Can Broadband Really Save Healthcare?
The government is super stoked about the potential of greater broadband access to improve the U.S. healthcare system. Part of the 376-page National Broadband Plan report released by the Federal Communications Commission (FCC) last week gushes about health IT, e-health, m-health, telehealth, and electronic medical records (EMRs).
Can broadband really save healthcare? Well, technology is part of the solution for some of the industry's problems, such as physician and specialist shortages and disparities in access to care. But it's only part of the solution. And it comes with problems of its own. (Read more about wireless health, telehealth, and more in the March HealthLeaders magazine cover story, Medical Breakthroughs That Will Change Healthcare.)
Here's just one example of how technology solves problems, raises new issues, and leaves still others unresolved. One exclamation point-filled sidebar in the report is titled "Stroke Victim Makes Full Recovery—Thanks to e-Care" and it tells the story of a 49-year-old woman who was connected by video to a specialist at a Boston hospital. The specialist made the right diagnosis, which allowed him to choose the right course of treatment—and the result was a good outcome.
What's wrong with that picture is everything you don't see: How or whether the specialist was compensated for his time, the time and money it took to create video- and data-sharing capabilities between the two hospitals, the fact that hospitals that share data in this manner have to agree upon a compatible platform, and the number of hospitals that aren't spending the time and money on this type of program, just for starters.
The bigger underlying problem is that while telehealth helps alleviate physician shortages, it doesn't solve that problem by a long shot. Telehealth is an excellent tool. But despite what the headline of that sidebar would have you believe, without the caregivers on both sides of the camera, it's worthless.
In the report, the FCC makes several recommendations to start to address some of the barriers to implementing broadband enabled healthcare technology.
Physicians and hospitals shoulder most of the cost of e-health technologies while payers and patients benefit. But if the Centers for Medicare & Medicaid Services (CMS) paid providers for using effective health IT solutions, everyone would be happy.
Unfortunately, fee-for-service reimbursement doesn't necessarily work when it comes to health IT—and payment reform is years away. One solution the FCC offers is for Health and Human Services (HHS) to include e-health technologies in future iterations of its meaningful use program, using the same rigor it does to measure meaningful use of EMRs.
The FCC's recommendation: Congress and HHS should develop a strategy that documents the proven value of e-health technologies through pilots and demonstration projects, proposes reimbursement reforms that incent their meaningful use, and charts a path for their widespread adoption.
The report notes that it's hard to collect and aggregate digital health data—an understatement if ever there was one.
Meaningful use incentives will help, pushing providers and vendors toward interoperable solutions. But clinical research will continue to suffer without uniform standards, according to the report. Coordinated standards and protocols will likely increase innovation and discovery within basic science, clinical, and public health research, "helping alleviate many failings of the healthcare system." (I told you they were rosy on the whole technology-will-save-healthcare thing.)
The FCC's recommendation: The Office of the National Coordinator for Health Information Technology (ONC) should establish common standards and protocols for sharing administrative, research and clinical data, and provide incentives for their use.
The U.S. is not taking full advantage of health IT opportunities—out of 11 countries, we rank in the bottom half of every adoption metric, according to the report. Despite government incentives, we're at the bottom of the list when it comes to EMRs, electronic prescribing, and electronic clinical note entry—ranking 10th in all three categories. E-health adoption is also low—less than 1% of provider locations use e-health technology.