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Health insurance reform depends on IT

Let's start with a not uncommon situation. Someone is brought into hospital unconscious. He or she has collapsed or been involved in an accident. Fortunately, there's a driver's license so the hospital knows the identity of the patient, but there's one small problem. Without free access to this person's medical records, how do the doctors know what existing health problems may be contributing to this collapse? Worse, there's no way of knowing whether there are any drug allergies or whether drugs are already being taken which might interact with any new medications the hospital might propose to use. At best, this slows down decision-making. At worst, it exposes the patient to the risk the treatment might make their condition worse. In an ideal world, all medical records would be available online so that, with a patient's identity, a hospital could get immediate access to all relevant information. Except this is not an ideal world and many doctors still keep only paper records.

Let's be clear about this. The overall standard of care would improve if there was effective and comprehensive information sharing across all healthcare providers. Costs would be saved by removing the need for tests to be repeated. Doctors to a case can quickly see the pattern of diagnosis and treatment, avoiding diagnoses now eliminated and focussing the search on the remaining explanations for the symptoms. Even more importantly, it also allows a new pair of eyes to see what might have been missed or misinterpreted. When you can save costs and improve treatment outcomes, this is a win-win for everyone. Except it can never work unless there's a better IT infrastructure to collect and store the information securely, and then only allow access to those with a need to know.

Now add in Obamacare. If you are going to mandate people to carry cover and make the insurance exchanges work properly, you need up-to-date information to identify those without cover and encourage them to enroll. Although federal and state agencies have some money to pay for this work, small practices and rural hospitals have neither the expertise nor the funding to implement effective IT systems. Worse, if local practices and doctors were allowed to implement their own systems, the result would be a piecemeal system with little chance of one system interacting effectively with any other. It needs a centrally coordinated design for all interested parties including the insurance industry. Obviously, the insurers are not going to be pleased if lists of their customers are accessed by the state. They will claim this is commercially sensitive information. Yet without a free exchange of information, it will be difficult to make public and private healthcare available to the maximum possible number of people.

There's a certain irony in all this. Normally, we would think the improvement of our healthcare services would depend on better drugs and more effective treatments. Yet what we now see is that health insurance can never deliver a completely safe and effective service without proper information exchange. Worse, without access to the health insurance companies' databases, how will the state enforce the mandate? Except the cost of all this IT work is billions of dollars and there's no real sign the federal government has budgeted for it.


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