Kojo speaks with "Speak No Evil" novelist and D.C. native Uzodinma Iweala about his second novel and how his local upbringing affects his storytelling.
Doctors and policy makers have long promised that technology would transform healthcare in this country, improving care while curbing costs. But even as some practices and health systems have moved to computerize operations, most aspects of the doctor-patient relationship have changed little over the last two decades. We explore paths and obstacles to innovation in the American health system.
- Harry Greenspun, M.D. Chief Medical Officer, Dell; co-author "Reengineering Health Care: A Manifesto for Radically Rethinking Healthcare Delivery" (FT Press)
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Technology has transformed the way we read books, order takeout and pay our parking tickets. So why hasn't it changed the way we go to the doctor? Sure, there's plenty of technology at your doctor's office. The receptionist keeps track of appointments with a computer.
MR. KOJO NNAMDIThe practice might keep digital records of prescriptions and tests administered. Your physician might even scribble notes on a tablet instead of that illegible script known as doctor handwriting. But most aspects of the healthcare delivery pipeline and the doctor-patient relationship haven't changed much over the last 30 years. We still have to take half a day off work and scramble to get across town to get six minutes of face-to-face time.
MR. KOJO NNAMDIWe still use phones and snail mail to nail down appointments or get test results. This hour, we're exploring paths and obstacles to innovation in the healthcare system. And joining us in studios Harry Greenspun, chief medical officer at Dell and co-author of the book "Reengineering Health Care: A Manifesto for Radically Rethinking Healthcare Delivery." He's also a member of the World Economic Forums Health Advisory Board. Harry Greenspun, so good to see you. Thank you for joining us.
DR. HARRY GREENSPUNGreat to be here, Kojo. Thank you very much.
NNAMDIWhen I go to the doctor's office these days, I see computers in the waiting room. My doctor might be carrying around that tablet PC, a digital device measures my blood pressure. But in many ways, the entire routine hasn't changed much since 10, 20, even 30 years ago. Why is that?
GREENSPUNWell, frankly, even 100 years ago, we were pretty much doing things the way we do now and -- though, Kojo, I know you're not that old. One of the amazing things is that we have grown up in this healthcare system where we have brought lots of new technologies in. As you mentioned, there are, you know, if you walk into a hospital, we've got lasers, we've got robots, we've got a lot of very cool things.
GREENSPUNBut the way that we manage records, the way that we manage patients and, frankly, the whole process where -- how healthcare gets delivered, really has not changed much over many, many years. And it's gotten more complex and as we've seen in debate with healthcare reform, it's really unsustainable the amount of money we're spending on our healthcare system and the value we're getting out of it.
NNAMDIWell, with a click of a mouse or a flick of the finger, I can download music and books onto my mobile device. I can order a burrito to my exact specifications using my mobile phone. I can make a reservation at any restaurant on a site like opentable.com. So why can't I make a doctor's appointment? Why can't I log on to a secure website and get the results of my blood tests? Why can't I consult with my doctor directly over the internet?
GREENSPUNWell, a couple of things have gotten in place of this. The first one is, is that that's not how our health system pays for medical care. The health system pays for a doctor to see you in the office or for you to be treated at a hospital as opposed to interacting in these more modern ways that all of us are used to doing. And that's been a real barrier.
GREENSPUNI think another barrier is that whoever your doctor is, that doctor is running a small business and it's in that doctor's interest to actually have your records in his or her office so that you keep coming back to that doctor and not make it so easy for you to switch to another physician.
NNAMDIIf you'd like to join the conversation, have you been to the doctor recently? How has the experience evolved over the last 10 or 15 years? Call us at 800-433-8850. Or how has it not evolved? 800-433-8850, go to our website, kojoshow.org and join the conversation there. Send us an e-mail to email@example.com or a tweet at kojoshow. I can access all sorts of data about my life in the cloud, my banking information, my investments, my address book, but if I wanted to access any of my medical information, I'd be out of luck. Why is that?
