1 Why is there a general lack of attention devoted to HIT among the presidential candidates?
I think it’s really such an “inside baseball” story that it doesn’t have a lot of resonance. Most of the candidates are worried about global warming and oil consumption, but you don’t hear them talking about how to design engines for greater fuel efficiency. It’s the same thing with healthcare; they’re focused on issues of accessibility, quality, and cost. But how they achieve those things is inside the factory, and the candidates are just not that worried about that.2 What can be done to increase the awareness and understanding of HIT among the voting public?
One of the things the Alliance has learned from talking with consumers is that they think this stuff already exists. We did a series of focus groups in New Orleans, and one of the groups believed their providers already had computerized medical records because when these patients went to the emergency room, someone entered their information into a computer. They had been with an admitting clerk and given their insurance information, but that’s not a medical record. Consumers typically assume their physicians have all of their relevant information, and so HIT just isn’t compelling to them.
I used to dream that we would get to the point where patients would walk into their doctor’s office and ask if they had an EHR system. Now, I don’t think that is going to happen. I see a lot of parallels to the efforts to “consumerize” quality in healthcare. Early on, quality advocates were saying, “If we can get consumers to really focus on this issue, they’re going to choose their providers on the basis of all sorts of quality information.” The reality is that consumers assume they’re seeing the highest quality provider, so when their leg is broken, they’re just not that fixated on going online to see who does the best job of setting a broken tibia. I think the same thing happens when it comes to HIT. We may increase consumers’ awareness that they can schedule appointments online or that their insurance and other information ought to be available to their provider, but I don’t think we’re going to get much beyond that.3 Is there a particularly deserving HIT proposal that hasn’t received much attention on Capitol Hill?
Hillary Clinton has been an HIT advocate for years. She has a sophisticated view of what’s going on; she and her staff were the architects of a lot of what’s contained in the Senate HIT bill. Senator Obama seems to have a pretty good idea of what HI could mean in terms of engaging more consumers and connecting outlying communities. I think his ideas get at the core of increasing accessibility through HIT. There hasn’t been nearly as much movement on the Republican side, I think in large measure because their political ideology is “get the government out of healthcare,” not “make new proposals for even more in-depth government involvement in healthcare.”4 Which of the current HIT bills do you think is most likely to bear fruit?
I’m not sure. Th e Senate bill is through; it’s a mix of many different things, and it doesn’t really have a driving ideology. If you go back to the last session of Congress and look at Nancy Johnson’s bill, it was crafted with a consistent theme of what they wanted to achieve. I think the Senate bill that’s come out of the current session takes more of a “bread upon the waters” approach. The Democrats in the House don’t seem to be as enamored with that, and the Republicans seem to be dead set against a lot of it.5 How can physicians encourage a greater focus in Washington on the benefits of HIT?
I think most of the policy makers understand the potential benefits of HIT. Th e bigger struggle is to get policy makers to understand the complexity of the current system’s structure. There seems to be this notion that “we’re going to talk about the benefits of HIT and somehow mandate the use of HIT, and then somebody is going to sprinkle pixie dust all over the country, and voilá, we’re going to have all these benefits of HIT.” The reality is that this will be far more complex than simply buying a computer system. It’s the transformation in care practices that really generates the benefit, and those transformations take an enormous amount of time, money, and effort. Yes, they’re supported by HIT, but it’s clear that simply putting the computer into a doctor’s office doesn’t really change anything.