A dangerous paradox is at work in the midst of what we call healthcare reform. The risk: That by the time Americans grasp it, Medicare and private insurers will be armed with massive amounts of data, which will then be used to create computer-based formulas for patient care and capped reimbursements. While data-driven healthcare holds promise, it also diminishes the judgment of doctors—and sets a stage for pre-approved allocations of care based on data analysis.
Data-driven healthcare is a core element of current reform efforts. As envisioned, if you have diabetes, your condition would be matched to a database of others treated under similar circumstances. Your treatment would then be decided on the basis of what worked best for others.
Ideally, treatment plans based on best practices could be great—both improving health care and saving money. But what happens if pre-approved treatment formulas are flawed? To move responsibly in this direction, the first step must be transparent and meaningful data analysis. The federal government acknowledges this. Without quality measures, we could end up with bad data driving decisions on everything from medications to surgeries.
Are we ready for data-driven healthcare?
By many indicators, the nation is not ready for changes taking place right now. Consider: Federal rules in effect now require doctors to collect lots of information on individual patients. That is why doctors often type while they are seeing patients.
Yet the nation won’t even have the advanced technology for comprehensive data analysis, and sharing of patient records among providers until 2024. That is by the government’s own estimate, which may be optimistic given the overall lackluster state of Electronic Health Record (EHR) systems in use today. Last year, 36 professional associations raised questions about the very security of patient information contained in EHRs.
Worse yet, due to gag clauses in contracts with EHR providers, many doctors and hospitals can’t reveal the problems they experience with electronic record keeping. This means the public can’t even intelligently assess the current state of medical records technology, even though $30 billion in federal tax dollars subsidized the installation of EHRs. The Senate Committee on Health, Education, Labor, and Pensions held a hearing on this issue earlier this year.
The current push for data-driven healthcare is called “population health”. However, the term itself needs to be commonly understood, at the very least by healthcare professionals. Recently, after interviewing a number of healthcare stakeholders, the editor-in-chief of Healthcare IT News concluded that “what has become eminently clear is that defining population health depends on whom you ask.”
Federal mandates are moving the medical profession toward a new system for deciding patient care for individuals. But we can’t define this new system, and whatever it is, the technology is a long way off.
The paradox of this whole scenario is that in the name of improving the science of medicine, change is happening absent the necessary foundation to advance a science. That sets the stage for careless reform—and the potential for less care for individuals. And that’s the reverse of the common goal for the nation.
Brian P. McDonough, MD, FAAFPPeer
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