Institutional health care should, by definition, be focused on the patient. I will refer to it as a Patient-Centric Health Care System (PCHCS). It would provide lifetime care that includes promoting healthy lifestyles, reacting appropriately to diseases, injuries and events such as pregnancy, organ failures, etc.
The most important information a doctor needs when treating a patient is that patient’s medical history. A little-known feature of the Affordable Care Act (ACA) requires the creation of Electronic Health Records (EHR) so that medical histories can be easily and efficiently shared with healthcare providers.
Currently, health care in the United States is based on accounting principles rather than a PCHCS. An accounting model is built on opening and closing of accounts. Consider year-end resets of pricing and benefits. Every January 1, my medical costs/obligations are reset. I wish that my health concerns could be so easily rebooted!
Account data are also limited to specific providers, accounts at a primary care physician’s clinic are not recognized at any hospital nor any other clinic where the patient is treated. The account information is primarily financial. It shows that diagnostic tests were billed but does not include the results of those tests. A new provider may gain some insight knowing what procedures have been done, but really needs the results to take care of the patient. This often requires repeating of procedures which delays treatment and wastes money and time.
Other anomalies of the current system are separately administered plans for dental work, vision services and hearing issues. When I look in the mirror, I never see my eyes, ears or teeth detached from the rest of me. Why do I need separate insurance plans?
Currently we are hearing calls of “Medicare For All.” However, simply paying for medical bills will fall far short of what is really needed to fulfill the goal of PCHCS. Consider our current menagerie of government-sponsored health care providers and payers. Medicare and Medicaid will pay most providers at least partially. We also have insurance plans for government workers, medical care for active Armed Forces members and their dependents and the Veterans Administration. One of the major reasons that the ACA mandated the EHR was that there was no electronic medical records interface between the medical computer systems used by the Armed Forces and the system used by the VA.
PCHCS implementation will assign everyone an EHR identification number for use from cradle to grave. I spent my working years in and around the medical laboratory with the last 28 years helping to manage the lab computer for Intermountain Health Care (IHC). In the mid-90s, IHC initiated a cradle to grave medical records system for in-system patients. It was extremely difficult to complete for many reasons, including when to create new patients in the system. Many people use different names when registering at different providers. Women change their last names when they marry and divorce, etc. For the PCHCS process to work, everyone must use their full name every time they access health care.
This project was not my idea. It caused me a lot of work but, in the end, it has resulted in health care that is much more efficient to deliver for IHC patients. And IHC-generated medical records are available everywhere inside the system. It also has given rise to significant financial savings.
I know IHC is continuing work on electronic exchange of data with other corporations and providers. The process is extremely complex but is possible to do and should be completed. There are models to follow available from Western democracies like many of the Scandinavian countries.
Efficiently delivered PCHCS will promote overall wellness, which is a key to happiness. It will reduce costs by eliminating duplicative testing and making delivery of service more efficient because the EHR provides a better treatment starting point.
Wayne Wilson
Wayne Wilson, of West Jordan, has worked in and around medical laboratories since 1970. He retired from Intermountain Healthcare in 2018 after nearly 38 years of employment.
