Momentum, Incentives, and Freakonomics
Lot's of news posted in recent days on Healthcare IT. "Health files to go high-tech" in Arizona. "Blue Cross Funds Patient Safety Initiatives" in Pennsylvania. "Hospitals go high-tech" for the Veterans Administration all over the country.
What's all this momentum about? Electronic medical records and the benefits of IT?
That last one, for example, prompted introduction of two bills in the California legislature, one to provide a "15 percent tax incentive for private California hospitals and health-care providers to set up health information technology systems, including the creation of Electronic Medical Records (EMRs)," and another to store "medical records and other identifying information into a 'smart card' which can be used by Medi-Cal patients" (State Sen. Abel Maldonado, R-Santa Maria).
Ah! Incentives!
That naturally led me back to the lessons of Freakonomics, Steven Levitt and Stephen Dubner, and the importance of understanding incentives in economic dealings. Basically, there are three kinds, remember? Moral, social, and financial. I do something because it's the right thing to do. I do something because I want you to see me as doing the right thing. I do something because it's the best cost for me to do it.
What's the incentive for creating EMR's? (read also: electronic health records, personal health records, Medic-Alert key-chain USB storage devices, smart-cards, implantable chips, regional information exchanges, you name it...)
If you're a nurse, or any clinician dealing with patients directly, the incentive is moral. In any other case, I maintain, it's financial. For all healthcare beneficiaries (payers, providers, and consumers), quality of care, patient safety, interoperability of HIT systems -- in short, all the benefits that HIT is likely to provide -- are gauged according to how they affect the bottom line.
My bottom line happens to be bang-for-buck in return for my out-of-pocket healthcare expenses (i.e. insurance premiums). My incentive to use and promote EMR's -- i.e. my personal health record -- is strictly financial. How about giving me a 15% cut in my monthly premium if I establish and require use of my PHR, regardless of delivery mechanism? (Actually, I'd prefer a URL that links, in a secure fashion, my personal medical information to the outcomes and results of treatments I receive in a whole slew of healthcare service delivery activities. No muss, no fuss.)
I have the idea that, while providers and consumers (or their advocates) are launching ambitious ten-year plans for governance considerations and privacy concerns and data sharing and all that technical stuff, payers are quietly analyzing costs, quality, and outcomes for optimal delivery of service. That's the best financial incentive of all.
What's all this momentum about? Electronic medical records and the benefits of IT?
That last one, for example, prompted introduction of two bills in the California legislature, one to provide a "15 percent tax incentive for private California hospitals and health-care providers to set up health information technology systems, including the creation of Electronic Medical Records (EMRs)," and another to store "medical records and other identifying information into a 'smart card' which can be used by Medi-Cal patients" (State Sen. Abel Maldonado, R-Santa Maria).
Ah! Incentives!
That naturally led me back to the lessons of Freakonomics, Steven Levitt and Stephen Dubner, and the importance of understanding incentives in economic dealings. Basically, there are three kinds, remember? Moral, social, and financial. I do something because it's the right thing to do. I do something because I want you to see me as doing the right thing. I do something because it's the best cost for me to do it.
What's the incentive for creating EMR's? (read also: electronic health records, personal health records, Medic-Alert key-chain USB storage devices, smart-cards, implantable chips, regional information exchanges, you name it...)
If you're a nurse, or any clinician dealing with patients directly, the incentive is moral. In any other case, I maintain, it's financial. For all healthcare beneficiaries (payers, providers, and consumers), quality of care, patient safety, interoperability of HIT systems -- in short, all the benefits that HIT is likely to provide -- are gauged according to how they affect the bottom line.
My bottom line happens to be bang-for-buck in return for my out-of-pocket healthcare expenses (i.e. insurance premiums). My incentive to use and promote EMR's -- i.e. my personal health record -- is strictly financial. How about giving me a 15% cut in my monthly premium if I establish and require use of my PHR, regardless of delivery mechanism? (Actually, I'd prefer a URL that links, in a secure fashion, my personal medical information to the outcomes and results of treatments I receive in a whole slew of healthcare service delivery activities. No muss, no fuss.)
I have the idea that, while providers and consumers (or their advocates) are launching ambitious ten-year plans for governance considerations and privacy concerns and data sharing and all that technical stuff, payers are quietly analyzing costs, quality, and outcomes for optimal delivery of service. That's the best financial incentive of all.
posted by Dr. George at 10:13 AM
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