TL: What cost control measures would result in greater savings?
JO: We could save money by setting budgetary targets for national health spending. For example, the Clinton administration proposed to cap increases in health insurance premiums. We could also create a system that let private and public insurers coordinate a national payment schedule for medical providers. That would help us restrain prices for medical care.
TL: Will America ever adopt these measures, or is medical inflation destined to relentlessly rise forever?
JO: As the saying goes, forever is a long time. If Congress adopts legislation that substantially increases insurance coverage—and there is a good chance that will happen this year—the incentives for the federal government to restrain spending will become stronger since the government will be spending lots of money to subsidize people to buy insurance.
TL: What will happen down the road when everyone realizes that health IT has not produced the promised savings?
JO: We will eventually discover that we can’t compute our way out of the health care cost problem. So the more important question is: What effect does health IT have on the quality of medical care? So far, the evidence that electronic medical records improve quality and outcomes is quite mixed.
TL: Can the systems in use today talk to one another?
JO: We don’t have a national health IT system that is interoperable. Interoperability means that records from one doctor’s office can actually speak to a doctor in a different office or to a hospital. To really be effective in managing care, that sort of information sharing must happen. The Kaiser and VA systems are integrated systems, and that may be one reason they have better results.
TL: Is there a requirement that systems be interoperable?
JO: I think the stimulus legislation requires hospitals to make progress in this area before receiving federal money.
TL: What is the key story journalists should be sniffing out about health IT?
JO: How the Obama administration defines the use of electronic records. Here it’s not just a case of the devil being in the details—the dollars are in the details.
TL: What other stories should the press be tackling?
JO: I would say there haven’t been many stories looking at who stands to profit from the money we are spending on IT—with the exception of The Washington Post. I also think there needs to be more attention to the experience of Kaiser and the VA. The question of why providers are not using the VA’s VistA system, even though it’s available to them, is an interesting story that The Boston Globe highlighted.
TL: What does lack of acceptance about the VistA system, which is freely accessible, say about American marketing and sales practices?
JO: We have a fragmented health system, and that fragmentation shows up in many ways, including the marketing and sale of multiple health information technology systems. That decentralization has advantages—it may produce more innovation. But it makes coordination quite difficult. If health IT is going to help us better coordinate medical care delivery, first we have to ensure that we have a coordinated health IT system.