someone sees a new doctor, for example, that physician is unlikely to have the time to examine in detail what for older patients could easily be a file an inch or more thick. Is there something in there, perhaps years old, that could explain the situation today? Was there some combination way back when, a one-in-a-million juxtaposition of drugs, circumstances or symptoms, that could suggest a course of action seemingly at odds with the immediate clinical evidence?
Medicine has historically relied on doctors' experience and training to detect that sort of thing. But that model presumes a relationship with a physician seen regularly over years, which in our mobile society is ever more rare. Plus, the complexity of medicine is increasing exponentially, which makes it difficult to track every possible combination of factors involving every patient. That is especially true for patients seen infrequently - or if the patient is unconscious in an emergency room away from home.
But imagine if a doctor could go online or scan a chip and have immediate access to a patient's entire medical record. And what if the computer could identify possible ties between present symptoms and something in those records?
No one wants to replace doctors or for machines to make diagnoses. But a computer could recommend a particular test or analysis be considered. Perhaps more important in emergency situations, doctors would no longer have to rely on patients' memories about past conditions or medications. The computer could red-flag drug interactions, allergies and contraindications. And with nothing but virtual time on their hands, computers may be able to connect the dots between a lifetime of individual symptoms and treatments in ways few humans can. Who knows where that might lead?
As to costs, more successful care is by definition more cost effective. Better information could help doctors get the diagnosis and response right the first time, with fewer tests and trials. More good outcomes should mean less need for additional treatment.
Computerized records could also mean fewer tests would be repeated because results cannot be found or because the original scans are not available. One medical information expert told National Public Radio that reducing such redundant care could save $4.5 billion in Massachusetts alone.
There are daunting questions, of course, about privacy, medical ethics and technology. Software and hardware would have to be designed appropriately and standardized. What access insurance companies might have needs to be settled. Economists debate how many jobs would be created - the stated purpose of the stimulus, after all. And there are the inevitable questions as to who pays for what. The data-entry requirements alone are staggering.
But $20 billion should go a long way toward answering those questions, and the potential benefits are huge. And a nation that has seemingly digitized and computerized every other aspect of life should be able to handle something as important as medical records.