I just can't keep up with him. I sit here drinking my morning coffee, and I see that Shahid Shah, the Healthcare IT Guy, has done it again. Yesterday he posted an interesting article from guest writer Dennis de Champeau of Ontooo called Is e-Health An illusion?. It raises an issue I've discussed before - our healthcare system costs way more than any other developed nation and delivers a coin-toss level of quality (e.g., in eWeek: Digital Health Coming to Grandma's House). He looks at a solution that may or may not be the answer, but is certainly a component of one - telehealth or telemedicine. I think it's a great idea, but I'm not so sure it'll be adopted here.
A recent Health Affairs article, Health Care Spending And Use Of Information Technology In OECD Countries, shows that the US is a dozen years or more behind OECD nations in the adoption of Health IT. They also help us understand why:
Economists recognize that use of IT in health care has a strong public-goods component, which means that a particular stakeholder often does not reap the full social benefits produced by new HIT investment. Consequently, according to economic theory, the private sector will underinvest in IT relative to its social benefits, which leads economists to recommend that public subsidies be used for the development of HIT systems, even though they will be used by private stakeholders. Also, the value of a particular HIT system installed by one stakeholder tends to increase with the number of other HIT systems installed elsewhere with which that stakeholder’s HIT system can communicate. For these reasons, many industrialized countries have subsidized the application of HIT with public funds, albeit it on the condition that those HIT systems can interconnect.
The article understates the problem - it's not just the use of IT in healthcare, the entire system has a strong public-goods component. That's why 45+ million Americans are underinsured. Our healthcare not only costs more than the OECD nations, we get worse quality care and less of it. Public goods are a classic example of the Prisoner's Dilemma problem.
Moreover, many providers and consumers of healthcare IT in the US are not motivated by social benefits - they are either profit-motivated, or non-profits struggling to break even. With our current focus on economic Darwinism in the US, we cannot yet as a nation see our way to the answer. Barring altruistic actions, unlikely in a free market economy, public goods problems can only be solved at the public level. When the US finally truly commits to public health, health for the whole public, we'll solve the problem.
Telemedicine will definitely be part of the solution, as will a national EHR and a wealth of other health IT innovations, but the real problem is one of will. No amount of IT can solve that problem.