The Sickness Industry

This month's Technology Review has a nice piece ("A Pound of Cure") on the importance of electronic medical records (EMRs) to the future of health care. The article takes the issue beyond the mundane cost/convenience arguments for EMRs, and puts it in the proper context of a future health care system that is preventive, predictive, and, more personalized. Of course, EMR implementation is only a first step toward this end, but the author reminds his readers that this step is yet to be embraced by a trillion dollar 'health' industry that ultimately survives by selling things to sick people, rather than by keeping people healthy.

Today, thirty-five years after Wall Street began phasing out physical stock certificates, when virtually every industry from airlines to zoos employs integrated electronic record-keeping and tracking, the U.S. health care system still stubbornly refuses to adopt technology that could save doctors' offices and hospitals hundreds of billions of dollars (according to Richard Hillestad of the Rand Corporation, Health Affairs (2005)), and facilitate further cost- and life-saving measures by allowing comprehensive data collection and comparative safety/efficacy analysis of existing therapies. Such data, not accessible via our modern dinosaur system, are usually invoked for their policy (e.g., regulatory and reimbursement) implications, but they are less often appreciated for their importance to technology development (see my original post on the role of innovative medical technology, and why it is a powerful tool for the cost-reduction campaign). Simply, when scientists and engineers have more data and a clearer picture of relative effectiveness, they tend to ask better questions to direct better research.

I acknowledge that early detection and prevention are ambitious, complex undertakings, years in the future, and far from automatic once EMRs are in place. But it is difficult to imagine how any such advances can occur without the fundamental first step of radically improving our systematic approach to data collection and management. Perhaps this reality is what will ultimately drive EMR adoption among the nation's leading hospitals and clinics; those institutions that rise to the technical and operational challenges and invest in improved health IT will be rewarded by an elevated status and increased popularity that are likely to follow the federal money and national media spotlight.