BBI Washington Editor

WASHINGTON The nation's healthcare system may see an unprecedented transformation in this decade, a former political insider told attendees at The Emerging Technologies & Healthcare Innovations Congress (TETHIC), held here during the latter part of September. Newt Gingrich, former Speaker of the House, said his prediction hinges on three paradigms taking place in the collective consciousness of Americans who are almost to the point of saying, "we've had enough." Reaching that point will precipitate a transformation of the nation's healthcare system, Gingrich said while serving as the kickoff speaker for the second annual TETHIC gathering, which drew an audience of health insurers, clinicians, analysts and representatives of the information technology sector.

Other programs touched on such subjects as the "empowerment" of healthcare consumers, which is seen as giving legs to the changes foreseen by Gingrich; an almost futuristic look at healthcare delivery that already is occurring; and the digital revolution in hospitals.

The former Georgia congressman, speaking as founder of the Center for Health Transformation (Washington) and promoting his new book, Saving Lives and Saving Money, told attendees that healthcare transformation will occur in a multitude of individual changes rather than through a broad, sweeping legislative effort. "Transformation will come in several hundred steps rather than a thousand-page bill from Congress. It will happen much like a wave, and the changes will occur over a period of time," Gingrich said. "Culturally, there shouldn't be any reason why it takes 103 days for a health insurer to pay a bill." He cited a key distinction between transformation and reform. "The bill that Florida passed in June, requiring doctors to write more legibly, is a great example of reform. But the bill Rhode Island passed in July, implementing an electronic-based prescribing system, is an example of transformation," Gingrich said.

The initial problem, he emphasized, is a gap in the current healthcare system and the life that Americans currently actually live. "You can go to the web-based travel sites anytime of day or night, for free, and make travel arrangements. You pick the airline, the seat, the time of your flight and what hotel. Why do we expect this level of service in our personal lives, but accept the burdensome health system we have?" Americans will see a drastic change in the health system once they begin stating that they've had enough of the current system, Gingrich said.

Secondly, there's a gap in the level of patient care we should have vs. the patient care we get, he said. The thought process has to be focused on saving lives before saving money can come into the picture, he said. "After your fourth day in the hospital, you are 2,000 times more likely to get an infection from it than you are to die in an airplane crash," Gingrich said. "We as a nation haven't applied the safety predicate we expect from the airline industry to hospitals. You wouldn't fly if the ticket agent announced that the plane was as safe as the last-quarter compliance report, so why should hospitals be any different?"

Lastly, the threat of biological weapons and biological threats from infectious disease will drive transformation in healthcare, he said. "There's more chances for a threat from a biological attack than there is from a nuclear attack," Gingrich said. "We need the connectivity and ability to communicate in crisis now. If it's not built before a crisis, we'll never be able to cope once a crisis has occurred."

Americans also need an incentive to manage their own health to help create the transformation, he said. "General Electric [Fairfield, Connecticut] is experimenting with a program now where it rewards diabetic employees and beneficiaries with a reward at year's end if they are in compliance. They've discovered that it's less expensive for them to reward the patients than cover the costs of treating their acute episodes," Gingrich said.

The federal government's role in transforming healthcare is key, he said. "As the nation's largest payer, the federal government should be leading the way in electronic records and e-prescribing rather than the current paper-based system that's cumbersome and full of red tape."

Consumers empowerment is key

Voicing a similar theme was a panel of healthcare experts from a variety of perspectives within the industry who reinforced Gingrich's view that drastic changes may be on the horizon for healthcare, but only when consumers are empowered enough to feel they are stakeholders in their own healthcare treatment. The panel session, titled "Employers, Consumers, Retailers, Payors, Providers and Technology Converge: Drastic Changes on the Horizon," dealt with the concept that empowered consumers will be the driving force in tomorrow's healthcare delivery system. But there's a mixed perception as to how long that transition will take.

