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By Mark D. Uehling

January 15, 2003 | The first warning sign of an anthrax epidemic could be visits to medical Web sites, which presage patient visits to physicians. To distinguish a real disease outbreak from hysteria related to anthrax news coverage, you would need a national IT infrastructure for health care – something the Bush administration is now actively exploring.

The Institute of Medicine, a division of the National Academy of Sciences, has issued a report called “Fostering Rapid Advances in Health Care: Learning from System Demonstrations.” Health and Human Services Secretary Tommy Thompson requested the document, and, in November, he chaired a private daylong bull session with the report’s authors to explore ways to propel its ideas forward.

Blue-Ribbon Panel
The IOM report is interesting reading for IT strategists in the life sciences. As a product of a blue-ribbon panel of academic physicians, the 93-page document offers ideas for weaving together unwieldy national objectives -- such as cheaper health care -- by focusing on chronic care, primary care, IT, and state health insurance.

Specifically, the report recommends an unspecified number of five-year, IT-centric pilot projects. These would develop Web-based communication between patients and doctors. Also on the IOM wish list: computerized access to patient information, both in hospitals and online; knowledge management to present data from the scientific literature; and decision support systems for doctors and patients.

All of the projects are supposed to be “bold and transformational.” To cynics, that may sound like an academic fantasy of how to fix a broken health-care system. But, as the report notes, pieces of an IT infrastructure for health care are already falling into place at selected medical centers around the country.

Now the emphasis is on linking short-term projects of limited scope, not creating a vast new bureaucracy. “We’re not talking about Fantasyland,” says Don E. Detmer, an American surgeon who is professor of health management at Cambridge University in England. By using demonstration projects, Detmer says, the government could overcome the natural resistance to systemic reforms of the sort proposed by the Clinton administration.

All the federal government needs to do, the IOM says, is provide minimal funding and coordination to accelerate and link the most promising efforts. One model: the Defense Advanced Research Project Agency, which sponsored a robust military network that morphed into the Internet.

Patients and Hospitals Linked
IT, Detmer believes, will be a central part of any Republican administration and congressional effort to fix the health-care system. “You can integrate the patient into the care process via the Web in ways we did not imagine,” he says. “We want to see a national health infrastructure.” The report does not say exactly what that means, but ostensibly it would involve a secure network and begin to address the administrative costs of health care, which amount to perhaps 20 to 30 percent of all medical expenditures. The new infrastructure would be less paper-based, offering electronic patient records and databases linked via common standards for clinical information.

Examples sketched in the report seem promising. Detmer, who is also a consultant to the United Kingdom’s National Health Service, says that the U.S. Veterans Administration is the best-executed example of IT improving medical care for millions of people over a large network of hospitals. Despite their threadbare image, VA hospitals have computers that exchange information across medical disciplines, hold computerized patient records, and facilitate electronic communications with patients. The report also cites existing innovative IT projects such as one in Winona, Minn. (run by Cerner Corp.), which attempts to network the population of a small town with its primary care physicians, and another in Indianapolis, which has a communitywide electronic medical records system run by the National Library of Medicine.

In every project, the vision is for vendors, academia, and government to work hand in hand. As the report states, “All demonstration projects in this category would include the formation of some form of public-private partnership.”

On the downside, many IOM reports about broad reform or antibiotic resistance have eventually been shelved and forgotten -- and a similar fate could await this one. The IOM is a think tank, not a funding agency. The White House or Congress would have to push for funding and starting the demonstration projects. Having heard Thompson and spent time on more than a few expert panels, Detmer says he’s optimistic that the ideas in the IOM report might actually get implemented. He speculates about Richard Nixon’s improbable overture in China as a precedent: “It’s not the Republicans you would expect to move forward on this, but funny things happen. Momentum has been building, the pace is picking up.”

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