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Commission on Systemic Interoperability
Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Yechnology

Transcript: Commissioners Video

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What are the benefits of connecting health information?

>> The biggest benefit to connecting patients and individuals and doctors to health information will revolutionize the level of knowledge that people have about their own health and what doctors know about the people that they're treating.

>> There are probably more opportunities to describe place and times when I wanted information as a doctor, and couldn't get the record because it was tied up, locked up in somebody's office or something like that. Usually you found a way around it, but the problem, of course, is that we can't do that anymore. Medicine's becoming too complicated. Protocols for some illnesses are such that, in fact, if you don't have the information at hand when you need it, you really can have problems.

>> I think in this incredibly complex industry that we have, there is just so many opportunities for mistakes. There are so many errors that can take place just because people don't have the right information at the right time. And I think we can truly make a significant difference in the lives and health of people if we can just get our various computer systems, our various data systems to connect.

>> I think we see the benefits of having health information that's online, that's accessible, that you can take it to the doctor when you need to get there, so you're not finding yourself listing all your prescriptions and all of your surgeries over and over, not filling out numerous forms. It simplifies your life in many ways in terms of getting it around. I experience that with my own parents, who are both disabled. In trying to become the family historian and go from doctor to doctor with them, having to recount their history, having to remember all of their drugs, it really was overwhelming in many, many instances. And I look at so many of my friends and neighbors who are doing the same thing with their parents. I also think about it as a mother, because with my own son, you know, just trying to get his immunization information around--and we moved several times. And trying to get that history and keep up with it, it's very complex.

>> I think that for providers, the greatest benefit of an interoperable health system is that you have the information you need at your fingertips to do the right thing and just the right thing at the right time and in the right way. Today we do what we know to do at best about 60% of the time. And in many cases, about 40% of what we do is actually unnecessary.

>> I first became involved with computerization of healthcare back in the mid-eighties. I'm a physician and have practiced in the emergency room for almost 30 years. That's my specialty. In the early- to mid-eighties, I looked at my practice and realized that--and I think this is something you'll hear from many physicians--that my handwriting was so poor that it bordered on the illegible, and I was in the midst of a busy emergency room grabbing nurses, making sure that they understood my orders to make sure that I was not in any way injuring or hurting patients, making sure that they understood what my orders for treatment, injections, medications were. I think that this is replicated throughout healthcare, this sort of lack of communication, the fact that the information doesn't easily get from one place to another to really support patient care and optimal healthcare.

>> I think that particularly the people that I really feel the most sorry for are particularly mothers, usually mothers, parents of children with chronic illnesses or developmental problems. These poor people have to go through repeating their story over and over and over again to a whole array of people, not just doctors and nurses, but insurers and so forth. So I think they're both opportunities to avoid errors and real serious affordable injury and even, in some instances, death. But equally important, just the amount of wear and tear that we put on people to get their care is just--it's not acceptable. It's no way to run anything.

>> We all have a lot of great ideas about what the future of healthcare would look like in an interoperable system. You can imagine tricorders, and you can imagine people getting connections from one part of the globe to another. But honestly, I think a big advantage would be just to simply get your prescription transmitted easily to the drugstore across the street. I think it would--it'll make a difference just to reduce the number of forms you have to fill out in the course of a patient-care episode. And so I think the advantages and the opportunities are going be in many cases small, relatively insignificant transactions that, when you add them all up, will literally transform the industry as we know it.

How do you define interoperability?

>> Interoperability is a technical term for working together. When all participants in the healthcare system--patients, doctors, pharmacists, and payers, are working together as a team enabled through the collaborative use of healthcare information technology, the benefits will be enormous.

>> The value of interoperability, obviously for patients and consumers as well as providers, has to do with increasing communication and quality of care. I think many of us have had experiences where patients have not been able to easily communicate with their providers, and providers have not been able to communicate easily with each other. This has reduced the quality of care.

>> Interoperability basically says, how do you connect all the services that surround the use of all these great advancements in medicine to make it useful for people?

>> Personally, I think most importantly the individual patient has an opportunity to really carry information to their doctors or their nurses wherever they are so that, in fact, it's not this divided, separated boxes that we currently live and work with.

Why is connecting healthcare important?

>> This issue's important to me because I am first a provider, and so that I have taken care of patients without the information I need. I also am a patient, so I deal with both the inconvenience and the quality problems on the systems. And I know it's solvable now, so I want to see us come together to solve it.

>> The most important element of the healthcare industry to date has been our ability to remember things. And I think that the most important thing we can do is to make sure that people's lives don't rely on the individual memories of a particular patient or a particular physician or a particular technician. As I get older, I appreciate more that how fragile memories can be, and I just can't imagine having my future healthcare needs, the healthcare needs of my family, dictated on the ability of somebody to remember a particular drug that they were on or a particular procedure they had years ago. I think that's frightening to me. And I think if there's one thing we can do as a result of this commission's work, it's to make sure that the entire system doesn't depend on somebody's memory.

>> I think it's important to everybody, because every one of us--I'm actually a physician, but I think every one of us is a patient as well, at least in truth or potentially. And increasingly in the U.S., you have the situation in which adults are caring for children, but they're also caring for their parents--a so-called sandwich generation, a very common proposition. And in all of these circumstances, having an up-to-date healthcare record is a really big advantage. We also move around a lot. We move, and we have family from coast to coast. I do, in fact. So that the ability to see what's going on would just be a tremendous advantage to me personally and, I think, as I say, to just about every American.

