Editorial
OPINION: Revolution right in your doctor's hand
Michael J. Dowling is the president and CEO of North Shore-LIJ Health System.
During his presidential run in 1968, the late Sen. Robert Kennedy invoked the words of George Bernard Shaw: "There are those who look at things the way they are and ask why. . . . I dream of things that never were and ask why not?"
Words like these are the maxim of innovators and change agents the world over. They represent a sensibility that has given us amazing inventions - iPods, BlackBerrys, laptop computers - and the ability to search for information in an instant and to communicate that information just as quickly.
These innovations, some of which were mere fantasy over a decade ago, are now so commonplace that they have forever revolutionized the way the world communicates and receives information.
Now, too, health care has joined the electronic revolution in a way that promises to forever change the practice of medicine.
For doctors and their patients (in other words, all of us), the electronic health record is a far more revolutionary idea than those that brought us the ability to download a song, post a video online or read and send e-mails when you're on a camping trip. While those other innovations indirectly enhance the quality of life, they are designed for entertainment or business purposes. The EHR directly improves quality of life because the end result of its design is better health.
Similar to an iPod or BlackBerry, the electronic health record resides in a device that fits in the palm of a physician's hand. It automates inpatient and outpatient medical records in physician's offices and hospitals - giving the clinician instant access to these records.
Doctors can retrieve patient data and scheduling information in real time from hospitals, outpatient facilities, laboratories, pharmacies and other physicians.
Embedded within the device are automated guides that improve clinical care, prevent illness and avoid medical drug errors. When the physician enters a patient's problem or symptoms, a list of diagnostic tests and therapeutic interventions that are considered best practices appear on screen, as an aid in the decision-making process.
Once the elements of a care guide are selected, a long-term plan for patient monitoring and preventive measures is recommended. In this way, and by connecting providers to each other with the latest information available, the EHR improves the management of chronic diseases, sets a course for preventive care and increases quality outcomes as a result.
Sounds like a good plan. But as you might expect, starting a revolution isn't cheap (but then again, neither were the first PCs or iPods). The full cost to implement an electronic health record system for an individual physician is $44,000, plus monthly operating expenses. To implement and operate a system that will connect up to 7,000 physicians and 13 hospitals in our area, North Shore-LIJ is investing $400 million - about half of which will be used to subsidize up to 85 percent of physicians' costs and monthly operational fees, provided they agree to use the device to report and share performance data.
The potential return on such an investment? It's bigger than we can even imagine. To start, we anticipate better health outcomes for patients and a movement toward a pay-for-performance model for physicians and hospitals that will tie reimbursement to the adherence of best practices across the region and, eventually, the nation. Those two factors alone will transform the entire face of health care.
In the middle of a seemingly never-ending national debate on health care reform, this technology enables us to make a major and unprecedented stride toward improving care locally, even while we are dreaming of the things that never were on a more global scale.
It's reason for great optimism, and enables us to believe in the words of Tennyson that Sen. Bobby Kennedy was so fond of quoting: "It is not too late to seek a better world."
