Health care reform hinges on technology

Most health care reform proposals before Congress would expand the use of health information technology, say health care IT specialists.

Both the House and Senate are contemplating some sort of online marketplace that would allow Americans to compare and buy insurance plans. The concept is referred to interchangeably as a health insurance exchange -- not to be confused with an electronic records exchange -- or gateway. A microcosm of this model already exists in Massachusetts, where the so-called Health Connector offers brand-name and publicly subsidized health insurance options to state residents.

"The underpinning of all health care reform relies on information," said Harry Greenspun, chief medical officer and executive vice president at Perot Systems. Massachusetts hired Perot Systems in 2008 to provide technical support in building Health Connector, its statewide electronic marketplace.

Greenspun, who has developed software that measures the outcomes of cardiac surgery patients, said insurance gateways combined with data from electronic health records ultimately will allow people to compare treatments as well as prices. The stimulus package that President Obama signed provides nearly $20 billion to make e-records standard by 2014.

For "The availability of verified and accepted quality information that can be agreed upon and trusted . . . nationwide, you're probably looking at an almost decadelong process," Greenspun said. "The more data you have, the greater your ability to make better decisions."

Earlier in his career, Greenspun worked with Aneesh Chopra, the Obama administration's chief technology officer, when both were at the Advisory Board Company, a Washington-based health care consulting firm. Chopra, the first to hold the title of federal CTO, will be guiding the nation's health IT strategy.

The gateways lawmakers envision would require "pretty sophisticated systems" to calculate which plans are best-suited for each user -- and keep that information private, Greenspun said. The eventual system would have to process "very complex rules," he said, to determine where a person is eligible to shop and what the person will pay under each option.

For example, one plan might reimburse a person seeking knee surgery at 100 percent and another plan might pay nothing because it covers only alternative treatments, such as physical therapy.

The Web exchange model also is critical to expanding health care coverage, said Cindy Hielscher, a senior executive at Accenture's public service health division, which serves government customers. The technology should simplify the process of enrolling in a plan and drive down the cost of expanded coverage by streamlining administrative processes and detecting waste, fraud and abuse, she said.

"If you stopped with stimulus, you would still have some good technology in place, but health reform takes it to the next level" in providing quality, reducing cost and increasing coverage, Hielscher said.

But some privacy advocates are concerned that the government is building the technology before building in protections for personal information.

"I can tell you we desperately need the data about what works for treatments in mental health... but the problem is that they are moving ahead to make every electronic health record be wired for this research without giving Americans the chance to grant permission. It's not ethical," said Deborah C. Peel, a practicing physician and the founder of the bipartisan Patient Privacy Rights organization. The group wants the government to give people the ability to control all access to their health records.

Consumers must have confidence that their health data is adequately protected, Peel said. "People will stay away from the health system [if they believe] the system is not private."

The best method for collecting information about treatments for sensitive illnesses, such as depression, AIDS and cancer, is to collect data only with the express consent of the affected patients, she said.

"We don't want to inadvertently create a system that causes suffering or even death . . . or prevents people from using the system," Peel said.