GREENSPUNAgain, most of the information is held wherever you got that care. And I think there's been a fundamental issue where that providers really believe that the medical record really is about what they've done to you versus what's happened to you and having it as your own record. It's not as though you have a large manila envelope at home where you've gathered up all your medical information.
NNAMDILike my tax information.
GREENSPUNExactly. And though you're probably very likely to do your own taxes, I'm not sure you'd take out your own appendix. So you'd have to rely on someone and they'd want to keep that information about you. So we're in this funny position where the -- how a doctor gets paid, how they keep track of what they do, is all kept at their office and not with you the patient versus just about everything else you do.
GREENSPUNAnd you mentioned finances and other things you have access to. You can travel anywhere in the world and put your ATM card in the machine and get money in that currency there based on your account, but you can't get your prescription list.
NNAMDIWell, there could be a difference between all of that kind of information and my health information. If, for instance, I decided to design and market some cool app that complies information about a network of friends on Facebook, if I mishandled the data, it could be bad, but not catastrophic. It could, on the other hand, be catastrophic if I mishandled data about whether someone was HIV positive, couldn't it?
GREENSPUNAbsolutely. There are some very, very particular concerns privacy and security about health information. Actually, treated legally quite differently than other types of information. And, frankly, within health information certain types of information, like HIV status or mental health information, is also treated differently.
GREENSPUNSo one of the things that we face is the fact that there is a needed desire to improve the quality of care of delivery and make it better for you by having your information available at your provider's location, wherever you are, but there's a concern.
GREENSPUNCertainly, among the public, that the information will be mishandled or be leaked and, frankly, about, you know, a majority of the American public has some piece of information in their medical record that they simply don't want to share.
NNAMDIInformation technology is really good at breaking down barriers, finding inefficiencies but medical information isn't the same as information about what restaurants are within a one-mile radius. Nevertheless, it's something you think we can do?
GREENSPUNYeah, you know, one of the -- what I find so interesting, you talk about restaurants. So, for example, I need to meet someone earlier today, I need to find a restaurant within a certain radius of this building that, you know, was open at the right time, had a table available for me, the right kind of food and the right price, everything else like that.
GREENSPUNBut if someone asked me to find a physician in this area who was a high-quality, low-cost provider that took my insurance and could -- had sufficient experience in my kind of medical conditions, I couldn’t do it. That information's not available.
NNAMDIWe're talking with Harry Greenspun, chief medical officer at Dell. Which brings to me why does a company like Dell or Northrop Grumman need a chief medical officer? You are a medical doctor.
GREENSPUNI am. I'm a cardiac anesthesiologist by training. I was chief resident at Johns Hopkins and actually I've been a lifelong Washington D.C. resident and a proud WAMU member for many, many years.
NNAMDIThank you very much.
GREENSPUNAnd I got involved in using health IT to improve the delivery of healthcare many, many years ago. And some of the companies you mentioned, where I've worked -- now I'm at Dell. Dell, right now, is the largest provider of health IT services globally. So we're in, you know, your hospitals. We're in your doctor's offices. We're in insurance companies. We're in life sciences and pharmaceutical companies.
GREENSPUNI see you looking around the room here. We're at WAMU as well. But, you know, I came actually from Perot Systems, which Dell acquired back in 2009. And, you know, there are many of us in the organization, over 300 collations, that work with doctors, work with nurses, work with techs, work with others to allow them to improve the quality of the healthcare they deliver by using technology as an enabler.
NNAMDIYou're also a friend of computer guy, John Gilroy. I'm wondering if that has any connection to the Dell equipment that I'm seeing in here right now.
GREENSPUNWell, you know, it's interesting, you know. We have -- one thing that we came from in terms of using health IT to improve healthcare is that, you know, we've got a lot of understanding of improving the workflows and making the process of delivering care better. But we've got cool stuff, too. And I think that's what John likes and I, you know, I've got on me brand-new Dell smart phones. I've got a Dell Streak. I've got some tablets. And so the real question is, how can we use some of these great technologies to improve a system that really hasn't changed fundamentally in the last century?
