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At a meeting with reporters Feb. 27, Intels head of health IT touted upcoming products, but said that he didnt see how the U.S. market would pay for them.
Whats at issue is not whether the technologies would improve care or bring down health care costs, but how insurers, patients, doctors, and employers would foot the bill for them.
Louis Burns, manager of Intels Digital Health Group, also said that Intel would become more active in establishing common health IT standards.
“[At hospitals,] the single largest spend on software is writing interfaces between proprietary systems,” he said. “Thats insane in my book.”
But even if better standards lower the costs and increase the utility of health IT, promised savings cant come without up-front investments, said Burns, praising the United Kingdoms decision to pour billions of pounds into health IT.
“Youve got to build in the infrastructure before you see the benefit,” he said.
Securing that up-front cash is more difficult in a market like the United States, where a motley collection of government programs, private insurers, and individual patients pay health care providers, he said. Its not surprising that rare “closed systems,” like the Veterans Administration or California HMO Kaiser Permanente have led technological innovation.
“In a system like Kaiser, which is both a payer and a provider, the returns are clear,” said Burns.
Thats not the case when health care providers and payers are different entities.
“The question is who is going to pony up the cash,” he said. “I dont know how thats going to get done when its separated.”
Richard Pearl, head of Kaiser Permanente, was more acerbic.
“There are no incentives to keep people healthy,” he said, “Youre not going to get people to make investments in preventing disease, when they are going to make money treating it.”
Burns hastened to add that U.S. government committees were trying to find solutions and that lower costs could come as a side effect for improving health care quality.
But Pearl said that current trends requiring patients to shoulder more health care costs would thwart such improvements because many patients would simply skip preventive care, and doctors would see patients at their sickest.
Such a situation would limit physicians abilities to improve patients health, even with the best IT systems.
One of Kaisers claims to fame is the comprehensiveness of its medical database, which was used to demonstrate that the arthritis drug Vioxx could cause heart problems.
EKGs, blood tests and other data collected by one health care provider can be viewed by other clinicians treating the same patient.
In fact, Kaiser uses individuals information to generate health checklists that are given to patients with each doctors visit.
Pearl offered a poignant anecdote to describe the effectiveness of such lists.
Pearls father developed a fatal pneumococcal infection some time after returning home from an operation on his spleen, during which time hed had other doctor visits.
In his grief, Pearl entered his fathers symptoms into Kaisers database. Sure enough, the system recommended a pneumococcal vaccine.
“There is no question in my mind that if my father had belonged to Kaiser Permanente, he would have been alive today.”