A Question about Healthcare

Posted by: Michael Mandel on May 27

Sorry I’ve been delinquent here…I’ve been focused on a big story, and I don’t seem to have enough bandwidth to do a good job blogging at the same time.

But until I’m out from under, here’s a healthcare question for you to chew on. If you had a choice, which would you rather have?

1) Fully electronic health records, at a cost of $100 billion over the next ten years, or;

2) A full cure for Alzheimer’s, same cost and timeframe.

Please pick either #1 or #2. Feel free to substitute in any other medical advance, if you’d like.


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Reader Comments

CompEng

May 27, 2009 01:27 PM


#1 is a necessary but not sufficient component of a proper triaging and diagnostic process (I submit the current one is largely ad-hoc). In my experience, if you have a non-trivial non-acute health problem, it's currently incumbent on the patient to do all the legwork and much of the required research to figure out what's going on. This can involve bouncing from doctor to doctor several times, getting 15 minutes of a doctor's time and as much history as you can concisely state and the doctor read (if you're lucky and the doctor can actually take in the problem properly in the midst of the level of context switching he/she has to do).

Whenever I think about the current diagnostic process, it reminds me of bad tech support, except the people are much better trained and the process significantly more dysfunctional.

#1 has the potential to be far more valuable, but I can so easily see us implementing electronic health care records in the current broken process and get nothing out of them.

Brandon W

May 27, 2009 02:21 PM

#1. Hands down. As CompEng suggests, this may not be the answer to the problem; but even if it is not, we'll never arrive at the answer without electronic records as part of the solution.

dave

May 27, 2009 03:25 PM

If you have ever tried to get improper data out of your credit file; an electronic data base for health records will make you think twice. I have has several inaccurate or mixed up medical tests. As for the choice for this problematic data base vs Alzheimers cure...stupid question. Both quests will make big bucks for the business success of either so we will probably get both.

Mike Mandel

May 27, 2009 06:12 PM

No fair changing the question!

Let's assume that you can get the cure through research to understand the biological processes involved, combined with controlled clinical studies.

LAO

May 27, 2009 06:58 PM

Is this a trick question? Realistically, I would take #1, because there is just no way that anyone can promise an Alzheimer's cure within time and cost constraints, and there could be very little to be recouped from the investment if it fails.

Electronic health records have the potential to accomplish something -- with caveats as above. They even have the potential to point to a cause or key precursor of Alzheimer's and many other maladies, if researchers can only be allowed to plow through tons of standardized data without violating privacy.

Kartik

May 28, 2009 04:43 AM

I say #2.

A cure for Alzheimer's would pay for itself in increased productivity of elderly people, and longer careers.

Plus, Alzheimer's is the only leading cause of death that is still rising per capita. Heart disease, stroke, and cancer are all falling in terms of death rates.

Sure, #1 will accelerate other advances as a byproduct, but that is far from guaranteed. HMOs like Kaiser already have electronic health records to some degree.

Catherine Arnst

May 28, 2009 06:47 AM

Cathy Arnst here, medical writer at BusinessWeek. As much as I'd love to see a cure for Alzherimer's, I would have to choose electronic medical records (EMRs), because they would do the greater good for the greater number of people. Alzheimer's is a horrible disease, and Kartik is right that the numbers are rising as our odds improve of surviving heart disease and cancer (thus enabling us to live long enough to develop dementia). But most victims develop the disease in the last year or two of ther lives--Alzheimer's is most common in people over 80, half of all people in that age group develop the disease---so their suffering is relatively limited. Electronic medical records hold the promise of cutting huge amounts of overtreatment and errors out of our system, now responsible for one-third of U.S. medical spending, thus allowing us to devote those now-wasted recources to provide better care to the whole population. EMRs would also give researchers the data to figure out the best treament for a wide range of diseases. As Lao says, they would yield the epidemilogical data that could help pinpoint a cure for Alzheimer's, or better yet, effective preventive measures. Electronic medical records are the building blocks of a modern medical system.