NNAMDIHave a lot of callers who would like to talk to you. The number, again, is 800-433-8850. We'll start with Cindy in Silver Spring, Md. Hi, Cindy. Cindy, are you there? Can you hear me, Cindy? Cindy seems to have walked away from the phone. Cindy, I'll put you back on hold and see if we can talk with Erica in northwest Washington. Erica, you are on the air. Go ahead, please.
ERICAHi, Kojo. I have a comment and a question. I have been a member of Kaiser Permanente since 1982 and have witnessed amazing changes with electronic medical records. I can make all my appointments online. I can check -- I can look at my whole chart online. I can order all my drugs online and e-mail my doctor whenever I want. And I'm wondering why Etna and everybody else doesn't do this?
NNAMDIThis book "Reengineering Health Care," of which Harry Greenspun is the co-author, talks about places like Kaiser that are innovating and the places who are not. Maybe you can talk about that with Erica?
GREENSPUNSure. Erica, you're bringing up a great point and you're almost the poster child for why we ought to have this. It's a tremendous convenience, it lowers costs, it improves quality, it gives you much better access to your care. The sad thing is, is that, people like you are a minority in this country. There are fewer than about 20 percent of medical practices actually have electronic health records and the ability to do these sorts of things.
GREENSPUNSo Kaiser has been a great leader in implementing these things. It was interesting. I have some good friends at Kaiser. One of the biggest complaints that Kaiser gets in its complaint line is from people who leave Kaiser and then no longer have access to their records or their prescriptions the way they used to. And suddenly, they're sort of experiencing healthcare the way most of the country experiences it.
NNAMDIErica, thank you very much for your call. And what I wanted to bring up along that line is when I go to the doctor's office and submit to various tests, that information is really my information. But ask anyone who has tried to change their primary provider or specialist and you'll often hear the same story. There was some sort of delay. The old practice forgot to send the records through or they charge me $50 or $70 to hand over my own medical records to me. What's that about?
GREENSPUNWell, again, it's the issue of, you know, these are small businesses and they are holding on to the records. And the good news is that the government is now established some criteria for electronic health records and the exchange of information. The word is inoperability to make it that electronic information in one office will be transferable to another office and you'd have access to information. You know, the more important thing is that, you know, yes, it is your information and you need that information when you wind up, you know, in an emergency room or another doctor's office or in a hospital somewhere outside of your own physician's office and you need care and you want the doctors and the nurses to be able to know what's going on with you and to treat you effectively.
NNAMDIBut the problem here, in your mind, isn't that doctors are luddites. In fact, the opposite is often true, but both sides of the equation are clinging to old models of what medical care is.
GREENSPUNYeah. I think one of the big barriers that people view sort of the move to electronic health records is sort of just replacing what they do with a pen and paper, with a computer. And many people see that as a barrier to help them interact with a patient. I can't imagine you wanting to walk into your doctor's office and for that six minutes that you get with your doctor have them with his back turned to you, typing away at the computer. You want that interaction. So, you know, rather than sort of, you know, digitize an existing system, one of the things we focus on, particularly in the book is how are there ways that physicians and other providers can incorporate technology while preserving the best of the interaction that you'd have with your doctor but get more out of that visit.
NNAMDIOn to Maria in Chevy Chase, Md. Maria, your turn.
MARIAWell, I'm a physician in the district who is a concierge doctor, speaking to your point that not all Americans can have that sort of health care. But I can communicate with him when he's on vacation, when I'm on vacation, through a secured website on the Internet. And I've had doctor -- I've had conversations with him back and forth about symptoms and he's able to refill prescriptions. And I still see him a fair amount during the year when I need to. But there is a shortcut to it and it's really a fabulous platform to be able to communicate with him.
GREENSPUNYeah, Maria. I mean, you bring up a great point. And for those of you don't know what concierge practices are, these are practices where people pay extra money actually to get a higher level of service. And, you know, what we -- you know, I think it's great that you get that kind of service. When we think about our health care system overall in the country is how do we deliver that kind of care and those kind of interactions for the average person who has the average insurance or, frankly, is on Medicare or Medicaid?
