I am reading this book by a Harvard Professor and have decided that it would interesting to blog on her book as I come to points of discussion. The first thing I noticed about her book is the cover page, which sites Bill George, a Harvard business school professor and former CEO of Medtronics stating that this is a "brilliant analysis....a must read." Wow: really. One of the concerns we should all have is that all the so called experts on health care seem to be have all the credentials except one, a medical license. All of the theories, books and congressional discussions on how to transform health care come from these outside experts. That is a real problem. I absolutely believe in the principle that you cannot be an expert at anything until you have been in the trenches and know what the system is really like from the ground up. This is true of all things but especially in business. I suggest all interested parties read this book so that we can discuss the half hearted attempt that Mrs Herzlinger has made at fixing our health care system. She has written this book with fractionated explanations. Therefore, I am not sure if she really understands what she is saying or if found enough information to twist the content into making it fit into her arguments. Non-the-less, I am insulted by her book. Get me a publicist and I will write a book about who really killed health care. (I do not know Mrs Herzlinger and I do not want to reprent in any way that she does not know her materail or trade or that she a character issue. I am merely reading her book and arguing points of concern as a Physician.)
EMR (electronic medical records) why this is such a problem to implement.
On page 179 she discusses the EMR. EMR is in fact the way of the future and it will have qualities of efficiency, fluency and medical error safety. The problem is that one person/entity would have to be responsible for the control and accuracy of the information. It is not feasible to house a server that all doctors and hospitals can log into and add information. Why? because they all have enough to do as it is that there is no time for more redundant work. This principle is true only due to the fact that doctors are not reimbursed fairly for the cost of running an office in an efficient manner. If reimbursement were not an issue, then EMR's would and could work if the Family Physician became more of a figure head/gate-keeper/administrator of health care. If one person or practice's sole responsibility was to truly provide health care and administrative duties then this EMR could work (the key point here is that they would need to get reimbursed for doing these things). I can't tell you how frustrating it is to have been working with a patient on their diabetes for years and come to find out that on their last visit to their Cardiologist, the PA (physicians assistant) changed a medication. Arrrrrrrrrrrrh.. This makes me so mad because it is a great example of how the system breaks down. A P.A., come on America. You go to the Cardiolgoist and the P.A or Nurse Practitioner is changing your medications. Maybe in an urgent care or your primary doctors office, but the Cardiologist office. I could given a detailed discussion here of how technology, one main medical server for a region, email or instant messaging and an improved role of the family doctor (one with more time alloted to managing a persons health rather than running in circles to make a dollar and not remembering what you just wrote a prescription for five minutes ago) could improve health care in so many ways.
Getting back to EMR. It has to come of age and the main reason that we cannot implement this is due to the "free market design" which this book so adamantly is a proponent of. More on how free market health care has ruined my profession.