Online Healthcare System Real world or future world?

by David Orenstein free-lance writer

Somewhere between visionary leadership and irrelevant idealism is the Institute of Medicine’s recent report, “Fostering Rapid Advances in Health Care: Learning from System Demonstrations.” In a section on information technology, the group boldly calls for several states and communities (might Dallas be one?) to build model networks that would finally move the healthcare system online.

The report (online at www.nap.edu/openbook/0309087074/html/57.html) is unflinchingly confident that medical information, such as patient records and claims, can be accessed or processed over a secure, reliable, and responsive computer network. IOM’s goal is that the entire nation someday will have a network that would make available information from appointment status to a public health rapid alert system. To show that all this would be possible and beneficial—and presumably to learn how to do it—IOM recommends that several areas around the country form public-private partnerships, claim some funding (wherever that comes from), and get cracking on implementation for five years.

We have all heard time and again about how this is going to happen someday. With federal fervor the IOM committee evokes the memory of the Interstate Highway System and the defense department’s creation of the Internet and predicts, “the return on investment in terms of dollars and health will rival the success of these other major national infrastructure investments.”

Much of the report’s optimism should be met with skepticism, and a few nuggets invite ridicule. That said, the notion that we should begin building a real-world approximation of an ideal online healthcare system is worthy. The committee is right to suggest that a national health network is a good enough idea to be inevitable.

The report is not entirely in the clouds, either. IOM lays out a three-phase structure for the demonstration projects. First, a lead organization would marshal the commitments of other members in the public-private partnership (made up of hospitals, state agencies, insurers, labs) over the course of six months. Then would come the dirty work—building the network by establishing security and flexible, but reliable, links among data sources. The report suggests that this second phase might take up to 24 months. The balance of the five years would be spent on the fun stuff—applications such as telemedicine , electronic medical records, and “claim submission with immediate verification of completeness and eligibility for payment.”

Although IOM is brazenly optimistic, it is not naïve. The report acknowledges that if data is going to come from many sources and be used by many people in many ways, then data standards for health care finally need to be formed and used, rather than simply discussed. It acknowledges that these projects would be quite costly.

The changes that are part of this vision, however, are not examined and probably are too great to be made quickly or lightly. Speaking on the National Public Radio show, “Fresh Air,” one committee member said she imagined that an uninsured patient could walk into a physician’s office and use the system to get enrolled with coverage during the visit. Is your office calm enough to accomplish such a complicated and time-consuming task? On a recent visit to my doctor, I couldn’t even find a seat in the waiting room, much less find an affordable insurance plan with a set of coverage benefits that is right for my family.

More power to the IOM if it can inspire momentum toward the efficiency and convenience of online health care. Still, I won’t sell my International Paper stock quite yet.

David Orenstein is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, e-mail him at davealli@attbi.com.