It will take a Herculean effort to lift the United States out of its health-care crisis, and few groups are big enough, powerful enough and well-funded enough to lead the way.
Last March, a bill was introduced in Congress that would make over 8 million employees covered by federal health insurance the guinea pigs in a plan to make health records portable, potentially saving the government billions of dollars as a result of efficiency and automation. The initiative, if carried out, could serve as a model for change in the private sector. But funding for the project remains foggy, and the bill -- H.R. 4859, also known as the Porter-Clay bill -- remains in a congressional committee at press time.
Now several large employers are moving ahead in the same direction. In November, Wal-Mart Stores Inc., British Petroleum and Intel Corp. announced a coalition to jump-start a plan to provide digital health records for their workforce, storing them in an enormous data warehouse that links medical services providers, including hospitals, doctors and pharmacies. Other big employers are expected to contribute financially to bring the plan to fruition. Once in place, the system would allow consumers and insurers to evaluate price and performance data and thereby substantially reduce medical costs -- and benefit costs -- by eliminating duplicate tests and incorrect information.
It's an ambitious plan, and one that faces large obstacles. For example, the coalition is counting on applying market pressure and incentives to get doctors and hospitals to cooperate (employee participation would be voluntary). But "only a small proportion of doctors now have electronic record systems," says Stephen Davidson, professor of health care management at Boston University's School of Management. "My guess is that even among that number, there is wide variation in the capabilities of those systems. Some would not be much use in this initiative." New systems would be expensive, he notes, and "whatever benefit is produced will accrue to others."
Achieving the hoped for mega-savings for employers will be no slam-dunk. "First, while it is true that there is a certain amount of duplication of services in the system, it is not clear that even if patients did have control of their medical records, as intended, they could avoid that duplication," says Davidson. "Maybe; maybe not. To my knowledge, no one has ever demonstrated it. If your doctor said 'I know this test was done recently, but I think we should do it again,' are you going to tell him you don't want it because it costs your employer or your insurer more money?"
Privacy is perhaps the thorniest issue. Will digital records be misused by insurance companies to deny coverage or by employers to refuse jobs? Some protections, such as stripping a patient's identity from records, will be built into processes, but whether they will be iron-clad remains to be seen. Helping employees to understand the use of digital medical records is another obstacle to the plan, says Joe Marlowe, senior vice president in Aon Consulting's health and benefits practice in Radnor, Pa. "But avoiding duplicate testing by making test results available to emergency room physicians and other medical providers who do not maintain a medical record on the patient -- and better quality of care, resulting in fewer complications -- can lead to lower costs," he says.