Level Three - Ones and Zeros
At the heart of this healthcare cost reform debate is a central nerve. What ultimately happens regarding this issue will determine if anything of substance actually takes place. That nerve, that issue is simply data and how it is disclosed and transported. Computer data is nothing more than a series of one's and zero's in a specific sequence that when presented in computer code translates to written communication, pictures, charts, and a seemingly endless number of new devices, software, and ways to dazzle patients. As free flowing as this data may be when all of those one's and zero's are in the correct order, there are things that cause it to stop, corrupt, hide, disappear, and slip into encryption. Oddly, none of this is caused by a virus or a bad driver in a program. Instead it is caused when various industries decide to label their data as "proprietary." It also fails when new devices and software are invented and there is no competition to hold the price within a realistic framework.
Today, we have the ability to store our individual health records on a single thumb drive or card that can be kept in a wallet or purse. Even more dramatic, the technology exists to store the data on a small chip that can be embedded just under your skin where it can be scanned in an emergency room or your doctor's office. So what's the problem? What, related to this issue, is causing medical costs to rise so dramatically; disagreement over ownership and privacy.
When you walk into a doctor's office you see hundreds if not thousands of manila folders with brightly colored tabs sticking out of endless rows of shelves. Somewhere in that chaos of files lie your individual health records. If you ask the doctor he will tell you that those are his files. That is true, but, what is in them, what is written down belongs to you. Doctors have resisted converting to electronic files for years using the cost to convert as the common excuse for not making the transition. That may have been a small part of the reason. More likely it was the same reason insurance companies have resisted the move to electronic data. Actually there are two reasons and they both directly impact your rights and the cost of healthcare in America. First, that paper, in most cases, is the only visible sign that you are getting something for the money you are paying these folks - doctors and insurance companies. Second, electronic data becomes mobile and can be easily transferred. It makes it too easy to lose to another doctor. Your personal medical information must be transitioned to electronic data and you need to have the ability to carry it on your person in case of an emergency or you should be able to purchase the services of a data storage company who will share your data with any emergency room in the country or anyone you give permission.
This pushes the other item to the front of the line. We have always had the privilege of confidentiality concerning our personal medical information. The government however decided that wasn't enough and passed a landmark piece of legislation, buried deep within a much more comprehensive bill called HIPAA. The purpose of the bill was to make sure no one, including someone's spouse, could see or have access to your personal medical information. That legislation has cost business billions of dollars in new procedures and systems to comply. It created entire new industries to help employers and providers comply. It also gave providers and insurance companies the broad protection they needed to refuse access to information that could be used in a productive way by allowing business to hire smaller, specialized companies to operate on-site medical clinics within the walls of the employer. These clinics save 20% to 30% on expenses that would normally be spent in the retail provider community.
In summary, changing the way personal medical data is stored and transferred is a key component in reforming healthcare cost. The word is "transparency." The application has to be "universal."