Mike

May 28, 2009 09:13 AM

Depends on the funding process... Assuming that it would be government funding for either choice I would have to go with making the medical records electronic.

Reasoning: Since I have experience with programming and have seen government procurement, I believe the probability of a successful project would be more for the medical database.

Also, a free market will search for a cure on its own to make a profit. The medical database would get competition and there fore drag out the process over a longer period.

Also, Dave you bank account, stock portfolio, this website and Google are all nothing but a database. Do you still think it is not viable to have a "functional" and "simplified" system? The report you see is a print out, I can assure you that is not what is seen inside the credit reporting agencies. They have no reason to make it easy for you, but they do have a reason to make it easy for internal purposes.

Ajay

May 28, 2009 01:18 PM

Neither, I'd spend it on software like this: http://www.ebusinessforum.com/index.asp?layout=rich_story&doc_id=7896&categoryid=&channelid=&search=starters

That 2005 article is about decision-support software but the truth is that software can completely replace most doctors. That is how we will see big savings in the coming years. Also, as someone who has been through the medical system, I will attest that CompEng is dead-on in his description above.

G22kKahnua

May 28, 2009 02:16 PM

Mike,

jokes aside, are you a moron?

Kartik

May 28, 2009 03:01 PM

Electronic Health Records :

1) Do other developed countries (Western Europe, Japan) have them? If so, what benefits have been yielded?

2) What has prevented Western European countries and Japan from adopting Electronic Health Records?

CompEng

May 28, 2009 04:44 PM

Ajay,

Excellent link. I don't think software can fully replace doctors even at the lowest level, but could certainly do the lion's share of decision support and be critical in the support of triaging. That's the project we should be embarking on. Still, I can't believe that computerized records wouldn't be an important point in that process.

Brian Cordell

May 29, 2009 09:49 AM

#2. #1 can only deliver value with a complete reengineering of medical processes. There is no chance the medical society will put up with that.

c

May 29, 2009 12:28 PM

#1

EMR User

May 29, 2009 01:34 PM

I choose #2. As a daily user of EMR, I have seen it develope into a creature that exists to feed itself more information, more tech support, and more promises unfufilled. When our organization started EMR, it was exellent. We had just what we needed to take care of pt's in a better, more organized manor. Now, the emphisis has morphed into keeping track of information for information's sake, at no added value to paitent care. Also, if we are lucky enough to survive and benefit from all the medical technology, we are all going to get #2.

Lord

May 29, 2009 01:56 PM

#1 probably has a 50% chance, #2 a 1% chance, so I would go with #1 as well.

Alarmed at Cost

May 29, 2009 05:20 PM

What $100 billion for a simple ERP system? Are you guys nuts...It should not cost that much money...Is this the case of buying a hammer and charging $1000 and a toilet for $20000. Modern ERP systems can build this using off the shelf modular software components...Every doctors office has a computer and access to the internet...Making it secure using secure token and encryption technology is not rocket science....What world are you guys living in 1980 mainframe...pascal world? Get out of the time warp...its 2009!

Sean

May 29, 2009 06:46 PM

Imagine if 100 years ago someone asked whether we would rather our pharmacies had fax machines or penicillin. Technology is great, its convenient, it even saves a few lives. But let's cut to the chase. Medicine is about treating sick people and the best way to do that is to find treatments and administer them.

Mac

May 29, 2009 07:04 PM

Mike,

There are problems with your reasoning (i.e., let the government fund #1 since private sources will fund #2). This is the same logic being applied across the board to justify subsidies for every alternative energy scheme, mortage-backed security, and other crazy malinvestment that can't find buyers in the private sector. These government subsidies leads to higher taxes on private investment in addition to "crowding out" private investment. So even if #1 is funded by government, it will absorb resources that could have gone to private investment elsewhere. You don't get a free lunch just by funding one option through government.