How will interoperability transform healthcare?

>> Interoperability will help transform the healthcare system in two important ways. The first is for providers. People involved in treating patients are anxious to know as much information as possible in as timely a way as possible so that they can make the best decision in the interest of the patients. And interoperable healthcare I.T. systems will greatly facilitate that. The second will be to empower consumers. The more consumers and patients are aware of their own healthcare status, their health needs, et cetera, et cetera, that really will make for a better healthcare system for all of us, and I can assure you that people on the provider side are most interested in seeing that happen as well.

>> I see transforming the healthcare system as much as cell phones have transformed every one of our homes across America. There's no technology out there that we haven't introduced to our own lives, whether it be television or GPS systems or cell phones or e-mail that suddenly when you introduce that into your life, you're suddenly so much more empowered. And so now with interoperable healthcare where you can get it when you need it, what you need where you need it, it will just absolutely revolutionize people's homes as much as, like I said, other technologies already have.

>> It will mean that there can be seamless conversation between various health providers. So, for example, if somebody has information in one system, it can easily go to the other system. People who want their health records transmitted can have them transmitted more rapidly. One doesn't have to worry about trekking around with x-ray records, lab statements, trying to get them from previous doctors or practitioners that you've been to, because the information system will make it just almost automatically available, again, if the patient wants it.

>> Or, like, in any use of technology, it's going to increase productivity. It's going to increase capacity. We have so many people who weren't covered necessarily in the right way in our country by healthcare. This will help us reach more people in a more systemic way. I think it will eliminate errors, absolutely. It will increase, I think, the relationship and make--have a better relationship between the doctors and the patients, so that we can deliver the right healthcare to everybody at the right time.

>> Interoperability will transform the healthcare system by giving us the opportunity to build a system that isn't bound by geography. We are a mobile society living in a big country where a patient might need care on Monday in San Francisco and on Thursday in New York. Healthcare information technology will remove the barriers of geography, and give every American and their doctors the tools they need to make the best decisions whenever and wherever those decisions need to be made.

What is your hope for Ending the Document Game?

>> I hope that this report will help people focus on how to move through this journey over time. The progress toward an interoperable health system is a journey. It's not a single event. And people have been working on various pieces of what needs to be done for, you know, over 30 years. What no one's done before is to sit down and say, "what do we have to do this year and then next year and then the year after that, to each year get to a more interoperable system over time?" we've tried to lay that pattern out in this report.

>> Congress created this commission to give it advice, to give it insight. I think that at the same time, there's a realization of this impending train wreck of healthcare, and a desire to try and address that with information technology. There's a huge fear of information technology, and a huge lack of information about how this ought to be done. And the impact of the commission's report really should be to provide guidance to policymakers, to give them some concrete ideas, to give them some concepts and some timelines so that it's not an intractable problem; it's a series of steps that they can be taking.

>> I hope the report really raises the level of recognition of how important this is and that we can't just simply go along, get along. There's a need to really react and to make the changes that need to happen. Get the standards in place so that we can really move this forward quickly.

>> Whether it is hospitals and physicians, payers, government, or suppliers and vendors, I am hopeful that we will continue to bring these groups together to reach consensus on how we are going to better introduce information technology in healthcare, make better use of it to solve our problems. I think the first stage, the most important stage, is that we all agree on standards. We can't have the benefits of information technology unless we use common standards that allow us to share information and data effectively.

>> I think the impact should be to make this really, truly a national initiative. We've been working hard on this for 20-some years, a number of us, and it's really exciting to see the president behind this, electronic health records in 10 years for all Americans. The Secretary, the prior Secretary. I think people increasingly on the Hill on both sides of the aisle. I think this is clearly a bipartisan kind of activity.

>> I believe the impact of this report will really be twofold. First, I think it will build on some momentum that's already started, both in government circles, but also in the private sector to try to move forward in this direction. There are some critical public policy decisions that need to be made in the near future if we're able--if we're going to be able to move forward in a timely way. And hopefully this will provide the momentum to push those public policy decisions forward. The second is consumers. And I hope this report will help to inform consumers about the benefits of interoperable healthcare system, health I.T., and to raise their awareness and their interest in this important topic as well.

Why Now?

>> I think that the genesis of this commission was a realization in congress that there's a train wreck that's going to happen. We can't pay for all of the healthcare that we're using, all of the healthcare that's demanded, that is sought. And at the same time, we're staring at a system that is fraught with inefficiencies and problems. And there's a solution that's out there. And the solution--all of the roads of the solution lead through information technology.

>> I think there are really 3 reasons why we should focus on interoperability now. The first is that only in recent years really has the technological capability come along to be able to handle the enormous amounts of data that are involved in healthcare information. Secondly, quality is the most important thing that the American healthcare system should be providing to the people of our country. And interoperable healthcare systems will facilitate that a great deal. And then finally is cost. All of us are enormously concerned about the rising cost of healthcare. And while there are certainly many other elements that are contributing to that, interoperable healthcare systems will be an important element to help solve that issue as well.

>> Because it's possible now. The technology has reached a point that it's not a barrier to have interoperability. And the--so that's the first reason. The second reason is that we face a crisis in healthcare. The cost of our current system is too great, and the value delivered for that price is not adequate. And free movement of information is key to fixing that crisis. There's no excuse not to do it now.

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