NNAMDIThank you very much for your call, Maria. We move on to Kevin in Washington, D.C. Kevin, your turn.
KEVINHi, I'm an emergency physician and medical traumaticist and I'm currently working in the district. And there have been some issues with health information exchange that also leading to other areas of medical liability that physicians are held responsible for their contact that, you know, if -- you're dinner analogy -- if you end up at the wrong table, it's not that big of a deal. If your bank overcharges you, that can be fixed. If you end up in a hospital because of getting the wrong drug, that's a big deal.
KEVINAnd -- but things are working right now to improve that health information exchange to the point where it's ubiquitous, safe and reliable. It's very complicated. There's 30,000 different human diseases known and so it's, you know, while you may have several different types of table in a restaurant, just dealing with that complexity is a fantastic issue in terms standardizing your records. But I have question for other callers...
NNAMDIBefore you ask the question, Harry Greenspun, can that mistake made in health information exchange not take place as readily if we're doing it on the phone or in person as if we're doing it online? Are there not ways online or that this technology can provide to make sure, the two or three times over, it's checked to make sure it's the right health information.
GREENSPUNWell, you know, with any new process, you have the ability to overcome the limitations of the old ways and you also introduce new problems in its places. And so Kevin brings up a great point, is that, you know, health care is more complicated than making reservations at a restaurant. But there are ways that we can leverage technology actually to improve and streamline that process to really improve the quality of care.
NNAMDIKevin, thank you very much for your call. Kevin, you had a follow-up. Go ahead. Kevin, you there?
NNAMDIGo right ahead, please, you had a follow-up.
KEVINOh, yeah. One of the issues that comes out, though, with this health information exchange and I wanted to agree with you that I think, I'm convinced that health information exchange with make things much safer, much more efficient and all -- better process for everybody concerned, physician and patient. But one of the issues with the health information exchange is how are we going to make that information available to physicians when you're seen?
KEVINI'm an emergency physician, obviously, you know, I'm very much interested in getting information on people who I see in the emergency department. But that's the problem whenever you're seen by a consultant or referral and there -- what do people think about the privacy and security issues? The technology is there, but a lot of it is just getting the public buy-in that, you know, they're willing to give up a little bit of control over their information in order to get better care.
GREENSPUNKevin, you know, another great point. And I kind of hearken this to the TSA when they started the pat downs in that the TSA implemented a program in order to extensively to improve security of people who are flying, yet they failed to communicate those kinds of benefits to general public. And instead, over the holidays what we have is this, you know, great backlash among travelers over what was going on in the airport security lines. I think we had the same thing in health information exchange. And again, to define that for the listeners, health information exchange is the electronic transfer of health information from one system to another system at the time of care.
GREENSPUNBut, you know, the public needs to understand why it's a value, why it's something that they would want so that, again, if they wind up in your emergency room that the records from their doctor's office will be there. I think one of the key issues in terms of privacy and security is that, you know, most people, as I mentioned, have some piece of information in their medical record they don't want to disclose, but, you know, if I'm dying, I want people to know anything about me in order to save my life.
GREENSPUNAnd so I think what we're going to be looking at are better information systems that will be able to sort through the kinds of information people want to keep private and that needs to be shared in the event of an emergency. So that if there's something appropriate that the physicians caring for that person will know about it.
NNAMDIKevin, thank you very much for your call. On to Cindy in Silver Spring, Md. Cindy, are you there now?
CINDYYes. Hi, Kojo.
CINDYI have a comment and a question. Like the previous caller, I also have Kaiser Permanente and I have found that they make great use of new technology. I can communicate with mine and my children's doctors, order prescriptions, check test results, ask for referrals to specialists, all without leaving my desktop. And that is actually, I think, increased my personal relationship with physician because I can keep in touch with him more often for follow-ups or questions I might have about care or prescriptions. Given -- my question is, given that Kaiser has incorporated all of those technology and it's working well, what do you think are the barriers to this becoming a more common and widespread use of technology among other health care providers?
