Information Technology Reference
In-Depth Information
could do those things. At the top of the reasons given for not having one were the cost
and the uncertainty about achieving a return on the investment. Interestingly, physi-
cians who had implemented such a system had a high degree of satisfaction and saw
clinical benefits to their patients, a part of the survey not as often cited as the low adop-
tion numbers. Some might be tempted to be critical of physicians based on this, but
they are acting rationally and exactly as the theory of a complex adaptive system
predicts - in a manner to maximize their own perceived self-interest.
Fixing this requires new incentives. In our highly fragmented health system usually
only Medicare which, according to MEDPAC (the advisor to Congress on Medicare
issues), paid for some 23% of personal healthcare spending in 2010 [
13
] , has the size
and market presence to introduce transformative change. This study and other data led
to the decision by the federal government to essentially pay the cost of electronic
health record technology in provider offices and hospitals
if
those systems are used in
a manner called “Meaningful Use” that could transform care, at least modestly. In
parallel, the Affordable Care Act of 2010 introduced Medicare Accountable Care
Organizations (ACO), to create financial incentives, similar to those in an HMO, but
utilizing a contractual arrangement with existing community-based care providers.
Many major private health insurance companies are now also adapting a similar
model. The needed new incentives may now be in place. We turn to them next.
References
1. Woolhandler S, Campbell T and Himmelstein DU (2003) Costs of Healthcare Administration
in the United States and Canada. N Engl J Med; 349:768-775
2. Thorpe KE and Howard DH (2006) The Rise In Spending Among Medicare Beneficiaries: The
Role Of Chronic Disease Prevalence and Changes in Treatment Intensity. Health Affairs 25
(2006): w378-w388
3. Kumar S and Nigmatullin A (2010) Exploring the impact of management of chronic illnesses
through prevention on the U.S. healthcare delivery system - A closed loop system's modeling
study. Information Knowledge Systems Management 9:127-152
4. Medscape Physician Compensation Report: 2011
http://www.medscape.com/features/slide-
show/compensation/2011/
Accessed 19 July 2012
Accessed 19 July 2012
6. Anderson G and Horvath J (2004) The Growing Burden of Chronic Disease in America. Public
Health Reports 119:May-June 2004
7 .
http://www.hhs.gov/news/speech/2004/040721.html
Accessed 19 July 2012
8. Committee on Quality of Healthcare in America (2001) Crossing the Quality Chasm: A New
Health System for the 21st Century. The National Academies Press
9. Drucker P (2002) They're Not Employees, They're People. Harvard Business Review
10. Smith CR (1969) Publishers Weekly, September 8, 1969
11. Rouse WB (2008) Healthcare as a Complex Adaptive System. The Bridge, Vol. 38, Issue 1,
pp. 17-25
12. DesRoches CM
et al
(2008) Electronic Health Records in Ambulatory Care— A National
Survey of Physicians. N Engl J Med 359:50-60
