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"Here there be monsters,” warned ancient mariners’ maps of the uncharted corners of the seas and the creatures that lurked within. The oceans of paper and mountains of file cabinets required to track patients in the U.S. health care system today is akin in many ways to the murky depths, reams of maps and collections of chronometers and sextants which not long ago guided the global maritime industry. Since ancient times—Homer tells us that Odysseus relied on the Pleiades star cluster and the Herdsman and Bear constellations to steer him from Calypso’s cave towards Ithaca—navigators have depended upon celestial navigation, enhanced by technology and coastal charts, to determine position and plan the movement of their vessels.
More recently, electronic navigation techniques such as radio navigation and radar, have enabled ship’s officers to obtain the information they need to safely travel the seas. In the last twenty years however, the development of satellite navigation through the Global Positioning System largely displaced radio and radar. Today, GPS provides the fastest, most accurate method for mariners to navigate, measure speed, and determine location, and is used by merchant vessels, fishing fleets, and naval operations.
GPS enables real-time, completely automated understanding of vessel location and provides vital information for vessel traffic control in busy seaways. In addition, Global Information Systems technology provides critical tools for the management and operation of port facilities, facilitating the automation of container shipment movements. The information technology applications and systems enabled by GIS and GPS have changed how the world’s maritime industry performs its basic (though still exceedingly complex) functions.
Similarly, IT applications and systems could help our nation’s health care system, in which fewer than half of patients receive the right care at the right time, navigate the complex waters of coordinating care, reporting quality outcomes, understanding which drugs, devices and treatment plans offer the best course of care, and re-engineer the health care delivery process to improve quality.
Mapping clinical and payment data to health care outcomes could be as revolutionary for the U.S. health care system as GSP and GIS were for the maritime industry. Health IT systems, properly implemented, could transform how health care providers deliver care—resulting in a quality-focused health care system that improves lives, lower costs, and boosts health care productivity.
Health IT and Health Care Reform
In some ways, creating a 21st century health care system should be technologi cally simpler than transforming global maritime trade. We have many of our instruments and maps in hand, in the form of technological improvements and policy proposals. Two years ago, the Center for American Progress released its Plan for a Healthy America. One of its core tenets was to improve the value of health coverage by improving health care quality, health outcomes, and health system efficiency.
To take advantage of the efficiency and quality improvements promised by cutting-edge health information technology, the Center proposed a new health IT infra structure improvement fund to further the adoption of standardized, compat ible, and scalable IT solutions. This fund would be complemented by new federal leadership in advancing IT’s promise of administrative and clinical efficiency through demonstration projects, such as changes in Medicare reimbursement, de signed to encourage the implementation of new technologies.
Policymakers, academics, and industry leaders from both ends of the philo sophical spectrum have embraced this approach, which would provide public support for health IT acquisition while leveraging the Medicare program’s im mense purchasing power to promote technological change within the health care industry. These ideas differ: some proposals would provide an add-on incen tive for the use of health IT to Medicare payments; others would create modest bonus pools for quality care. All of them, however, embrace a Federal role in pro moting health IT.
Then last year the Center proposed in Promoting Prevention and Preempt ing Costs: A New Wellness Trust for the United States that the federal government develop a personal electronic prevention record, either as a stand-alone personal health IT tool (akin to the Medicare drug discount cards available in 2004 and 2005) or as part of a larger electronic health record. This electronic prevention record would serve as the IT backbone for a national prevention program, permit ting lifelong tracking of individuals’ use of preventive services.
Today, the Center for American Progress presents a plan that expands upon these previous progressive proposals to improve the American health care system through the use of health IT. CAP sees health IT as a fundamental building block for a reformed health care system—one of the pieces that must be put in place as we work to provide affordable health cover age for all Americans. Health IT’s prom ise for improving administrative efficiency, facilitating national health goals, improv ing the processes of health care delivery, and ultimately improving the quality of care, places it at the center of our com mitment to improving the value of health coverage for all Americans.
This promise can be realized if we make the immediate policy changes necessary to promote the rollout of health IT systems and adopt a comprehensive strategy de signed to integrate health IT, process and quality improvement into our health care financing system. This paper will outline the steps that need to be taken to convert our health care system into a results-based industry that reflects our progressive vi sion of a healthy life for all Americans.