GREENSPUNWell, sure. I think, Kojo, it's interesting that all the people calling in are people whose doctors have electronic medical records. I think the rest of the people are just waiting around in the doctor's office to be seen. You know, one of the -- there are a lot of barriers to adoption of electronic heath records and health information exchange. You know, we talked about privacy and security. Cost has been a big factor, though, with the stimulus bill that was passed. There's incentive payments that are going to physicians in hospitals to encourage them to become users of Health IT.
GREENSPUNYou know, a fascinating thing, though, another barrier is that, you know, along with the workflow things that we talked about is that, you know, Kaiser has a great system. But were you to leave Kaiser and go to another provider, they would not have access to those records at Kaiser. It could be transferred, it would be cumbersome. But, again, you'd have to find another physician who had the ability to have those kinds of records put into their own system. And they'd have to have a system in place, so. And you'd also have to be willing to have that information moved around, which is, you know, as I mentioned earlier, a real concern among a lot of people.
NNAMDIIt's one thing for Kaiser to be doing it, but shouldn't there be somebody presumably in government or some organization someplace who's at a level 10,000 feet high that's looking over all of this and say, no, it shouldn't just be these individual health delivery systems that are doing this. There needs to be some coordination.
GREENSPUNWell, and actually there is a guy. He's Dr. David Blumenthal. He's the national coordinator for Health IT. And sadly, he's announced that he's actually leaving the government, but they're actively looking for his replacement. The Office of National Coordination for Health IT has been a key part of Health and Human Services for establishing policy and promoting this adoption of Health IT. And I think we're just now beginning to see some of that fruit beginning to bear.
NNAMDIThank you very much for your call, Cindy. We got this e-mail from Beth in D.C. "In my K Street's ENT's waiting room, I watched a visiting French family pay the bill for a doctor visit for the father. While containing their amazement, they chatted excitedly in French about the antiquated filing system behind the reception desk and the ancient rituals involved in the rest of their experience. I could hardly keep from laughing myself since I've been to a medical facility in France and I know about the system with the digital cards that would seem futuristic to most Americans. Will we ever get there?
GREENSPUNWell, you know, I travel around the world and I've seen the health systems in many, many different countries and all have their advantages and disadvantages. You know, one of the problems that we have in this country is that we have a health system that has grown up since the '30s and onward, where your health care coverage is tied to employment and how doctors get paid a certain way and where medical care is delivered, is done in a certain way. But other countries, whether it is Canada or the U.K. or France or, you know, anywhere else you might go in the world have very interesting systems, which have addressed the problems.
GREENSPUNUnfortunately, there is no one best solution because even your previous guest discussed, there are cultural differences between countries and there are economic differences in countries. And a system that will work there won't necessarily work here. What we should do is find out what are the best things that those countries have to provide, whether it's electronic health records, whether it's a focus on prevention and wellness, whether it's individual responsibility for your own health. Whatever that is, what can we learn from those countries and bring here.
NNAMDIWe're going to take a short break. Our guest is Harry Greenspun, chief medical officer at Dell and co-author of "Re-engineering Health Care: A Manifesto for Radically Re-thinking Health Care Delivery." He's also a member of the World Economic Forum's Health Advisory Board. As I said, we will be taking a short break to continue our winter membership campaign. But after that, we'll continue the conversation that we're having with Harry Greenspun. So if you have already called, stay on the line. We will get to your calls. And you can call now at 800-433-8850 or join the conversation at our website, kojoshow.org. I'm Kojo Nnamdi.
NNAMDIWelcome back to our conversation with Harry Greenspun. He is chief medical officer at Dell. He is co-author of the book, "Reengineering Healthcare: A Manifesto for Radically Rethinking Health Care Delivery." Harry Greenspun is also a member of the world economic forums health advisory board. Maybe part of the reason why the health care system hasn't changed so much over the last 30 or 50 years is because the experiences of people offering services, doctors and medical administrators, might be different from the experiences of people using the services.
NNAMDIIf you're a restaurant manager or a chef, you know at an elemental level how your patrons are using your service. But there seems to be a huge disconnect between doctors and patients. The typical trip to the doctor's office is few hours. As we said earlier, you have to take half the day off. The average experience of the doctor is just six minutes with you. Does that affect how the system is viewed and why it's so difficult to change?
