Reform of healthcare in America must begin with issues supported by political consensus rather than on issues frozen by political infighting. That was the main message delivered by Sen. Hillary Rodham Clinton (D-New York) in a keynote address at the World Health Care Congress, co-sponsored by CNBC and The Wall Street Journal and held in Washington in late January. Touting her new legislation aimed at pushing the broad implementation of information technology [IT] in healthcare, Clinton said this "is something we can do currently because there's no political consensus on other issues inside the beltway, like medical malpractice." And she presented her plan as a "must-do" in order to produce positive change in healthcare delivery. Referring to "breakthrough devices and treatments that were undreamed of five years ago that are now available," she added: "The problem is taking those treatments and devices and making them available throughout the system."
Clinton said the current system "sucks up so much of the resources that businesses lack adequate information on what they actually pay for in healthcare. In 2000, we spent two to four times more than any other nation on healthcare, but our outcomes aren't two to four times better. So what are we actually paying for?" The answer to date, Clinton said, has been a huge bureaucracy created just to push money back and forth within the healthcare system.
"Go to your local hospital," she advised attendees, "and look in the ER, the OR and walk the halls and look at the level of personnel. Then ask to see the billing department, and behind that closed door you'll see the fastest-growing field in medicine today." For every hour of care delivered to a patient, there is an additional half-hour of paperwork a provider is required to complete that was created by the private sector, she said, citing figures from an American Hospital Association (Chicago, Illinois) study. Additionally, using healthcare IT to eliminate barriers in communication would lower costs and improve quality, Clinton said. "With the push of a button, a doctor should be able to get the latest journal articles, patient medical records and be able to send a prescription to the pharmacy," she said. "But the system needs to be secure and protect the privacy of the patient."
The proposed legislation outlined by Clinton and having the backing of Senate Majority Leader Bill Frist (R-Tennessee), she noted has five main components:
First, the legislation would require increased research on quality of care. "This statistic may scare you, but 80% of care delivered today is not backed by research. We need more head-to-head trials and comparative trials to determine what treatments and drugs are most effective, not the most advertised," she said. In addition to standard clinical research, the U.S. Department of Health and Human Services (HHS; Washington) would be required to conduct its own studies on how to best design hospital operations.
Second, healthcare should include standardized quality measures. "There should be a standard provider reporting system that is consistent in all states that patients can use as a comparison," she said.
Third, the government should lead by example, Clinton said. "The VA, FDA, CMS, HHS, CDC should all use the same system. If a clinician is required to submit a report to the CDC on SARS, for example, they should not have to submit additional reports to HHS and the FDA. Rather, those agencies should have to obtain information from each other." A key component here would be the creation of IT standardization ensuring that different systems can communicate with each other.
Fourth, patient and provider information should be available in real-time and should be capable of being delivered on hand-held devices to help providers determine if a procedure or medicine is medically necessary, based on data and research, Clinton said.
Lastly, providers should be awarded for top performance. "There should be incentives that reward hospitals and physicians for quality of care and efficiency in delivering care," she said. "We should not overpay for the privilege of getting under-par care. MedPAC has told Congress that the Medicare payment system is not up to par, and my legislation would increase demonstration projects on different payment systems to determine what works best."
Clinton was hardly a lone voice on this topic. Paul O'Neill, former secretary of the U.S. Treasury and a vocal critic of the current administration, also emphasized to attendees the expanded use of healthcare IT. He recommended the installation of IT software and operating platforms in all hospitals. "Nurses spend too much time on paperwork about 57% of the time and not caring for patients. A majority of that time not caring for patients is spent on paperwork and hunting for equipment, or verifying a medication from an illegible doctor's prescription," he said. And he argued that systemwide use of existing technology could save $700 billion annually. "The money that's freed from this massive deployment could be used to deal with the problems of access and halt future double-digit increases.