Access Points

May 07, 2009

Companies and organizations are working at ways to speed the flow and increase access to health care information.

To the average person, a walk through a hospital intensive care unit, with its staff huddled around banks of computers, breathing machines, heart monitors and other gleaming and blinking life-saving devices, is impressive.

But lay that picture against this fact: Health care is second only to mining in the inefficient use of technology.

Nowhere is this more apparent than in health care records, many of which remain on paper, in manila folders, in a metal file cabinet, in a primary doctor’s office. Locked away.

The doctor comes to see the patient with clipboard and paper file in hand. The patient holds no file.

“The most pervasive tool used in medicine today is the pen,” says Laura Kolkman, founder and president of Mosaica Partners, a St. Petersburg company that helps states, regions and private companies adopt electronic health care information systems.

“It is 20 years behind other industries.”

Currently in the United States, about 15% to 20% of doctors are using electronic medical records and about 40% to 50% of hospitals are using those technology tools.

“We basically have a memory-based industry, only as good as the memory of the patient and what the doctor remembers from medical school,” Kolkman says. “We need to move to information-driven care.”

Kolkman and other businesses are gently trying to change this situation by working with government, organizations and industry.

Electronic health care records are significant to the Gulf Coast for several of reasons, including the number of seasonal residents and visitors, with doctors in other locations, and the area’s large elderly population, which goes to doctors more often and needs more access to their records.

After Hurricane Katrina, many customers of UnitedHealthcare lost all of their health care records. But an electronic file of claims that United kept was able to recover a lot of that information.

United has since improved that electronic record for its customers and is watching a current move by the federal government to mandate some kind of electronic health care information system.

But this move by the government is all voluntary, says T. David Lewis, chief executive officer for UnitedHealthcare in Tampa.

“I can’t speak for competitors, but our system has been out there for years,” Lewis says. “When it comes to innovation on the clinical side, we’re far…ahead of other companies.”

Kolkman called United’s electronic system, “A start.”

What Kolkman and Lewis find is that even though some electronic records are out there, not every doctor or provider uses them.

Electronic health care records help doctors and other providers avoid errors and better serve patients, Lewis says.

“A lot of them unfortunately are still stuck on paper,” he says. “Unfortunately, its pure choice.”

In the trenches
Before becoming an entrepreneur on the Gulf Coast, Kolkman worked as a registered nurse for 10 years in Minnesota. She remembers pulling a print-out off of an EKG machine, wondering if all of the information nurses gathered every day on a patient could be kept electronically, in the same place.

She approached the hospital about it. The hospital said that could only be done for the business office at the hospital.

So Kolkman moved back to Michigan to get another degree — in computer science. She approached a second hospital with her idea and was rejected again, but took a job with pharmaceutical company Upjohn,  eventually becoming Upjohn’s head of information technology for global research and development.

After working in England, Kolkman came to Tampa to work as chief information officer for Pharmerica, which exposed her more to the use of technology in health care.

In 2005 she formed Mosaica, which is Italian for mosaic. Like a mosaic, Kolkman and her staff assemble parts of state and regional organizations to make health care information more centralized and accessible.

Mosaica helps its clients by talking to hospitals to share information, building support in the community and forming business plans.

“People will change their behavior for something they value,” Kolkman says.

Changing economics
Why has the health care community been slow to adopt electronic records and new recording keeping systems?

Because the system and its financial incentives are designed under an old paradigm: To treat the sick, not prevent sickness. The business plan for hospitals is still measured by episodes of care, such as the number of surgeries.

The financial incentives in the industry are aligned to sick care, not health care. Doctors are paid by the number of patient encounters. They are running a business as well as a practice. Add to this the cost of technology and training the staff on it.

“There’s very little incentive to adopt technology,” Kolkman says. “If you eliminate redundant lab tests, you’re taking money out of the pockets of the lab.”

But people like Kolkman and Lewis are hopeful that companies will recognize the value of sharing health care information, making it accessible and using technology to save costs and boost profit and efficiency, at the same time, promoting preventative health.

In some markets, doctors are reimbursed for answering patients’ email, as well as seeing them in person.

There is $17 billion available from the federal government for implementing electronic health care records, although not everyone can access it. There are concerns about competition among the states for these dollars as well as unfair and over-aggressive practices by vendors who want government contracts and are pushing states to sign up with them now.

But the overall push for health information reform should be a good thing for the health care industry because doctors and patients will have the latest and fullest information, Kolkman says.

“I am absolutely optimistic,” she says. “This is a once-in-a-generation opportunity.”

But Kolkman admits it won’t be easy. There are many players in the health care industry and changing the financial incentives and keeping everyone happy will be complex.

Lewis is proud of United’s electronic records, but it operates in a health care system he calls, “so fragmented.”

“I don’t know how many providers are accessing the records, but it’s there, accessible and available,” Lewis says. “Other than printing off a copy, I’ve got to speculate there’s very little provider utility. These guys are running from room to room.”

Kolkman believes health care record reform is moving, but it will take time.

“We call it a health care series of events, not a system, because a system has some kind of coordination and order,” she says.