GREENSPUNYou know, one of the, you know, health care is a service industry. And one of the things if you look in any service industry is feedback from their users. You know, how well are people doing. And, you know, I travel around the, uh, around the world, and I talk to doctors. And I'll look at a doctor and I say, are you a good doctor? How would you know? How would you know that you're practicing high-quality medicine, safe medicine?
GREENSPUNThat you're doing all you can to provide the best possible care for your patients. We don't have that kind of feedback. I mean, it's ironic. If you look in other parts of, I'll call it health care, you know, I've got a beautiful Siberian Husky named Nashy (sp?) and, you know, I get postcards in the mail telling me it's time for him to get his shots.
GREENSPUNI never got a note from my doctor telling me, hey, Harry, it's time to get your colonoscopy. Not that I really wanted to get that card, but, you know, the kinds of things that we experience in other parts of our lives, if we had those same very basic elements in health care, we'd get much better service.
NNAMDIHere is Aaron in Chantilly, Va. Aaron, you're on the air. Go ahead, please.
AARONYes. So regarding Dr. Greenspan's comments just there, my wife and I opened a vet hospital in Chantilly, and, you know, we're able to invest in a digital x-ray and ultrasound and endoscopy, and I was wondering if he could -- and much of that equipment is the same equipment that used on the human side. And my wife has -- her education cost more than $100,000, if not now $200,000.
AARONSo the cost seemed to be relatively the same as what human doctors have to experience in providing care, and yet she's able to give appointments from, you know, 20 or 30 minutes up to an hour just -- and provide a much wider range of services and upload diagnostics to specialists to get their -- you know, to get them to read x-rays and ultrasounds and such. And it seems like it's a more reasonable cost than when I go to visit my doctor, there's barely any technology and they're using dip sticks to hold down your tongue and they may have a stethoscope.
AARONBut they're really, you know, in order to get an x-ray, as you said, Kojo, you've got to, you know, take half the day off and go someplace else. And is it just because of strictly liability that human doctors can't provide more quality care in a longer appointment time?
NNAMDIHere's Harry Greenspun.
GREENSPUNWell, you know, Aaron has, you know, great points. And, you know, your clinic sounds like a great place to get care. I would like to get care there, you know, in a modern place like that. You know, one of the -- one of the big barriers again is that that, you know, people who go to a veterinary practice, I mean, they -- they pay -- the pay cash, or they pay with their credit cards. And they compare service. And if they don't like the service they're getting at a veterinary hospital, they'll find a different one.
GREENSPUNAnd the challenge from moving one to another, aside from getting, you know, a pet's vaccination records is pretty low, versus going from a doctor's office to a doctor's office it's much more difficult. The other thing is, most of us are pretty well insulated from the true cost of care. We pay a $10 or a $50 co-pay when we go see the doctor, but we really don't understand what those costs are. And if the practice is inefficient, or very efficient, we don't really know about that.
GREENSPUNAnd we actually, an average patient won't save money by going to a doctor that provides safer higher value care than one that doesn't.
NNAMDIThank you very much for your call, Aaron. We move on now to Melissa in Charlestown, W. Va. Hi, Melissa.
MELISSAHi there. I actually -- I work part-time right now for a company called MediConnect -- MediConnect Global that has -- they work on the back end a lot with insurance companies and life insurance providers and things, where the company needs to get a hold of patient medical records to review. And so a lot of people's records are already in that system, and available to them if they -- it's mymediconnect is the website.
MELISSABut if your records are already in there, you can access them for free. You can also, you know, doctor's offices charge a fee typically for record reproduction services, but you can pay to get your records from your current doctor's office and they'll scan and digitize them, and you can actually download it onto a USB fob and keep it with you so that you do have your own, you know, copy of your medical record to take with you if you're, you know, going to different -- various different doctors or whatever and they need to keep track of the back and forth information, or just to have your record with you.
