Sean Khozin, MD, MPH

Chronic diseases such as high blood pressure and diabetes account for over 85% of the $2.3 trillion annual healthcare expenditure. This includes dealing with the acute complications of these diseases. A recent article in Health Affairs directs attention to the need for reorganizing our healthcare delivery system to better handle the management of chronic diseases. Pointing out that “it takes nearly eleven hours per day for a lone clinician to provide good chronic care to the average panel of patients—a time commitment made impossible by shortages of primary care doctors,” the article highlights the benefits of the Chronic Care Model (CCM) where multidisciplinary teams use evidence-based protocols to manage patients with chronic diseases.

Moving the Chronic Care Model from a theoretical framework to a reality that can be replicated on the ground by healthcare providers can be a great challenge and a potentially expensive undertaking. Will the benefits outweigh the costs of care delivery reorganization? What is the goal exactly? Is it to reduce healthcare costs or pain and suffering? Is it to prolong life or increase quality of life? How do you measure quality of life anyway?

I think answering the above questions requires a little soul searching and introspection for patients, policy experts, and healthcare providers but trying to address them can set a more realistic tone when mulling over the current swarm of healthcare reform proposals. The realists are beginning to realize that there may be no perfect solution that can make everyone happy but for some, to quote Neil Peart, “the future does not have to contain any flaws until it becomes the present.”

Author and blogger Maggie Mahar writes about a report by the National Bureau of Economic Research (NBER) with an interesting finding: patients care more about hospital amenities, such as rooms with views and flat screens, than the quality of care delivered.

I think there is nothing wrong about seeking a pleasant environment when you’re sick but knowing your chances of survival at a particular hospital is also important. Then again, most quality measures are very murky and not well-understood by the average consumer.

The market is saturated with hundreds of EMR/EHR/PHR systems. Most of them are inefficient systems that disrupt physicians’ work flow, adding little value to delivering better care. This is more than mere lack of insight on behalf of software engineers and points to a more important barrier to smart health IT design where the needs and changing requirements of third parties (i.e. insurance companies) often supersede that of patients and doctors. As a result, most health IT systems end up being clunky billing machines, focusing mostly on capturing data that satisfy the needs of payers and regulators, not providers and patients. Enhancing the doctor-patient relationship, the foundation of delivering effective care, has rarely been the focus of health IT. Neither has been capturing and analyzing data that can have a positive impact on clinical outcomes.

I think practical health IT should be Intelligent, Integrated, and Interoperable. Intelligently designed systems prioritize  the needs of patients and providers. An electronic platform with well-integrated features ensures a consistent and smooth operator experience. Interoperability stands as a prerequisite to deriving real societal value from health IT and facilitates health information exchange among networks of patients and providers.

It’s been over a month since my last blog post. A lot has happened since then. Barack Hussein Obama was sworn in as the 44th president of the United States, not once, but twice! Our medical practice was featured on CNN in a segment called “You won’t go in to see the doctor,” showcasing a video consultation I recently did with one of my patients. The Open Letter I organized on behalf of America’s physicians surpassed 12,000 signatures. A clinical trial that involving the world’s second best selling drug was stopped because the sponsor declared bankruptcy. The financial markets, of course, continue to fluctuate with uncertainty.

These are the signs of our times, signaling the need for, and emergence of, novel ways of thinking that can open new windows of opportunity to carry us forward into the next phase of prosperity.

This, my friends, is the time to innovate.