Information Technology Reference
In-Depth Information
Any medical student already knows this. Primary care physicians such as family
doctors, general internists, pediatricians and gynecologists can expect to make far less
than they would earn as a surgeon or specialist. [
4
] As a result, we have a shortage of
primary care physicians, the front line warriors in the battle against chronic disease.
[
5
] To leverage those scarce resources and achieve better results requires a different
approach than the traditional physician-centric, episodic office visit with little or no
contact with the patient managing their disease at home between these visits.
Why a different approach? Consider any acute, life-threatening problem. It is
likely to be diagnosed and treated within a relatively short period of time. The care
will often take place in
one
highly specialized venue where care coordination,
though hardly guaranteed, is substantially simpler and the patient is essentially a
passive participant.
Contrast that to a diagnosis of chronic disease which, by definition, is not curable.
Treatment will take place over years or even decades in multiple venues that may be
widely geographically dispersed. The complexity of coordinating care is com-
pounded with multiple chronic diseases, particularly in our highly fragmented and
specialized system of care. So “while the average Medicare beneficiary sees between
six and seven different physicians,
beneficiaries with five or more chronic condi-
tions see almost 14 different physicians in a year
[emphasis mine] and average 37
physician visits annually”. People with five or more chronic conditions fill almost 50
prescriptions in a year. [
6
] In fact “virtually all of the [Medicare] spending growth
since 1987 can be traced to patients treated for five or more conditions.” [
2
]
Success in treating chronic disease depends heavily on the behavior of patients
when they are outside of what is traditionally thought of as the healthcare system
.
Not only are these diseases often caused by issues such as poor diet and lack of
exercise but proper diet, exercise and medication compliance is almost always criti-
cal to successfully managing them. New technologies such as the Internet and wire-
less and mobile devices are of great interest because of their potential to engage
these patients at home and change their behavior both to prevent and more success-
fully manage chronic disease.
Health Data Logistics
“Our healthcare system needs all the help it can get. And health information technology is
some of the best medicine we have.”
-
Tommy G. Thompson
[
7
]
Among the key problems for which information technology is clearly good med-
icine is insufficient data sharing among the many care providers treating patients
with chronic diseases, particularly those with multiple diseases. According to the
IOM, the “fact that more than 40 percent of people with chronic conditions have
more than one such condition argues strongly for more sophisticated mechanisms to
communicate and coordinate care. Yet physician groups, hospitals, and other health-
care organizations operate as silos, often providing care without the benefit of
