Summary
The administrations’ focus on cutting healthcare expenditure through automation is an important first step to expand coverage without added burden to the American economy. Despite all good intentions, the project to integrate VA-DOD medical records will provide NO benifts as a model for a national electronic healthcare system.
Analysis
Americans spent 2.7 trillions on healthcare in 2007, or $7,900 per person. The United States Department of Health and Human Services projected in a recent report (Feb 2009), that healthcare expenditures will reach 4.3 trillions by 2016. The administrative cost –alone- of healthcare delivery was 31% of the total cost, and expected according to the same report to reach 1.29 trillions by 2016.
While healthcare cost per capita is the highest in the developed world, Americans lag in all related statistics such as lifespan, infant mortality rate, and number of uninsured. Despite the huge market potential, the undisputable benefits of automation in minimizing medical errors, and maximizing efficiency, the Electronic Health Record adoption in the United States is under 2% for several legitimate reasons including procurement cost, the limited interoperability between existing applications, and privacy issues.
The VA-DOD integration project will improve healthcare delivery for active duty and veteran population, but fails to address the challenges in a global and comprehensive way. The shortcomings of this approach are the dependency on application-to-application integration, and the assumption that all patient’s Electronic Health Records exist physically in the same system.
A successful national Electronic Health System has to create an interchange hub built around the patient’s process flow. The minimum requirements for such system are the following:
1. Provide the capability to collect historical data from multiple sources in different electronic formats (text & images).
2. Provide a continuous and timely updates throughout the individuals’ lifetime, using multiple systems/applications.
3. Insure that automation is capable of handling unorganized workflow, where every patient can have different procedures, on different occasions, in unpredictable order.
4. Every healthcare provider should have the ability to access, and update ONLY authorized data using multiple systems/applications seamlessly.
The travel industry faced similar problems forty years ago, with multiple content providers using different IT systems (Airlines, Hotels Cars, and tours), and millions of agencies facilitating travel through different interfaces. Today, Global Distribution Systems maintain a lifelong updatable passenger records, address privacy issues, provide flexible workflow, connect the content and service providers at extremely low cost.
The travel industry can provide a working model to the healthcare industry, while the VA-DOD project is more of the same.
