As we approach the Second Annual Symposium on E-Healthcare Strategies for Physicians, Hospitals & Integrated Delivery Systems, our industry continues to be rocked by turbulence. For many of us, we leave a watershed year of thin margins and uncertain future prospects. For most, it has been a year of intense concentration on making the infrastructure work more efficiently and seamlessly, discarding what isnít needed and inventing new processes. But, the exciting new development has been the massive shift of American consumers and businesses onto the Internet. The promise of cyberspace has given physicians and hospitals new tools for recapturing a vision.
We had a vision in the last decade of developing coordinated, cost-effective, seamless continuums of care in our communities. Leaders in physician groups, hospital systems and health plans aggressively pursued mergers, acquisitions, joint ventures and alliances in order to assemble the components of networks. Toward the end of the decade, the focus had shifted to making these networks work more efficiently. In the last two years, the technologies have become available to make the vision of integrated healthcare achievable without heavy capital investment and unwieldy formal legal structures, and without the need to acquire and employ physicians.
The following appeared in the program description for the March 1995 Symposium on Integrated Healthcare held in Aspen, CO: "The basic vision is a solution to the cost, access and quality shortfalls of the current system. The integrated system of the future will assume responsibility for the health status of communities. When healthy individuals first enter the system, a comprehensive health status profile will be placed in the computer data base. Extensive provider networksÖwill provide easy access to care when it is needed. A new generation of information systems will monitor clinical progress and track outcomes, as the patient moves along the continuum. Whether the patient sees a primary care physician or sees a specialist, his or her electronic medical record will be accessible to all care givers. The information system will connect remote practice sites, laboratories, imaging centers, home health agencies, surgery centers, insurers, and hospitals in comprehensive community health information networks. Bureaucracies will be leveled. Costly duplicate systems, between medical groups and hospitals will be eliminated. Paper, postage and phones will give way to the electronic superhighway."
Today, even as physicians and hospitals wrestle with the economics of the Balanced Budget Act, many of us are coming closer to achieving this 1995 vision. Letís eaves drop on a scene that is happening right now in the upper Northwest.
A physician in Washington state is preparing for his next patient visit. With a click of his mouse, he calls up the patientís electronic medical record. He checks his e-mail for lab results and imaging reports. He sees that these have been received and with a click of his mouse, he sends them to the patientís electronic medical record and to the patientís personal health web site & record. He notes that there was a referral to a consultant. He checks his e-mail for the consultantís progress notes and finds them. He is now ready to see the patient. In the exam room, after hearing the patientís complaint, he pulls his palm top from his pocket and enters a few key-strokes. He calls up some specific information dealing with the patientís condition first. Then he moves to the prescription writer and checks both for potential adverse drug interactions and for formulary coverage under the patientís health plan. Then he taps in an order.
"Mrs. Jones," he says, "I just prescribed a medication that will help you. Which pharmacy is the most convenient?" He punches send and the prescription goes via the Internet to the pharmacy she names. A record of the prescription goes automatically into the patientís electronic medical record. The doctor wants the patient to see another specialist. He e-mails a referral request to a staff member, who completes and submits an online form. The managed care authorization takes 3 minutes to receive. The confirmation goes to the practice and the specialist over the Internet in a matter of seconds. In minutes, the primary care office receives its authorization number, and the consultant gets all the information needed to bill for the consult. Just before the patient leaves, the physician says, "Be sure to check my web site for more information on your treatments when you get home. Also, you can view the potential side effects of the drugs you will be taking and the results of your recent lab tests on your personal web site."
After the patient leaves, the physician dictates a note that is entered by voice recognition software directly into the electronic chart. He then logs onto the hospitalís Intranet to check his patients. For one patient in intensive care, he calls up the direct feed from the bedside monitors. He adjusts the medication for the patient, sending an order to the nurse. Even as the physician is tending to his business online, his back-office staff are ordering supplies, submitting claims, checking eligibility and performing other tasks all in a paperless environment.
This is how medicine will be practiced in the 21st century. And this is what this conference is all about. The goal of this symposium is to make the connection between strategy and technology in achieving a vision that continues in full force in many of the nations leading healthcare systems.
To provide physician and health system leaders with a better understanding of what is achievable through technology in developing Internet-enabled healthcare networks.
To examine the progress of health systems, as they implement the new connectivity solutions, along with the operational implications.
To address the issues of privacy, security, confidentiality, and patient-physician connectivity.
To explore the current state of the art and market trends in "wiring" physicians for the Internet era.
To present the physician userís perspective on e-applications at the point of care.
To provide an outstanding networking opportunity.