PRESIDENT Bush and Congress have pledged to support the people of Louisiana, Mississippi, Alabama, and now Texas, as they embark on an unprecedented rebuilding of their communities on the Gulf Coast. But at least when it comes to health care, rebuilding should not necessarily mean replacing what was lost. Instead, we have the opportunity to give the Gulf Coast the first 21st Century health-care system in the country.
There are a number of Gulf Coast hospitals and countless doctor’s offices, nursing homes, clinics, labs, and pharmacies that are beyond repair. In the words of an official from the hospital-accrediting body, “Essentially the health infrastructure of New Orleans is gone — it no longer exists.” Because of the scope of the damage, the Gulf Coast communities have the opportunity to design their health-care systems from scratch.
A condition of federal assistance for the rebuilding of the health systems should be that they be designed for the information age.
Although technology has revolutionized nearly every corner of society, only 14 percent of physician practices have electronic medical records, according to a new survey by the Medical Group Management Association. Hospital numbers are not much better. One of the primary obstacles to investment has been the cost to providers, because much of the financial return on investments in health information technology — 89 percent, by one study — accrues to those who pay the bills.
But on the Gulf Coast the entire infrastructure is being rebuilt anyway, with the federal government largely paying the bills. There we can build a smarter, safer, more efficient system, and probably save money in the process. Out of the wreckage of Hurricanes Katrina and Rita would emerge a model for what health care can be.
We should begin by making a personal health record available to every citizen in the affected areas. Under the leadership of the national coordinator for Health Information Technology, Dr. David Brailer, there is already a crash program under way to make these patient-owned Web-based health records available to evacuees in shelters. That way, when they move to more permanent housing, their health information will not be lost.
We also need to rebuild our facilities for the information age. There is no reason that any doctor’s office should be rebuilt with big rooms for storing paper records, or without broadband-Internet access. Hospitals should be heavily wired and built with robust tele-medicine capabilities, so that rural populations can have better access to high-quality care. We should ensure that every provider in the new facilities who wants to switch to electronic medical records is assisted in doing so.
By integrally incorporating these technologies, we will be able to design health-care facilities differently. In an electronically enabled health system, for example, we may need fewer hospital beds, because length of stay is reduced and remote monitoring of patients from less intensive settings is available. Waiting rooms may become unnecessary as computers improve scheduling and reduce paperwork. With this sort of streamlining, building new, re-engineered facilities may actually prove cheaper than rebuilding what was lost.
The benefits of moving health care into the information age would be enormous for the Gulf Coast residents. It could mean the end of those infuriating clipboards, of photocopying health-insurance cards, of being sent for duplicate tests. It could mean that a doctor or nurse would always see emergency-room patients with critical information, instead of asking them what color the pills in their medicine cabinet are and how often they take them. Most poignantly, no Gulf Coast resident would ever have to worry again about his or her medical history’s being washed away.
Patients could communicate with their providers by e-mail and schedule appointments online, and their chances of being harmed by a mistake or of missing important preventive care would drop. Meanwhile, doctors could see the number of claims rejected by health plans fall, and the administrative burdens of coding and billing decrease, as electronic medical records automatically generated bills to electronically send to health plans.
This revolution could have particular benefit for those living in poverty — provided we are sure to include their health-care providers in these efforts. Low-income people move more often than others, are less likely to have stable relationships with care providers, and are more likely to have chronic diseases. There is no substitute for providing reliable health insurance, but at least with personal health records, these people could consolidate their information and make it available to any provider who was authorized — thus raising the quality of the health care received.
I do not minimize the challenges in realizing this vision. It will require speedy, collaborative action by a number of stakeholders to ensure that privacy and security are iron-clad, that the right data are available when needed and authorized, and that physicians have the necessary support to make implementation and maintenance smooth. It will involve changes that will take time to figure out. But these are not technological or even fiscal challenges; they are challenges of vision and leadership.
Here in Rhode Island, we know these challenges, and we are making great strides toward bringing our health-care system into the information age. On Oct. 20, Dr. Brailer, the Health Information Technology national coordinator, will make his second visit to see our progress and explore how the federal government can accelerate it. Still, as any of the dedicated Rhode Island stakeholders can attest, building this revolution into a complex existing system is difficult.
Nobody would ever ask for the tragedy that befell our neighbors on the Gulf Coast. But there is lemonade to be made of the lemons — if we can summon the initiative to build the future of health care, rather than rebuilding its past.
Patrick J. Kennedy represents Rhode Island’s First Congressional District.