A better argument (though I don't think it's the case here) would be to say that because of positive externalities of EMR that aren't reflected in return on investment, resources are being misallocated by the private sector.

Heartdoc22

May 30, 2009 07:43 AM

This Thursday, I began my first week using an EMR in our 22 person cardiology group. Aside from the obvious benefits we all know, my first reaction is that the EMR will create major problems that are not mentioned. The EMR slows down the process of care to what seems like a crawl. None of the doctors in our group can see the same number of patients as before the EMR. In addition, the actual process of using the EMR during the visit helps to destroy the physician patient interaction and is very distracting. If the new health insurance sends a sudden surge of new patients to us, watch and see how long it will take to get an appointment. And oh what happens when the electricity goes out?

CompEng

May 30, 2009 10:49 AM

HeartDoc22,

I'm assuming it's the data entry part of a doctor-patient visit that's being slowed. Would you think dictation software would much mitigate the slowdown? I would think you'd want a paradigm where the doctor basically used a personal recorder during doctor-patient visits and a clerk spent much of the time cleaning up the patient records afterward.

I think in this age of ever-increasing specialization, we have far too many expensive and highly-trained professionals doing their own computer secretarial work. I suspect the problems you're encountering are a symptom of that and not a fundamental issue with EMR. But truly, we're very bad at optimizing processes involving both people and technology for greater efficiency.

Mike Mandel

May 31, 2009 06:56 AM

>#1 probably has a 50% chance, #2 a 1% chance, so I would go with #1 as well

I intentionally left off any probabilities. Why would you think that #2 has only a 1% chance?

Nick S.

June 1, 2009 03:17 AM

"Productivity of elderly people"?????

They might continue to consume goods and services, but most surely don't work past retirement age! (Walmart employees are an exception).

This is a bogus question with no right or wrong answer. Naturally, society(health care companies) will spend more of THEIR money on whichever option has the highest expected return.

Squeezebox

June 1, 2009 11:34 AM

Nick S is wrong about the elderly not being productive. My grandfather lived to be 100 years old and he ran two mail-order garden supply businesses (Gardening Without Cultivation and Doyle's Thornless Blackberries) from his home until he was about 95 or so. His eighty year old second wife took over for another five years. His Seventy year old son runs the businesses today. Tell me the elderly aren't productive!

LAO

June 1, 2009 02:29 PM

If we are to believe reports of the direct and indirect costs of Alzheimer's (with increasing prevalence as the population ages) and if the $100 billion cure could be guaranteed, then of course, #2 would be the wiser choice, because it would pay for itself in just one year, and we would be freed of the fear of this financially and emotionally devastating threat. I think that the refusal of many of us to be tempted by that bet reflects the deep cynicism that our health care system has taught us. Though doctors still try to "do no harm", the system itself has no such conscience -- it appears to associate long-term disease with the opportunity for long-term cash flow, it ejects the costly insured on technicalities while keeping a lifetime of premium payments, it lures employees with retiree insurance that is canceled at employers' convenience, it pushes us around, it kills self-employment dreams and pretends that small business is a grave risk, .... Need I go on? To me, just the hint of a chance to wrest some measure of control from the hands of this abusive system, and the hope of some ammunition in the battle to get fair value from the high price is worth trying. The possibility that electronic medical records will not help is very real, but we have to start somewhere. Certainly if any business was in such a horrid condition as our health care system, productivity improvements through information technology would be a high priority.

Kartik

June 1, 2009 03:38 PM

Nick S wrote :

"They might continue to consume goods and services, but most surely don't work past retirement age! (Walmart employees are an exception)."

Who says? 40% of the Senators in the US Senate are over age 65. About 20% are over 75. They do work as long as they are able.

You must be one of those people who looks at the clock every 5 minutes to see if it is time to go home.

