By Mary Kate Cary, Thomas Jefferson Street blog
President Obama is meeting this afternoon with Republican lawmakers, trying to garner support for his $825 billion stimulus plan. According to the New York Times, the plan contains $37 billion in proposed spending in three high-tech projects, $20 billion of which is for computerizing medical records. (That's right, all those alphabetized manila folders behind the receptionist will be going the way of mercury thermometers, blue jars of Vick's VapoRub, and nurses in white caps and pantyhose.)
Skeptical Republicans are worried about the spending portions of the stimulus plan, for good reason. But computerizing medical records is no Bridge to Nowhere. Instead, it's a bridge to free-market forces in healthcare. It's a way to bring even more choice and competition to our healthcare system.
Digitalizing medical records may be opposed by some on the basis of privacy and security concerns, just as online banking once was. But one benefit of computerized medical records would be the ability to create a searchable database of research. For example, a patient's cholesterol numbers, blood pressure readings, and three-month average blood sugars (called a Hemoglobin A1C test) could all be entered and tabulated—without anyone's name attached.
This presents all of us with the ability to compare hospitals—and even specific doctors—on the basis of positive outcomes. An A1C test is not a subjective number. Like a cholesterol count, it can't be fudged. For kids with type 1 diabetes (full disclosure: my daughter has type 1 diabetes) it's measured every three months and charted out, since it's such a good indicator of whether you're consistently controlling your blood sugars.
Armed with whether a certain hospital or practice group is consistently lowering its patients' average blood sugar numbers, or cholesterol counts, or blood pressure levels, patients could make informed decisions about which diabetes, or cardiac, or hypertension clinics are best for them. It only follows that the most successful clinics and hospitals will be known for their best practices (and may even be pressured to share them) and that the worst ones will be forced to improve in order to stay in business. Given the lack of information sharing and support that goes on between hospitals these days, this would be great for all patients—especially those in less than world-class facilities.
It's the same argument as standardized testing in schools—and look what that's done for public charter and magnet schools. Parents can now decide which school is the best fit for their child, based on which schools excel at, say, math or science or art. Of course, like the teachers' union, there will be doctors' groups that oppose making information about positive outcomes public. But wouldn't you prefer to decide which doctor to use based on statistics like these rather than the only information we currently have: which doctors have had malpractice claims made against them?
Everywhere we look, transparency and accountability are the watchwords of reform. It's time to bring them to our most fundamental healthcare decision: which doctor to see in the first place.