Unlocking Solutions to America’s Healthcare CrisisJuly 24, 2019
William A. Haseltine - Contributor | Forbes
Health is a human right, enshrined in the Alma Alta declaration by the nations of the world. After satisfying the need for food, after satisfying the need for shelter, the next thing that every human wants to satisfy is the need for health: their own health, the health of their children, the health of their parents, and the health of their communities.
Here in the United States, health disparities are very noticeable. While we are home to some of the finest healthcare institutions in the world, the high quality care these institutions provide is not available to all citizens. If you look at our health outcomes, the United States ranks well below all other high income countries, despite the fact that we spend twice as much as any other nation on health services as a proportion of GDP.
Access to high quality affordable healthcare for all is a fundamental condition for social and political stability. The current political turmoil in the United States is partly due to inequities in access to high quality healthcare. Health insurance in the United States is generally provided by employers. The anxiety of those who lose their jobs as a result of international competition or technological change is dramatically exacerbated by the loss of health insurance. To lose a job is to lose access to high quality affordable health insurance.
The problem of access to healthcare is complex, but there is one key that could unlock a host of solutions to our current healthcare crisis and lead to a true transformation of the healthcare system here in the United States: information technology.
“What gets measured, gets managed.”
We are all aware of how information technology has transformed our personal lives. Technology has the power to transform our healthcare system as well.
First, information technology allows us to understand what is happening in our healthcare system, which is the basis for all improvement. Peter Drucker was right when he wrote “What gets measured, gets managed.” Take the example of NYU Langone Health, a medical center here in New York that installed a comprehensive information system a little over ten years ago, when the medical center was losing money and ranked in the bottom third of academic medical centers on its quality of patient care.
The new NYU Langone information system formed the basis for the institution’s transformation. The medical center is now a world class leader that today delivers clinical excellence, outstanding safety performance, and total patient satisfaction, all while generating a substantial financial surplus.
While all medical centers use some form of information technology to record patient information and share information among doctors, the NYU Langone system is unique: it is comprehensive (every activity of the institution including medical care, finance, teaching, and research is captured), real time (data is entered and made available instantly), integrated (there is no interface between the data center and the data input permitted), and transparent (relevant data is available to supervisors and peers in real time).
NYU Langone’s Chief Information Officer, Nader Mherabi, said it best when he spoke to me about his system, “We invested hundreds of millions of dollars to build a system that is integrated into one big platform. That was essential to our success in every subsequent effort.”
At NYU Langone, information technology allows real time analysis of the effectiveness and safety of every procedure. Information technology allows measurement of the fixed and variable cost of each treatment. Information technology allows measurement of patient satisfaction in real time. And information technology creates the basis for real accountability.
Information technology also serves the needs of NYU Langone patients. Prospective patients and their loved ones can search for the right doctors. Patients can compare the work of one doctor with that of another. Patients can view their own medical records at home. Information technology enables telehealth, allowing people to be cared for at home rather than in a hospital or clinic.
Information technology allows not just the measurement of healthcare in a single hospital system, like NYU Langone Health. Technology allows for the measurement of the health of a nation.
I recently traveled to Egypt to visit their 100 million healthy lives initiative which was launched under the Office of the President and the Ministry of Health. Every Egyptian over the age of eighteen and all high school students are being screened for active hepatitis C infection, diabetes, hypertension, and obesity. Free treatment for the three diseases is on offer, as is consulting for weight reduction. The data is captured electronically and tagged to individuals using official identification numbers. Compliance is assured by making proof of screening mandatory for those who want to obtain or renew a driver’s license or those who want to start or continue working for the government.
This and similar screening and treatment programs around the world are enabled by effective information technology. My organization, ACCESS Health International, has used similar programs to initiate screening and treatment of tuberculosis in the Philippines and in India. A comprehensive health information technology system is the foundation necessary to deliver high quality, person-centered care across America at a cost that individuals and our country can afford.
In upcoming articles, I plan to explore the NYU Langone Health story in more detail and will discuss the critical levers of change that transformed that medical institution and could help us transform our entire healthcare system.