Monday, May 17, 2010

Redesigning Medicine

Through provoking piece in the Washington Post today - Health Reform's Next Test by Jim Yong Kim and James N Weinstein at Dartmouth Hitchkcock. As they state
It is well known that U.S. health-care costs, as a share of our economy, are the highest in the world but that compared to other industrialized countries, our results are the worst. The Dartmouth Atlas has documented the enormous waste in our system and shown that spending more money and performing more medical procedures do not equal better outcomes for patients.
So true and so troubling as health reform marches forward under the new law. We do deserve good care and the blame storming that continues to affect all the efforts is counter productive and as they point out
We cannot blame government or insurers or physicians for the complex and multilayered problem. No single group or entity created the puzzle that is our health-care system; it is not reasonable to expect one group to solve it
Their use case shines a spot light on the challenges we face
Consider the moving pieces of a patient-health system encounter. A patient comes into the emergency room. Immediately, judgments are made about how sick she is and what treatments she needs. There is no universal medical record for that patient, so the provider has no idea about her medical history, medication use or preexisting conditions. Incomplete information is relayed through layers of nurses, physicians, specialists and the shifts of personnel who replace them. In the absence of real-time information, tests are ordered and treatment decisions made. Perhaps after an overnight stay, barring complications from drug interactions or perhaps an unrecognized underlying condition, she is discharged, with no further transfer of information to a provider and, more important, no follow-up to see whether the treatment was effective
But it is this summary point that amplifies the point:
The symptoms were treated; the patient was not.
This is exactly the point and their attempt to set up the "Center for Health Care Delivery Science" is one step int he process of many that needs to start with a realistic look at the challenges we face and the need for everyone to be part of the solution and not part of the problem.