17 Apr Interview: Dr. William Yasnoff on patient-centric IT
For this special issue of Wisconsin Technology Network, we asked William Yasnoff, founder of the eHealthTrust initiative, why his system can foster the adoption of electronic health records that today are fractured and limited.
Yasnoff is a speaker at the Digital Healthcare Conference 2006, where he will deliver a presentation titled “A New Patient-Centric and Sustainable Approach to Health Information Infrastructure.”
WTN: What do you mean by a “patient-centric” and “sustainable” healthcare system, and why doesn’t that describe what we have now?
Yasnoff: Let me start with the system we have now. The system we have now does not provide for availability of complete patient information at the point of care. The overwhelming majority of people receive their care in multiple places, and in each place they keep their own records, and really there’s no one in the healthcare system that’s responsible for keeping each person’s lifetime health record.
When you go for care, even if you’re lucky enough to go to a place where they can retrieve the records they have about you, those records are inevitably incomplete. Even if they were complete they would be on paper, which means they are difficult to access, you can’t reorganize them, you can’t display them in different ways, and you can’t easily apply decision support, certainly not automatically.
The system we have is not performing well, and this is demonstrated by the large number of medical errors. Errors do not mean mistakes by providers; these are errors that are inevitable because of lack of information. There’s the IOM report, though there’s some disagreement, showing tens of thousands of deaths in hospitals alone, and the RAND study showing only 55 percent of patients with chronic diseases are getting all the care they’re supposed to get.
So that’s the present.
What I’m proposing is patient-centric in the sense that the proposal, which is called an eHealthTrust, involves the establishment of a lifetime health record for each person that is paid for and controlled by the person. They decide who has access to which parts when, and no one else decides that.
The sustainable part addresses an important question that folks have had in terms of establishing community health information infrastructures. In order to accomplish the goal of anytime, anywhere healthcare information, everyone agrees that this needs to be done in communities.
WTN: Why not one national system?
Yasnoff: One reason is that the problem is more tractable in communities. To do it for the whole country at once is a problem just because of the scale. But perhaps more of the reason is that healthcare is a community activity. People get their healthcare in their home community. Even if people are away from home, if they get sick, at their earliest opportunity they’re going to go home to get their care.
Pulling together the information in the community is what’s needed. Furthermore, in order to do this you need trusting relationships, and that’s clearly easier to do within a community that it is over long distances.
WTN: Why hasn’t this been done yet?
Yasnoff: In the most advanced communities across the country that are working on this, communities like South Bend, Indiana, and Spokane, Washington, they have sustainable systems that provide partial patient information at the point of care. Those communities have developed a sustainable model through capturing value among healthcare stakeholders. But none of them have succeeded in having the complete patient information at the point of care, and the main missing element in the information they are able to provide is the outpatient information. Of course, 80 percent of healthcare is given in the outpatient setting.
The reason they have been unable to get that information is it’s not electronic. Part of the eHealthTrust model is that it provides financial incentives for physicians to acquire and use electronic health records systems in their offices, by paying about $3 for submission of the encounter notes from an outpatient encounter in electronic standardized form.
WTN: Are patients willing to pay for this?
Yasnoff: Ultimately the patient pays for everything, and the issue with healthcare coverage is whether the patient gets reimbursed. I would encourage health plans, health insurers and employers to provide coverage for the eHealthTrust, which only costs about $5 per month.
The eHealthTrust is immediately and inherently sustainable because it is paid for by the users, the patients. There was a national survey commissioned last year by Accenture, and they asked consumers across the country “Would you be willing to pay $5 or more for your medical records to be electronic?” 52 percent of consumers said they would.
Visit the Digital Healthcare Conference web site and attend the conference for more on this and other issues central to modern healthcare. Read part 2