In last years budget proposal, President George Bush called for $100 million to fund new projects in health information technology.
This week, New York City mayor Michael Bloomberg called for the same amount to be spent for health IT in his city. The proposal—to equip 100 city-operated clinics and doctors offices with EHR (electronic health records)—could lead to one of the worlds biggest experiments in health IT.
The goal is to use EHR to provide preventive care for poor patients, thus cutting hospitalization costs. While Medicaid has sponsored several pilot programs to assess whether chronic disease management can cut costs, it does not fund EHR.
Though most experts believe that health IT can cut costs and improve care, there is no comprehensive data showing how to make IT investments pay off.
The announcement follows scathing articles in the New York Times describing how successful diabetes clinics shut down for lack of funds.
While it is profitable for institutions to treat catastrophic consequences of diabetes, like amputations and other hospitalizations, preventive services usually lose money, largely because health care payers are unwilling to pay for them.
In the long run, however, the amounts health care payers spend on preventable acute services far outweighs money saved by skimping on prevention.
An EHR system could automate collection of diabetes information and be used to help patients better control their conditions.
In December, the New York Board of Health approved a program to electronically monitor patients blood sugar levels. Laboratories would be required to send test results to the health board.
Patients who do not control their blood sugar could get letters or calls from health care workers urging more frequent check-ups, healthier diets or better adherence to medication regimes.
Privacy advocates complained that the move violates patients rights, but Thomas Frieden, New York Citys health commissioner countered that the toll in health care costs and human lives justifies collecting and acting on such data.
Frieden is a strong advocate of aggressive preventive practice. For HIV treatment, Frieden wants to relax laws so that health officials can use identifying information collected about AIDS patients to contact doctors or patients about their care.
Bloomberg echoed this goal in his State of the City speech this week.
In that speech, Bloomberg announced goals of cutting the number of patients most prone to diabetes complications by 20 percent over three years.
Over the same time period, he proposes cutting the number of HIV-related deaths by 40 percent. He acknowledged that achieving this goal would require massive interventions.
"Public health is a fundamental responsibility of government, and we are going to do everything we can to help New Yorkers continue living longer lives."
Bloomberg proclaimed that the IT initiative would make the Big Apple national leaders for providing quality health care.
Bloomberg said he would ask federal and state governments, as well as the private sector to fund the EHR initiative. The New York City HHC (Health and Hospitals Corp.) annually handles 5 million patients at more than 100 community clinics and 11 hospitals.
HHC has an annual budget of over $4 billion.