Recently, I saw a special on CNN’s GPS, hosted by Fareed Zacharia, comparing healthcare systems around the world to our own in the United States.
One segment that fascinated me focused on Taiwan’s electronic healthcare information system.
Everyone in Taiwan has a personal health card, like a credit card, that stores vital information. All healthcare providers also have a card. In any clinical encounter, both the patient and the provider put their cards into the computer to document the visit. The patient's card provides information including allergies, prescriptions, etc., that helps the provider care for the patient. Almost immediately, the provider bills and gets paid for the visit electronically through the system. The health record is entirely electronic at every level of care. Information regarding the delivery of healthcare is gathered and processed immediately, providing detailed healthcare delivery data system-wide within 24 hours.
I was embarrassed to discover how long it takes us to generate the same information. Would it surprise you to learn that it is measured in years?
Part of the difference, and it is a big one, is that Taiwan has a single-payer system, not the time-consuming bureaucracies/payers and multiple delivery systems that is the U.S. “system.” Unlike here, in Taiwan it’s done in a way that serves the patient, as well as the provider. It also provides invaluable public health data, all within a time frame that makes it easy for the healthcare delivery system to respond to change and patient needs. And get this: Administrative overhead of their healthcare system is only two percent of expenditures. We have a long way to go when you consider that Medicare’s administrative overhead is 5 percent and private insurance overhead is approximately 17 percent of healthcare expenditures.
The Taiwan model offers a view of tomorrow’s health information technology today. It is one the U.S. should consider as it implements and integrates health information exchanges. In our practice, we are completely paperless, and I can access the entire patient EHR on my mobile devices — everywhere. This has dramatically improved the efficiency of our practice, from documentation to information sharing.
In my 30 years of practicing medicine, I have seen profound and complex change in the nature and structure of our healthcare system. I have been a fan of science fiction my entire adult live, and have always fantasized about the brave new world as portrayed by people like Rodenberry, Bradbury, and Heinlein. It never ceases to amaze me when reality moves beyond fiction.
One of the obvious areas in medicine that has evolved rapidly is information technology. Leaders in medicine, as well as most progressive legislators, have recognized the critical importance of information in improving and reforming the healthcare system. At least in my world, this has been a landmark year of progress in health information management.
With the Supreme Court decision, and the re-election of President Obama, it is clear that the Affordable Care Act, and nearly all of its components, is here to stay into the foreseeable future.
The reform law supports the concept of legislative and regulatory support for health information exchanges, which can now begin to truly emerge as a result of the ACA’s early support for adopting technology at the practice level through “meaningful use.” Its support in the form of dollars to assist practices and healthcare systems in upgrading their electronic health records systems didn’t hurt either.
Through the reform law, the Stage 2 measures for meaningful use will come into play in 2014, at which time measurable progress will have to be made in information sharing. Among other things, providers will have to exchange electronic clinical summaries during 10 percent of transitions of care, such as referrals and hospital discharges. Certified EHRs will have to be capable of generating those summaries and must be able to send and receive clinical messages using the direct secure messaging protocol. While 10 percent doesn’t seem like a big step, considering the many different makers of major EHRs, achieving electronic data sharing will be a huge step forward. Subsequent steps will be easier.
It has been a good year in my system as I have eliminated 99 percent of the paper records our practice team has to deal with, and we have made the transition and can see the promise of modern information technology. Let's hope that we can realize it system wide. Taiwan has apparently figured it out. Let’s hope we can as well. It is ultimately in the best interest of our patients. Ultimately, the patient benefits when we have more accurate, timely, and complete health information as we do our jobs and care for patients.
This blog was provided in partnership with the American Academy of Physician Assistants.