For his part, Russ Ricci, chairman of US Wellness (Gaithersburg, Maryland), a national provider of wellness centers that provide preventive health screenings, diagnostic testing and other services, said, "The notion of an empowered consumer is delusional." Right now, he said, "most patients don't even take their written prescription to be filled at the pharmacy, and they don't stay on the treatment regimen that the physician or other providers recommend."

Ricci predicted that "years from now, consumers will comply and play a part in their own healthcare," but that "the people sitting in this room will be representatives from Wal-Mart, Target and other national retailers."

Wal-Mart is the nation's leading pharmacy retail outlet and has invested capital in providing the best service at the least cost, Ricci said. "What do you think will happen five years from now when a patient comes in with a paper prescription and the pharmacist calls the doctor and says 'we can't fill a paper prescription'?" he asked. "What do you think the patient is going to do stop going to Wal-Mart or change doctors? They'll change doctors," Ricci said. Wal-Mart is one of the leading disease management companies because of its role in providing thousands of prevention-based screenings each year, he said.

A different perspective was offered by Kurt Miller, a partner in the global consulting firm Accenture (New York), who told attendees that it will take an effort on the part of consumers, providers and payors to come together before change can take place. "The consumers, providers and I mean providers in both the traditional and unconventional roles and payors all need to intersect before there's empowerment. The traditional providers will have to relinquish authority and power to other players, such as the Wal-Marts and Targets," Miller said. "Consumer accountability, however, will be the biggest challenge. The consumer has to consider lifestyle changes, such as diet and exercise, before change will take place."

Device manufacturers are playing an important role in empowering the consumer already, said Mark Leahey, president of the Medical Device Manufacturers Association (MDMA; Washington). "Device manufacturers already provide several diagnostic services that can be performed within the comfort of a consumer's home, such as glucose monitoring and cholesterol screening kits," he said. "Other manufacturers are incorporating automated telemetry into devices so that patients only have to hold the phone near a pacemaker, for example, to relay information to their provider."

The most radical theory presented, however, was that of eliminating the third-party payor system currently in place in healthcare. "Third-party payors skew the decision-making process on the spending side," said Greg Scandlen, director of the Center for Consumer-Driven Health Care at the Galen Institute (Alexandria, Virginia), a health and tax policy research organization. "Consumers should be able to make decisions about how their money is spent," he said. "Insurance companies spend the money, but it's not really theirs it belongs to the employees who contribute via payroll deductions."

It doesn't matter how much we currently spend on healthcare, Scandlen said, "because with the third-party system, no one knows what's going on. Physicians are dropping their participation in these plans and moving toward cash-based arrangements where they determine the interaction with their patients, and that's a more healthy relationship."

Military leads the way in delivery

If you're looking for a futuristic method of healthcare delivery, it should come as no surprise that the nation's military is leading the way. The U.S. Department of Defense, along with the Department of Veterans Affairs and several other federal agencies, are joining their efforts in establishing national health information standards and a computer-based patient record. In two short years, the U.S. military has gone from a medication prescription program, bound to each of its military hospitals, to an electronic version, said Robert Wah, MD, director of information for the TRICARE military healthcare system and a commander in the U.S. Navy. The TRICARE program offers health benefits to military personnel and their families.

"Since its beginning, the e-prescribing program has filled over 120 million prescriptions and caught more than 80,000 type one errors, which are serious enough to hospitalize a patient, or worse," Wah said. Approximately 97% of the military's prescriptions now are filled electronically, he added.

The technology is currently used in seven U.S. hospitals and will be deployed worldwide beginning next month. In all, the conversion to the electronic format will take 30 months, Wah estimated. "The program isn't limited to a military facility, either. Wherever an enrollee gets a prescription filled at a military facility, at a civilian outlet or through the mail order program it's all connected," he said.

Wah also demonstrated for attendees at TETHIC the newest computer-based patient record program the military is implementing. The program, which is being rolled out along with the prescription component, will allow healthcare professionals to access and add information to a soldier's medical record wherever the soldier is located. "We've been field-testing the system using laptops out on the battlefield, too, so whatever would be used in a tent in Afghanistan is being used here in DC at Walter Reed," he explained.

