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THE IMPACT OF INFORMATION TECHNOLOGY AND THE INTERNET
ON HEALTHCARE COST, QUALITY, AND ACCESS

Enhancing access and affordability of quality healthcare in America, while promoting more consumer control, will require that we effectively address serious infrastructure weaknesses in the current system.

The Internet and Internet-based information technology tools hold the promise of enabling the creation of the necessary infrastructure to reduce administrative complexity and waste; limit medical errors; provide continuity of care; develop and disseminate valid quality information; and improve health outcomes.

The information age is coming to healthcare, and it will create greater productivity and efficiency, just as it has done for other business sectors across the globe--if we do not get in the way! Until very recently, however, the investment in information technology and connectivity in healthcare has been miniscule--an estimated 2.5% of revenues, (less than the trucking industry!) -compared with 10-12% in other service industries. This is changing, but it will take time to catch up.

The paternalistic era of medicine is over. Information technology will make new models possible. Americans were in love with the healthcare system when it was a cottage industry, and revolted against the mass production brought about by managed care. The Internet has the capacity to personalize and customize healthcare and put trust back into the healthcare relationship--if managed carefully.

Cost

Lets look at the impact of Information technology on healthcare costs. It is estimated that 30% of the 1.2 trillion spent on healthcare is duplicative G&A costs and clinical inefficiency. The Internet can decrease costs substantially by streamlining and merging back office administrative processes of plans and providers.

In the future it is likely that we will go to the doctor less often but we will send data more frequently. Point of care testing, such as hand held blood and saliva analyzers will soon be available at home and in our communities. If patients could communicate with physicians or be monitored through the internet, more than 20% of in-office visits could be eliminated.

Equally important is the tremendous savings that can be generated by more efficient identification and channeling of resources to high risk patients, care delivery in lower cost settings, and elimination of the waste associated with medical errors--all possible if we effectively exploit information technology!

Quality

The Web can also impact quality in a major way, through electronic trails that measure, dissect, and ascribe accountability all along the way. IT will enable new payment schemes structured to reward physician performance and create financial incentives for improving the quality of care for patients with chronic disease--the 20% of the population that consumes 80% of healthcare resources. And new care management tools will be more effective and less obtrusive than a physician gatekeeper.

We will move away from consensus of experts and literature review toward Internet-based decision support systems at the point of care that organize and analyze clinical data and provide instant feedback. Individual practitioners and entire organizations will know how their care stacks up and will be able to learn from others in real time. Sophisticated disease management tools will provide the means to improve quality of life while reducing or eliminating future costs.

When widely available and adopted, informatics and artificial intelligence will dramatically decrease the cost of medical errors and improve patient safety. For example, bedside terminals to collect patient information can reduce medication errors by up to 80%. Hand-held electronic prescription pads for doctors can check a patients record for allergies or adverse drug interactions, indicate if the drug is covered by insurance, and e-mail the prescription to the pharmacy.

Access

The marriage of medical technology, like telemedicine, and the Internet can also have a very positive impact on access. Electronic delivery of health information and services is especially significant for rural hospitals that use it to receive consulting services from large teaching hospitals or to monitor patients in homes. The Internet will bring the capacity for care directly into homes, workplaces, schools and other locations throughout a community. New medical devices will integrate with the computer and be web-enabled. Many will become so inexpensive that providers and vendors will give the technology away to sell the services, much like what happened with cell phones and ISP services.

And finally, we may be able to address concerns about privacy as well as access to health information for those with a need to know through encrypted wallet cards with our total medical history, accessible only with unique passcodes.

By dramatically enhancing efficiency and reducing errors, information technology and automation can help offset cost inflation driven by aging, consumerism, biotechnology and medical breakthroughs. Most importantly, information technology will enhance healthcare value by allowing providers to deliver better care and improve outcomes at both the individual and societal level.

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