A Management and Information Perspective on Healthcare - Innovation Underway

Here is a sampling of innovative work in health care today.

The Veterans Health Administration Service is the largest integrated health system in the United States, with 5.3 million patients and 1,400 sites of care. Although it has not had a sterling reputation in the past, the VHA today is on the leading edge of innovation. It won the 2006 Innovations in American Government Award presented by The Ash Institute for Democratic Governance and Innovation at Harvard University's John F. Kennedy School of Government.

The VHA has created a system -- Veterans Health Information Services and Technology Architecture (VistA) -- that allows clinicians to view and edit electronic health records, and provides access to images such as x-rays, photos or documents, throughout its system. Veterans increasingly have access to their records and more opportunity to successfully manage their own health. The results are eye opening:

•    VistA's computerized system checks for incompatible medications. While one in 20 outpatient prescriptions are complicated by medication errors nationwide, VHA's process fails at a rate of only seven per million.

•    The use of clinical decision support and performance measurement to improve pneumonia vaccination rates helped save the lives of 6,000 veterans with emphysema. As VHA's vaccination rate became the national benchmark, pneumonia hospitalizations were halved even while VHA's patient population doubled -- all while reducing taxpayer costs by $40 million.

•    The President's Information Technology Advisory Committee (PITAC) estimates that nationally one in five lab tests are repeated because previous test results were not available at the point of care. The cost of maintaining VistA is $87 per patient per year, only slightly more than the cost of one unnecessarily repeated lab test.

•    Adjusted for inflation, VHA care is 32% less expensive than a decade ago, although health care costs generally went up 50 percent. And the VHA has measurably better outcomes in quality, satisfaction, access and patient function. The VA outperforms all other sectors of American health care in of 294 measures of quality in disease prevention and treatment.

Wouldn’t you like to be in that system?

We’re all more aware of the threat of terrorist attacks and natural disasters. When hurricanes Katrina and Rita struck the Gulf Coast in 2005, the VA Medical Center in Gulfport, Mississippi, was destroyed, and the New Orleans VA Medical Center in New Orleans was evacuated and closed. Nevertheless, medical records for 40,000 veterans in the area were almost immediately available to doctors across the country, and veterans could resume their treatment and refill their prescriptions.

What is going on at VHA and at private clinics around the country will transform the practice of medicine. Business technology first brought efficiency and speed to corporations. Then it began to change the conduct of business. In the same way, technology has begun to improve the productivity of health care, but in the future it will bring hard to imagine changes in how we treat disease and keep people healthy.

The Mayo Clinic in Rochester, Minnesota, is one of the organizations at the forefront. Ironically, we might blame the clinic for the manila folder. Henry Plummer, the fourth physician at the clinic, which opened 100 years ago, pioneered the idea of having one record for each patient, which would travel with the patient, replacing ledgers and various notes written and kept by individual doctors in their offices. He also studied how the industry moved information, and created a system of conveyors and pneumatic tubes to swish the records around the clinic.

This evolved into thick plastic jackets bulging with color-coded paper records. One patient might have as many as 40 of these jackets.

That’s all gone now. The clinic has digitized 4.4 million patient records in a unified system. The system must handle 1.5 million outpatient visits and 60,000 hospital admissions each year. It is used by 15,000 caregivers and staff, who have access to 15,000 terminals across the Mayo campus. Every week, about 55,000 clinical notes are added to the system, and 125,000 outpatient orders are made electronically for diagnostic tests, medications or consultations.

This is the productivity phase, in which accuracy, speed and connectivity improve exponentially. Doctors on opposite sides of the campus can call up a patient’s record on their screens and discuss it intelligently. Everything is in there – medications, history, even x-rays. This kind of technology is the norm in the corporate world.