A major problem in the healthcare industry today is the fragmentation of medical information. An average person’s healthcare record is scattered among at least 13 different locations. Every insurance carrier, hospital and healthcare provider has its own information system, and none of these systems communicate well with each other.

From the quality of care standpoint, the fragmentation of healthcare records requires patients and physicians to rely on memory, repetition and guesswork at every caresite. It is a major contributing factor to the high incidences of misdiagnoses, inappropriate medications, duplication of tests, frequent emergency room visits, unnecessary hospitalizations, and fraud.

From the financial standpoint, the cost of information transfer within the healthcare industry accounts for about 30% of the state’s $14 billion healthcare budget ($4.2 billion). The primary reason for this high cost is that none of the industry’s fragmented information systems communicate well with each other.

THE SOLUTION

The solution is to establish an independent, uniform, statewide healthcare information system. The system will produce privacy-protected Coordinated Patient Records and comprehensive statewide statistics and reports.

• INDEPENDENT: The system will be independent of any insurance carrier or healthcare provider. It will be run by a first-tier data processing company such as IBM or EDS. A citizen’s committee will determine the system’s policies and procedures. This will be an entirely new entity in the healthcare industry. It will be not-for-profit.

• UNIFORM & STATEWIDE: Every insurance carrier, hospital and healthcare provider in the state will use the same system. This is technically very feasible with 21st century technology and IBM level security. It is politically feasible if enough employers and individual citizens want it to happen.
  

• COORDINATED PATIENT RECORDS: These will be single records that contain accurate demographic and insurance information and comprehensive clinical information, including diagnoses, procedures, medications, allergies, orders, test results, referral information and preventive care reminders. The records will be privacy-protected. They will always be available to the patient, and at the patient’s direction to designated care providers.

• STATISTICS AND REPORTS:  The system will produce comprehensive, privacy-protected, statewide statistics and reports. An ethics committee will determine the appropriate content of, and access to these reports.

• COST: Utah’s employers and individual citizens are currently paying the hidden cost of the healthcare industry’s fragmented and inefficient information system. The cost of establishing and maintaining a uniform system for the entire state will be a fraction of what is now spent on the current model.

IMPLICATIONS

• AFFORDABLE HEALTHCARE: An efficient, uniform, statewide healthcare information system is projected to reduce healthcare costs by about 20% ($2.8 billion). As long as the system is designed and implemented correctly, the savings will be shared by healthcare purchasers (employers and individual citizens) and providers. There will be lower premiums and out-of-pocket expenses, appropriate reimbursement for valid medical care, and funds available for social issues.

• TRANSPARENCY AND ACCOUNTABILITY: Since the system is independent and can produce comprehensive industry-wide reports, it will allow purchasers to determine how every healthcare dollar is being spent. It will allow purchasers to distinguish between valid medical expenses and waste. The ethics committee will determine appropriate access to these reports.

• OPEN ACCESS: The uniformity of the system, and the patient’s control of their own records, will allow patients to be seen by any provider of their choosing.

• PORTABILITY: The independence and the uniformity of the system will allow patients to change insurance carriers, employers and providers without losing the information in their medical record.

• COORDINATED RECORDS: Coordinated records will significantly improve the quality of healthcare. They will eliminate the need for patients and physicians to rely on memory, repetition and guesswork. They will significantly reduce the incidences, and the cost, of misdiagnoses, inappropriate medications, duplicate tests, frequent emergency room visits, unnecessary hospitalizations, and fraud.