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Ballpoint Pen, Clipboard, Rows and Rows of Paper Files

From the March/April 2007 Issue

Those are the antique symbols of record-keeping in today’s healthcare industry, the last to resist the revolution in information technology. The backwardness is costing billions and killing thousands, writes Newt Gingrich. Now, companies like Wal-Mart and Intel aren’t waiting for the government, and things, at last, are changing.

Healthcare is the final major indus­try still clinging to the past. When was the last time you took out a pen, wrote out a check to cash, and then handed it to a bank teller? Online banking, debit cards, and a worldwide, interconnected ATM network wiped away the old paradigm. When was the last time you called every airline to check your flight options, and then had a ticket with multi­ple copies for each leg of your trip delivered to your mailbox? Expedia, Travelocity, and other websites have put consumers squarely in the driver’s seat.

Every major industry has taken advantage of the information revolution—except healthcare. It is a 1950s model of administration, epitomized by a ballpoint pen, a clipboard, and rows and rows of paper medical records. This backwardness under­mines both the quality and efficiency of care.

The Institute of Medicine has reported that preventable medical errors kill up to 98,000 Americans every year, and medication errors alone make another 1.5 million Americans sick. Since 2000, American workers have seen an 87 percent increase in premiums—a rate four times faster than the growth of wages over the same period.


As the ultimate purchasers of private healthcare, employers are struggling to finds ways to improve treatment and reduce costs. Many see health infor­mation technology as the key. Studies have estimated that a nationwide, interconnected electronic system will save upwards of $150 billion a year, or nearly 10 percent of the nation’s total health bill. From electronic prescribing to electronic health records, health information technology can transform our system so providers can safely deliver the right care at the right time to the right patient. But with fewer than one in five doctors and one in three hospitals using health IT to support patient care, we have a long way to go.

Wal-Mart, the nation’s largest employer, announced late last year that it is joining with other major busi­nesses—including Intel, British Petroleum America, Applied Materials, and Pitney Bowes—to modernize healthcare through the adop­tion of more information technology. The basic goal of their initiative, called Dossia, is to create an electronic exchange where employees of participating companies can choose to store their personal health informa­tion, enabling them and the providers they authorize to have a complete medical his­tory—from lab results and medication lists to allergies and hospitalizations.

Dossia is completely volun­tary for employees, as it should be, and participating employers will not have access to the data. Security is vital because most Americans, surveys show, are troubled by the perceived vulner­ability of personal health information. In Dossia, employees alone control access to their data.

The success of all of these efforts will depend on whether they solve real-world problems for consumers, or bring specific benefits to them. Otherwise, like every other product or service, the IT innovations will not survive in the market.

Employees who choose to use the system will undoubtedly see better health at lower costs. In the old model, physicians are often unaware of recent tests and treatments that their patients have received elsewhere. Redundant tests can cost con­sumers a hefty sum, particularly if they are using a high-deductible health plan with a Health Savings Account. Moreover, for the system as a whole, redun­dant tests cost tens of billions of dollars every year. Researchers estimate that one out of every five lab tests is unnecessary.

In the current model, life and death informa­tion can easily get lost. A physician may not know that a patient is already taking a blood-thin­ner, so he prescribes another, which may lead to a fatal stroke. Such errors happen every day, but they could be virtually eliminated if our nation’s doc­tors and other providers embraced transformational solutions, like the National ePrescribing Patient Safety Initiative. This is a coalition of technology companies, employers, and healthcare providers that will offer easy-to-use, safe, secure, and free electronic prescribing tech­nology to every physician in the country. With up-to-date information at the point of care (in a personal health record, online medication history, or an electronic health record), medical mis­takes and medication errors would be avoided, saving thousands of lives.

This kind of comprehensive medical history will be incredibly valuable not only to providers but also to consumers. Individuals can use personal health records to manage chronic con­ditions and medications, research treatment options and healthy lifestyles, track diet and exercise regi­mens, and otherwise improve their health.

Dossia is only one health IT initiative. Many health insurers are working with employers, as well as with leading IT companies like HealthTrio (based in Englewood, Colorado), to build and deploy per­sonal health records for consumers. Using claims data, these health records are often personalized with an individual’s medical history, lab tests and results, prescription drug information, and contact information for their physicians.

For example, WellPoint, a large health-benefits firm, is rolling out its 360° Health product where employees can use an online personal health record to comprehensively address preventive care, health improvement, and care coordina­tion. Employers in pilot programs saw a 2:1 return on investment for their employ­ees enrolled in the program.

Employees of companies like Wal-Mart and British Petroleum can voluntarily choose to have their personal health information stored in a common database, available to doctors and other providers.

Members of America’s Health Insurance Plans, a trade group, and the Blue Cross Blue Shield Association have come together to create a portable, con­sumer-centered personal health record that will fol­low individuals no matter who insures them. Today, as individuals move from plan to plan, or employer to employer, their information does not follow them—but it soon will.

AHIP, BCBSA, Wal-Mart, Intel, and others should be applauded for their leader­ship. It is important to note that they did not act because of a government mandate. They did not ask for a government grant. They came together as private sector leaders to move the sys­tem into the 21st century.

That is not to say that government cannot play a role. As the largest purchaser of healthcare in the nation, the federal government should be a key leader in transforming health through infor­mation technology. And there has been movement in Congress. Last year, Representative Patrick Kennedy of Rhode Island introduced H.R. 6289, the Personalized Health Information Act. This bill would create a public-private incentive fund that pays physicians to use personal health records, replace the clipboard, and communicate electroni­cally with patients.

The success of all of these efforts will depend on whether they solve real-world problems for consum­ers. Otherwise, like every other product or service, the IT innovations will not survive in the market. But if consumers embrace the new elec­tronic tools and find them valuable, through features like a comprehensive medical history, online appointment sched­uling, or email communication with their physicians, the changes will save lives and save money.

The migration to a mod­ernized, interconnected healthcare system is inev­itable. We can see doctors, hospitals, and other providers investing in new technology every day. But we must accel­erate the process. Taxpayers, employers, and their employ­ees cannot afford to carry our broken system for much longer. Too many lives are lost and too much money is wasted by tolerating an obso­lete and antiquated system. Health information technol­ogy, combined with consumer engagement, is a powerful formula that can tear down the old order and create a better health system. And to get there, we need continued bold leader­ship—from every stakeholder in healthcare.

Photoillustration by Avner Levona

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