MELISSAAnd Amy Rees Anderson, the CEO, has actually, you know, her focus this year has been a lot on talking about letting individual users get access to their medical records this way (unintelligible) . In the past, it was more focused on just the -- sort of the back business and with the insurance companies. But, I mean, I had never, you know, when I started working there I had never heard of anything like this. And I can't imagine that it's not gonna be, you know, there probably will be a lot more of them in the future hopefully all interconnected.
MELISSABut just the idea that you can get your medical record and have access to it like that, and have it in a portable format when you know that the information is stored securely somewhere, is not something that I've heard a lot about which, you know, is...
MELISSA...benefits this conversation.
GREENSPUNYeah. Melissa, it is a great point. I mean, the tragedy of all this is that there a subset of people who will have their records available somewhere, but as you say, someone who had their records in that system, they could get their information but on a USB drive, but for example, if that we were me and then I went to my doctor, my doctor doesn't have computer. And he's not gonna upload that information. He doesn't want to put that stuff in there.
GREENSPUNSo again, the issue of inner operability is a big issue. And, you know, there's an element, you know, Kojo and I are talking about this system as thought we don't know any better. But, you know, none of us would go to a bank that didn't have online banking. None of us would use an ATM card that could only work in the six ATMs that were in a city. And, you know, we -- all of us have examples in the rest of our lives of how information can move around safely and securely, and how we can control it.
GREENSPUNAnd, you know, what we haven't seen is this great consumer backlash of people demanding that their doctors adopt electronic health records, that that information is moved around, and that we get higher quality safer care.
NNAMDIThank you very much for your call, Melissa. The united Stets stand alone among major industrialized countries as a place without universal or near universal health care. During policy debates in this country, both sides have pointed to countries like the UK as examples of either how to do it right or how to do it wrong. How have other countries approached technology and innovation in the health sector?
GREENSPUNWell, you know, other countries have done some really interesting things. You know, in one regard with a nationalized health service like you have in the UK, or other countries, you have the ability for a -- a central organization to say we are going to adopt electronic health records, or we're going to move information around a certain way. The way the UK actually got tremendous adoption of electronic health records was they told physicians that you can pick one of these electronic health records to use, but by the way, the way you're going to get paid is by submitting your information electronically.
GREENSPUNAnd they got about a 99 percent adoption rate of electronic health records. So they can pull those kind of levers. I should point out in this country we do have some examples of great use of electronic health records. If you look at the Department of Veterans' Affairs, you know, the VA hospitals have a fantastic electronic health record. In military health they have the largest electronic health record in use globally.
GREENSPUNSo, you know, when we do have that kind of central command and control, you're able to have these kind of implementations. The problem is that we have a largely private health insurance system and lots of, you know, small practitioners doing things. So it's really only in the large governmental -- government run health care systems we're able to do that.
AARONThe other thing I will point out, and going back to the earlier caller's point about concierge care. In all of these countries, what you'll find is though they have a national health insurance system, or national health system, there is almost invariably a system sort of run on side for people with means that if they want a certain thing done at a certain time, and if they have the money to pay for it, they can get it done.
GREENSPUNSo, you know, if we want -- again, for the average American, the average citizen or the average person needing care in this country, is to get care, we're gonna have to fix the real bulk of how care is delivered.
NNAMDIOnto Margie in Herndon, Va. Margie, you're on the air. Go ahead, please.
MARGIEOkay. Thank you. One thing that hasn't come up is a question of, you know, the state insurance laws, state insurance commissioners that we have in this country as opposed to national insurance laws in other countries. We have 50 different state insurance systems. And then the question of liability that some of the callers mentioned, and IT security. I think we've dealt with the IT security in a lot of areas, and probably can do it very effectively in access to records.
MARGIEPortability on a thumb drive is questionable. I'm not sure if people should carry around their thumb drives with all their health information on it, in case something happens to them, just because it is accessible to whoever finds the thumb drive. But could your guest speak to the issue of the insurance questions, national versus state and how we can reconcile that?
