Commentary: The sorry state of U.S. health care IT

SAN FRANCISCO — Assailing the U.S. health care system as a "19th century cottage industry," a top executive with a nonprofit health plan recently offered his own prescription for recovery: information technology.

Robert Pearl, CEO of the Permanente Medical Group, made his comments at an Intel Corp. Digital Health Group press briefing here last week.

Permanente is one-half of Kaiser Permanente, a nonprofit health plan that serves 8.2 million people in the U.S. According to Pearl, Kaiser Permanente has for 10 years maintained an electronic database, known as HealthConnect, that includes comprehensive information on every patient's medical history, including doctor visits, test results and medications. Pearl detailed ways that Kaiser Permanente is using IT, including providing all its physicians access to medical records through the database and exchanging e-mail with doctors through secure messaging and the ability to make appointments online.

Most striking is not that Kaiser Permanente is offering such services but that the American health care system as a whole, apparently, is not.

The upshot of comments by Pearl and preceding remarks by Louis Burns, vice president and general manager of the Digital Health Group, was: The U.S. health care system is woefully behind that of other industries in embracing IT to enable connectivity and the efficient exchange and storage of information. The U.S. system could not only improve efficiency but also save and improve the quality of lives by adopting technologies readily available today and in use by, among others, banks and retail outlets.

Without systems that interface with each other or standardized methods and formats for storing and exchanging medical records, doctors and nurses treating a patient who has experienced unforeseen trauma are often doing it without access to critical information contained in a person's medical history.

According to Pearl, the majority of medical records in the U.S. are stored on charts in physicians' offices and are unavailable to responding doctors and nurses two-thirds of the time when a patient visits a hospital emergency room. Transferring records from physician to physician in the same town, one block apart, takes several days, he said.

To illustrate the problem, Burns said that there are 2 million "wrong" blood transfusions — patients receiving the wrong blood type intravenously — each year. (The good news, he added, is that this usually does not a kill a patient.) A simple, closed-loop RFID system that incorporates a tag in every blood bag and in every patient's hospital tag could prevent such a mistake, Burns argued.

Pearl gave the example of his own father, who passed away about 18 months ago. Pearl, who is a physician, said his father died essentially because he never received a post-operative vaccine that is commonly known to be needed after spleen removal. A lack of communication between his father's various doctors, he said, created a situation in which everyone assumed that someone else had already administered the vaccine. Pearl also noted that at least one of his father's doctors relied on the patient to tell him what medications he was taking—information that was stored on a tattered piece of paper kept in the senior Mr. Pearl's pocket.