The electronic medical record uses a Windows-based program and can be customized for each professional. Wah said, "If you have a cardiac specialist, for example, they can program the record to show certain windows and put the others in the menu." The medical records are being entered into a centralized database from the military's previous medical record storage system, he noted. "Each hospital used to operate independently, but now all the records will be in one central location."

Wah said that the program uses a program called Notewriter, which codes the text in the record for a database being built. Physicians go through a list of symptoms and check the positives, then they go through a second checklist and notate the negatives. The result is a coded list of notations along with a diagnosis and assessment, he explained. "Most electronic records have a text section, but nothing can be done with it. This will allow us to pull information and monitor trends, and measure outcomes," he said.

"This isn't vaporware, or something fictional; it's real and is happening now," Wah said.

Hospital survival keyed to digital revolution

In another session keyed to technological change hastened by operational realities, the officials who planned and opened Indiana Heart Hospital (Indianapolis, Indiana) last February told TETHIC attendees that they based their facility's operations on a real-world scenario: run 100% of the hospital with an 80% staffing level. "We knew going into it that we'd constantly be recruiting nurses during an already critical time in finding nurses, so we decided to use that reality in the planning stage up-front," David Veillette, the hospital's chief executive officer, said. Veillette was one of several hospital administrators and technology vendors on a panel at a session on "The Emergence of the Digital Hospital."

"I would encourage all of you to embrace the concept fully, and do it now," Veillette said. "We are light years ahead of other hospitals in our area, but light years from where we want to be." Veillette's hospital, which opened in mid-February, has only 100 beds, but has 650 computers throughout the facility. "You can't walk anywhere without tripping over a keyboard," he noted. The hospital already is seeing a return on investment dollars, he said, without elaborating on specific figures. "Nurses spend 35% of their time looking for a paper chart, retrieving documents to notate on or chasing another piece of paper. We took the pebbles out of their shoes and put the information right at their fingertips," Veillette said.

The hospital operates on a philosophy that its customers have high demands. "We built the place with the 'Baby Boomer' population in mind, which is very fussy and demanding," he explained. The two-story building has exclusively private rooms with sofa beds so that family members can stay overnight, Veillette noted. "We don't have separate units, so a patient goes in a vacant room, and we bring the level of care they need to the room, not the other way around."

Rather than serving meals on a specified schedule, patients call for room service, he said. "We're saving lots of money on food because we don't send a tray to the room when the patient isn't there, only to have the tray sent back down later. Patients order what they want when they want it." The concept seems to be working, because the hospital gained a 96% approval rating on its last patient satisfaction survey, and a 96% approval on food service alone, Veillette added.

Indiana Heart Hospital may look like a traditional facility, but caregivers would quickly discover that there's no square footage devoted to medical records. "We also don't have any storage rooms for [imaging] film," he said.

When looking for an information technology company to assist in building the hospital, Veillette said he was searching for a "super vendor." "I wanted one vendor for everything, so I only had to go to one person if there was a problem. Plus, I made the vendor responsible for integrating all the different technology in the hospital." Veillette's choice: GE Medical Systems (Waukesha, Wisconsin).

Curtis James, chief executive officer of St. Vincent's Hospital (Birmingham, Alabama), told TETHIC attendees that the transformation from paper to digital won't happen overnight, but the end result is worth the effort. "We started our change in November of 1991, and using the construction analogy, we are now at the 'topping off' stage of our program," he said.

"Paper is the symptom of a bad process," said James, whose hospital has invested $45 million over the 10 years in making the 338-bed hospital completely digital. "I tell people we're not in the healthcare business we are in the clinical outcomes business."

James credits St. Vincent's physician staff for embracing the change because the technology provides them with valuable knowledge. "We don't just give them data, but [rather] real-time knowledge so they can make the best decisions," he said. As one example of the changes wrought by an all-digital approach, James noted, "Our physicians no longer go to medical records to sign a chart. They do it online from their office or at home."