GREENSPUNYeah. You know, Margie, good question. I mean, there are many, many challenges to having information flow freely and securely throughout the country. The fact that there are differences in states and here we are in DC. So I live in Maryland. I've got an office in Virginia. We have another location down in D.C. If I get hit by a bus, I've got to worry about, you know, what are the laws around moving the information around. How can we get that done effectively?
GREENSPUNAnd beyond just the insurance issue and there are some elements of the health care reform law that address being able to move insurance across state lines and sell insurance across state lines. There are big concerns about privacy. So that if the -- each state has its own privacy law and there may be barriers that one state is stricter than another. So they may not allow that information to be moved across.
GREENSPUNSo the question is really not an issue of technology, it's almost an issue of governance and harmonizing...
GREENSPUN...very complicated laws and rules for the benefit of you and me.
NNAMDIThank you very much for your call, Margie. Here is Ginger in Arlington, Va. Ginger, your turn.
GINGERHi, thank you, Kojo. I'm also a veterinarian, and I, you know, we are switching over to medical records electronically, and it's actually pretty nice to have that. But my concern is with e-mail access. I have a lot of friends and family members who sit at their computers all day long and sent hundreds and hundreds of e-mails per day, and what I'm concerned about is that they send e-mails about absolutely every little thing.
GINGERAs a practitioner, I spend an extra two to three hours a day researching cases that have come in trying to make sure that I'm doing the best for my patients, returning phone calls and things like that. And on average, I get about three to ten phone calls per day. I'm afraid that, you know, once we have e-mail access that people that readily e-mail us, that number is going to go from three to ten to 100 to 300 per day, and I just don't have the ability to spend that kind of time, especially when...
NNAMDIThat may be another example of how the system is behind technology, Harry Greenspun, because I know you feel we have to find a way of compensating practitioners for doing those things.
GREENSPUNYeah. And I'll go slightly differently on this question, because, you know, the question is how am I going to handle those e-mails, and doctors ask the same question. If we start interacting with patients via e-mail, you know, I'll get 100, 200, whatever number of e-mails per day. You know, one of the things we highlight in the book is there are different ways of interacting with patients.
GREENSPUNIt actually may be more effective than our traditional ways. One of things we talk about are group visits where you bring groups of people together who have similar medical conditions and have similar questions, and let them -- let 12 people spend an hour with a doctor, and have a real quality interaction. Of course they sign waivers of confidentiality and those issues. But really improve the -- the kind of information, and how can we use technology for example to answer frequently asked questions.
GREENSPUNI mean, it's not as though other industries haven't faced this where if you open up the ability to communicate with your customer base, that you automatically get overwhelmed with questions. There are ways of handling -- there are ways of screening those questions, and there are ways of posting information that if people have those kind of questions they can get them much more quickly.
GREENSPUNSo, you know, one of the -- one of the reasons, you know, doctors haven't done this and not paid for it, but again, under health care reform with accountable care organizations and the ability to coordinate care, we may be in a situation where we're able to, you know, use some of these technologies to improve the outcomes of individuals, improve their health, and lower the cost of delivering care to them, and therefore allow compensation for these kind of interesting ways of working with people.
NNAMDIGinger, thank you very much for your call. Finally, you've said that technology is the enabler, but how will technology change health care in rural areas which have few doctors, hospitals and medical resources?
GREENSPUNYou know, again, you know, we can talk about the big cities, we can talk about the academic medical centers that have done very well, but again the bulk of care is delivered in your average community hospital, your average doctor's office. So there are a number of things in play. The first thing, you know, we've got to get technology out in the rural areas. So interestingly, the Federal Communications Commission has a director of health care. And one of the big pushes in that area is around mobile health.
GREENSPUNThat, you know, people may not have access to some of the fancy equipment there, but they certainly have cell phones. And how can we use mobile technologies to improve the transfer of health care information back and forth in a way to make that work.
NNAMDIHarry Greenspun is chief medical officer at Dell. He is also co-author of the book, "Reengineering Healthcare: A Manifesto for Radically Rethinking Health Care Delivery." Harry Greenspun is also member of the world economic forums health advisory board. Thank you so much for joining us.
GREENSPUNIt's been a great pleasure.
NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.
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