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How Technology Can Do More to Improve Health Care: A Q&A with Dr. Robert Pearl

The technology to connect healthcare is booming – but is it working to improve care?   Often it doesn’t.  The reasons and solutions to change that paradigm are the topics to be covered by Robert Pearl, MD, one of the nation’s top physician executives, at his presentation at the 9th Annual mHealth + Telehealth World Conference Monday, July 24 in Boston.

Dr. Pearl is chairman of the Council of Accountable Physician Practices, consisting of the nation’s more visionary medical groups.  He is also immediate past Chief Executive Officer of The Permanente Medical Group, and author of the Washington Post best-selling book, Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong. On a national and international level, Dr. Pearl is a global expert in charting what the future of health care can and should be. In his presentation at the Telehealth World Conference, he will highlight the real-world experience of using digital technology to transform an entire system of care and achieve the nation’s highest quality ratings.

For more insights into his drive to improve both care coordination and the use of technology that truly connects and engages, check out our conversation with Dr. Pearl.

What has led you to be so passionate about the topic of coordinated care?  
It began during my residency at Stanford where I was particularly interested in craniofacial surgery. Early on, I realized surgery is a “team sport.” Multiple disciplines working together as one can produce higher quality outcomes than any one surgeon ever could. The greater the coordination and collaboration, the better the outcome for the patient. This theme was reinforced when I arrived at Kaiser Permanente. When physicians work in the same medical group, share a comprehensive electronic health record (EHR) and can evaluate each other’s performance, superior outcomes are the result.

Unfortunately, I also have also seen what happens when doctors do not work closely together. My father Jack Pearl died prematurely from a medical error that could have been avoided had his physicians in Florida and New York effectively coordinated the totality of his care. My father’s death was the catalyst that drove me to write Mistreated: Why We Think We’re Getting Good Healthcare—And Why We’re Usually Wrong. The book provides a roadmap for the future of healthcare that begins with an important first couple of steps: Healthcare will need to be integrated, both horizontally within specialties and vertically across primary, specialty and diagnostic care. And physicians will need to share a single, comprehensive electronic health care record. If more doctors practiced in such an environment, we could save hundreds of thousands more lives each year.

Why is the US healthcare system having trouble with care coordination? What needs to be done?  
The problems limiting coordination are structural, not individual. Doctors don’t consciously commit medical errors or decide to harm their patients. They’re simply trapped in an outdated system. American healthcare today most closely resembles a 19th-century cottage industry, with doctors working alone in small offices, disconnected from others, unaided by modern technology and paid piecemeal for each service they render.

Improving medical care and its outcomes will require an overhaul of the current system. This will be difficult but possible to achieve. Uniting doctors through multispecialty medical groups helps to maximize collaboration and cooperation. Connecting physicians through a single, shared EHR helps prevent medical error while improving the quality of care. Prepayment models such as capitation make doctors accountable for a population of patients while rewarding them for improved outcomes. The best medical programs incorporate these elements of care, and they’re achieving the best outcomes and quality ratings because of them.

How is technology helping and hurting U.S. patients today?
Most hospitals and medical offices use technology held over from the last century, and most patients simply tolerate it. In what other industry would this be acceptable? We’re willing to telephone the doctor’s office between 9 and 5 to make a routine appointment, but we would never book a flight or hotel this way. We expect to be able to get money in the local currency wherever we travel, but we accept that the information in our physician’s EHR is not visible to the doctors in the hospital Emergency Room less than a mile away. And would anyone be willing to drive to their financial advisor’s office to review their investment information, but we go to the doctor’s to pick up our laboratory results or our child’s kindergarten form.

Modern technology is helping some medical groups provide preventive services rates 50% higher than the national average. It is supporting data analytics that can predict which patients in the general hospital are likely to be in the ICU the next day, so action can be taken before the deterioration occurs. Video allows neurologists to treat patients experiencing a stroke in half of the time and hospitals to lower the death rate by 40% for patients with sepsis.

And yet, these results are the exception, not the rule. Because context shapes perception, most American’s accept so much less in their health care than they would in the rest of their lives, and don’t see the shortcomings of the current American health care system. In the end, we spend as a nation 50% more than any other country, and our outcomes as measured by life expectancy and childhood mortality at the bottom of the 20 most industrialized nations of the world. Technology offers tremendous potential, but only when used in the right context.

What do physicians want and need from healthcare tech?
Physicians today are increasingly frustrated by healthcare technology. As much as half of their day is spent entering data, completing forms and documenting care. Doctors want technology to reduce their workload, not increase it. They would like for technology to help patients monitor their health and alert them when something is wrong. What they don’t want is to receive hundreds of rhythm strips and blood-pressure results that overwhelm their IT systems. And of course, doctors want technology to help them provide higher quality outcomes in more personal ways through easy to use IT systems, not the current ones that all too often get in the way of the doctor-patient relationship.

The large EHRs of today were built around claims, and use legacy applications from the past. Physicians want new systems that are mobile, comprehensive, in terms of the totality of a patient’s information, and allow data to be entered and retrieve with minimal effort.

What is missing in the current healthcare debate?  
The healthcare policy debate in Washington, D.C., is too narrowly focused on coverage: how many people, how much coverage, who pays for it and at what price?

The much bigger issue is the total cost of care delivery. Healthcare today consumes 18 percent of the GDP, with expenditures growing at a faster clip than our nation’s ability to pay. Over time, if health care costs continue to rise, all the choices will be bad, and health outcomes will suffer. To reverse the rising costs of American healthcare, we need to improve the efficiency and effectiveness of the care we provide. We will need to change the structure, reimbursement, technology, and leadership of medicine. These changes will be fiercely resisted by healthcare’s most powerful players, from large health insurers to hospitals, doctors, specialty societies and the drug industry.

It will be up to the patient in all of us to understand how much more is possible and then demand it. If change doesn’t come soon, the U.S. will devolve into a two-tier system. Those in the middle class and seniors on Medicare will find themselves with coverage but without access. They will be forced to delay their treatments or go without care. And if that happens, the health of the nation will be compromised. The time for change is now.

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