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Giving President Bush Credit Where It's Due
Posted 11:08 p.m., April 27, 2004
There are a lot of reasons to bellyache and guffaw about this president, and I've done a bit of both on these screens. But there is at least one area where George Bush decidedly is moving in the right direction, and that's in the realm of healthcare. And for that, at least, he deserves the nation's accolades.
I'm not talking about Medicare. I'm with my genuinely conservative friends on that issue (I exclude from that group the untax-and-spend Bush administration). The creation of an enormously expensive new drug benefit without the means to finance it (only a few years before the Baby Boom retirement tidal wave) strictly to corner the AARP vote is a mistake, I believe, of titanic proportions.
No, I'm talking technology.
A Vision of Electronic Health
In a speech at Minneapolis' convention center Monday, Bush enlarged upon a pitch for electronic medical records that he made in his January State of the Union speech--a point that passed nearly unnoticed in mainstream press coverage.
In the Minneapolis address, Bush laid out a more elaborate vision for a nationwide health infrastructure that would give nearly all Americans access to electronic health records within 10 years.
It came the same day that Bush ordered creation of a new federal bureau, the Office of the National Health Information Technology Coordinator. The coordinator will be a sub-cabinet post reporting directly to the Health and Human Services secretary, Tommy Thompson
Much of Bush's vision likely can be traced to the influence of the tech-savvy Thompson. If it comes to pass, Bush ultimately might pass on a legacy that, at least in this one regard, genuinely will result in the betterment of the society.
Setting Standards
Thompson has done good work, mandating computerization standards for coding and sharing medical records among federal agencies. He also granted cost-free access to SNOMED-CT (Systematized Nomenclature of Medicine--Clinical Terms), laying groundwork for a common medical language--which could lead to a unified electronic health record.
That's a lot more than the Clinton administration achieved, and represents badly needed change. The healthcare system has remained amazingly behind the times, even as other industries from banking to manufacturing have zoomed far ahead.
Banking is especially instructive, as I realized in 1999 when I traveled to London. I was able to insert the same ATM card I had carried with me from the United States, push a few buttons, and withdraw cash from my account--in British pounds.
Imagine that instead of needing cash in England, I'd needed healthcare. Further, imagine I needed it while lying knocked unconscious. Do I possess a card--or anything else--with all the identifying information and pertinent medical history that a provider over there would need to treat me effectively, to know, for example, if I were a diabetic, had a heart condition or was allergic to codeine?
No, I don't have anything like that. Almost nobody on these shores does.
Much to Do
Now, don't get me wrong, the Bush administration is not exactly going whole hog on this thing. Time will tell if this is yet another example of Bush announcing an initiative only to let the matter drop once the ceremonies end.
There is only $100 million of federal money in the offing for the whole initiative; it can easily cost a single hospital tens of millions to install one enterprise-wide clinical information system. Kaiser Permanente is spending about $100 million to achieve unified health records across its payer-provider system.
The federal seed money will be targeted at demonstration projects to illustrate the benefits of interoperable networks that enable hospitals, clinics and physician practices to trade information. Demonstration projects like that are already under way in a few New England states.
A lot more needs to be done. Strangely, the U.S. is far behind countries like England, Israel, even Thailand, in integrating information digitally and making systems interoperable enough to communicate one with the other.
Capitalism's Curse?
Healthcare is one sector, one could argue, where American-style capitalism is falling short. In England, for instance, a massive national health infrastructure is being built that will connect nearly all of the nation's hospitals, physicians and patients. Because of England's single-payer national health system, the U.K. can impose computerized uniformity on its providers.
Not here. In the U.S., the normally healthy forces of market competition have actually created roadblocks to health IT interoperability. Call it the Bill Gates effect. Companies have wanted to forge a place as the Microsoft of healthcare, so they've actively discouraged interoperability, hoping that their systems would rise to the level of industry standard.
It hasn't happened. Instead we have a tangle of incompatible systems, sometimes many of them within a single hospital.
This is the very thing that Tim Berners-Lee warned would occur if his invention, the World Wide Web, were commercialized. If the Web weren't free and ubiquitous, he argued, competing standards would emerge. Instead of one open platform, the Web, there would be multiple webs incapable of working together. Users would need multiple proprietary browsers, and probably would have to pass through "tollgates" to pass from one Web network to another.
That's a fair analogy to what has arisen in healthcare IT. And while there are many other issues in the way, too--grumpy old docs who don't want to use computers, for instance--interoperability is the iceberg blocking the channel.
If President Bush's national health infrastructure succeeds in cutting through the jam of competition, not only would it be an interesting reversal of his usual hands-off approach to economic regulation and oversight, it could ultimately result in his greatest contribution as president.
Correction: In an earlier version of this column, I wrote that Kasier Permanente is spending "billions" on its electronic health records project. I've since learned the figure is closer to $100 million.
Copyright 2004, by Kevin Featherly
