by Christopher Cornue

As a follow-up to my previous post on the ISQua annual meeting, I wanted to share some thoughts on one keynote speech by Dr. Karen Davis of the Commonwealth Fund. She delivered an impressive and humbling assessment of healthcare in the US and internationally. There is a great deal of work ahead of us all. The premise of her discussion is that if we, as a global community, are to achieve long and healthy lives, we need to have: 1) high quality of care; 2) access & equity; 3) efficient care; and 4) system & workforce innovation and improvement.

Recent studies conducted by the Commonwealth Fund have focused on some 30+ metrics (as part of a scorecard they created) and their findings may or may not be surprising to all of us. In the Why Not the Best report (2006), the United States scored 66th out of 100 – ranking it one of the lowest in the provision of healthcare. Another report released by the Commonwealth Fund compared six top countries, based upon 69 indicators, and the United States ranked last.

With regard to information technology, these reports indicate that the United States and Canada lag other developed countries significantly in primary care physicians usage of electronic patient medical records, with compliance percentages of 28% and 23% respectively. Denmark has 98% of their records electronically based … and have implemented a fee-based structure to encourage physician compliance. Specifically, physicians are paid for communicating with their patients electronically (e.g., through email), for “phone visits,” and are not paid until all electronic health information is submitted. The Danish health system has created a central data repository for patient information, which can be accessed by patients at any time – in fact, they can track who has accessed their information, so that privacy has a “check and balance” associated with it.

Preventative information is built into this central repository (e.g., they are contacted for routine, preventative appointments, screenings, etc.) and patient satisfaction has increased to a level that is top across Europe. The Danish health system also has 24-hour physicians available for consultation if a patient needs to access medical advice or help at 2:00 in the morning, for example.

Another example cited was the Geisinger Health System in Pennsylvania, who has been an early adopter of electronic healthcare information. They’ve implemented an electronic medical record and have created a portal for patients to access the hospital’s services, their records and have developed a “virtual” closer relationship with their healthcare providers. Patients can now schedule their own appointments, which has led to reduced no-show rates and increased participation by patients. There isn’t enough space in this posting to do their work justice, but suffice to say this is an excellent example of a well coordinated, patient-focused technology that will most likely change healthcare.

In closing, Dr. Davis charged the attendees, and in fact everyone in healthcare, to work toward a series of solutions she feels will rectify our healthcare crisis. Among them are: 1) extending healthcare insurance to all; 2) coordinating care around the patient; 3) pursuing and raising the benchmark, while decreasing variability in care; and 4) ensuring the private and public sectors work in harmony. Finally, she discussed the concept of a “medical home” for everyone – where a patient can feel comfortable knowing there’s one place one can go for coordinated and good health care. Patients all want their information in one place. They also want physicians who know them and provide specific care to their needs. These are laudable concepts that I believe are becoming the foundations for our work going forward in healthcare. Thank you Dr. Davis, for your charge to, and willingness to work with, all of us in healthcare.