Brian

June 1, 2009 07:55 PM

Given the choices stated in the original question i'd go with:

#2 - I'm definitely more worried about the potential of my parents or myself developing alzheimer's than of keeping all our medical records neat and tidy.

or, if we're going to continue considering mythical fairytale scenarios lets go with option #3: A magic pill to make everyone 6 ft tall, have 5% body fat, cure all illnesses, have a 150 IQ, and live to be 300, be able to fly, and become invisible when desired.

Joe Cushing

June 1, 2009 10:42 PM

Is this a government mandated or created electronic records system? Are these tax dollars? In that case I'll take the cure for Alzheimer’s. There is bound to be a private solution to electronic medical records in the near future. I'd rather the government stayed out of it.

Joe Cushing

June 1, 2009 10:53 PM

When you talk about probabilities, do you mean--if we spend the money that is the probability we get the results? That totally changes the answer. My choice would be neither. Let the government do nothing. That's the best choice of all. Do nothing.

Sean

June 1, 2009 11:58 PM

No one has mentioned that the lost productivity of the Alzheimer's patient is a very small component of the cost of the disease. Consider the time and resources expended by family members, caregivers, communities, landlords, etc. as a result of this dreaded disease. Not to mention, most of us would put Alzheimer's just about last on our list of ways we would choose to go out.

CompEng

June 2, 2009 12:12 AM

Joe,

Interesting perspective since I'd give the market a much better chance at getting Alzheimer's right than portable electronic data records.
There's no transparency at all in the current health and regulation system, and until that changes, competitive forces will work really slow at solving problems where the incremental perceived benefit is small. EMR would have decent benefits only if other things also line up which require entrenched interests to adopt change (and current regulation are part of the resistance). This is one of the few areas where government really has an obvious way to help that smaller actors would have more difficulty with.

lwild

June 2, 2009 06:59 PM

EMRs. And an EMR system that talks to a PHR program like MS HealthVault so that patients could build a personal health record (it would be nearly impossible to do that through doctor's records right now) and share it as they like with their caregivers. And I don't think it would cost what you are projecting. An improved and streamlined healthcare process will enable more funds to naturally flow to research and better care solutions for conditions such as Alzheimers.

Charles

June 2, 2009 10:44 PM

I believe the evidence is clear that Single Payer Health Insurance should be #1 on every American's list.

What good are either #1 or #2 if the first medical crisis that either my wife or I have is going to put us into bankruptcy because the American health insurance industry, an absolutely useless economic parasite. is in total control of Congress and the executive to the point that even a national debate on the subject has been censured out of existence.

Charles

June 2, 2009 10:44 PM

I believe the evidence is clear that Single Payer Health Insurance should be #1 on every American's list.

What good are either #1 or #2 if the first medical crisis that either my wife or I have is going to put us into bankruptcy because the American health insurance industry, an absolutely useless economic parasite. is in total control of Congress and the executive to the point that even a national debate on the subject has been censured out of existence.

Nick

June 3, 2009 04:01 PM

Clearly #1. It helps everyone.

Kaleberg

June 7, 2009 12:52 AM

#1 - I'd go with the record keeping, and the government absolutely has to be involved if only to deal with the liability, privacy and security issues. We need evidence based medicine, but we can't raise humans in cages and do medical experiments on them. Ignoring the moral issues, we'd have to wait a hundred years for results. The only reasonable approach is retrospective analysis.

One of the most valuable resources we have in this field is the Framingham nurses study database which has followed tens of thousands of nurses for decades. We need this at a national level, and we need a way for researchers to access it. Since we already have universal care in the U.S., with an endurable option for the "insured" and the catch as catch can ER panic option for everyone else, we could learn a great deal about health care and about improving health care systems.

Thank you for your interest. This blog is no longer active.

 

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Michael Mandel, BW's award-winning chief economist, provides his unique perspective on the hot economic issues of the day. From globalization to the future of work to the ups and downs of the financial markets, Mandel-named 2006 economic journalist of the year by the World Leadership Forum-offers cutting edge analysis and commentary.

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