(本文是笔者在读MBA期间所作的关于IT对美国医疗卫生系统影响的课题报告的一部分。美国对医疗卫生的投资达世界之最。虽然新技术应用于临床不可避免地提高了医疗护理的成本，而且药物开支一直在美国的整体医疗卫生消费中占有很大的比例，但研究表明由于治疗失误及因为缺乏共享病人的健康资料而导致的重复诊断等是引起高医疗消费的一个重要因素。此外，行政开支也占到美国整个医疗卫生花费的25%左右，有些研究表明行政支出甚至高达40%。IT技术提供了解决上述问题的一个有效手段。总部位于加利福利亚的KAISER集团是美国最大的封闭医疗卫生系统（Closed System HMO），也就是说这个集团集医疗卫生保险、医院、护理机构等于一体。KAISER是美国最早尝试将IT技术应用于医疗卫生系统的机构之一。KAISER的实践取得了较好的效果。通过高效的IT应用，KAISER系统的医疗质量得到了显著的提高，而同时病人的医疗消费也有所减少。KAISER模式目前得到了美国联邦政府及一些外国政府的高度重视。英国政府甚至组织了一个考察团前往KAISER去考察其运营模式，以期为其国内的医疗卫生系统的改革提供参考。随着我国经济的发展，我们国家的医疗卫生系统也面临着同样的问题。希望本文能够为解决此问题提供一个思路。当然建立全民整体的电子医疗卫生档案是一项投资巨大的系统工程，在我国广大农村和农民还缺乏基本的医疗卫生保健的时候谈论这个话题似乎是很不合时宜的，但建立有限区域内的集中医疗档案保管制度在一定程度上还是可行的。相比美国，我国的一个最显著的优势就是医疗卫生系统基本上都是国有投资的，因而不同医疗机构在共享病人的医疗记录时不应该存在利益上的纠纷。)

 

The United States has by far the most expensive health care system in the world, based on health expenditure per capita, and on total expenditure as a percentage of gross domestic product (GDP). For example, in 2003, the country spent $1.7 trillion on health care, which accounted for about 15.7% of GDP. Moreover, the health care expenditure has been increasing at a rate exceeding the inflation rate for a long time. The reason for the especially high cost of health care in US can be attribute to a number of factors, ranging from the rising costs of medical technology and preion drugs to the high administration costs resulting from complex multi player system. It has been estimated that about 25% of the total dollars spent on health care is spent simply on administrative costs1. Additionally, waste also accounts for a significant part of the total expenditure. A study done by the Midwestern Business Group on Health estimated that 30% of all health care dollars are spent on inappropriate care caused by medical errors2. Improving health care quality and making administration process more efficient, therefore, can help to reduce the continuously increasing high health care costs, at least control its growth rate. Improving health care quality and reducing costs have now become the essential strategy for every player in US health care system.

 

Many evidence and studies have shown that inefficient uses of information in US health care system accounts for the quality problem. For example, preventable medical errors kill almost 100,000 Americans a year. About 20,000 of those patients die because the doctor or nurse did not have access to their health care information; medical records or charts were missing, lab tests were mislabeled or patient and doctor didn’t understand each other3. Also, the NIH reports that a third of all U.S. health-care spending goes to treatment that is either duplicative, fails to improve patient health, or may even make it worse. Moreover, 20 percent of all medical tests ordered are repeats, because the results have been lost4. According to national survey conducted by Kaiser Family Foundation, about 69% of the respondents say that the coordination among different health professionals is a problem; 48% of the respondents noticed that the health care professionals did not have all their medical information; and 67% of the respondents did not have their own set of medical records5. 

 

It has long been recognized that clinical care involves major issues in information generation and management. Information technology offers the best way to address these issues. Advances in information technology can provide the foundation for important improvements in health care delivery, such as more cost effective monitoring and follow-up of patients beyond health care centers and dynamic, optimal targeting of specific sectors of the population for special education, screening, and early treatment where necessary. Information technology can also help to provide better feedback loops for connecting providers, policymakers, and patients with late-breaking research and discussions about clinical decision-making policy. Only information technology can help us take data from records of individual care and make them available for analysis of populations, both for the generation of new epidemiological knowledge and for the generation of prudent health policy. IT has successfully transformed many traditional industries; however, it has not received necessary attentions in US health care industry. Compared with other industry sectors in US, health care organizations invest the least on IT. Compared with other countries, the electronic health record (EHR) system adoption rates in US are also far below those of other countries. 

 

Improving use of IT in health care industry will produce significant implications on the quality and cost of health care. Many researchers and industry experts think that IT has the capability to transform current US health care system to a more efficient and affordable system. According to a federal study, reduction in medical errors and elimination of redundant tests could save as much as $500 billion a year nationally, a third of the nation’s cost of health care3, and improving use of IT will help to achieve this goal. A recent research at Stanford University found that more and better use of IT in health care could make transaction processing far more efficient, reduce costs, and improve the accuracy of diagnoses and treatment, thereby improving the quality of health care in this country. In fact, according to a 2004 report from the U.S. Department of Health and Human Services (HHS), improved use of IT could cut the nation’s $1.4 trillion annual health care bill by at least 10%6. 

 

In February 2003, Kaiser announced plans for a new records system, KP HealthConnect, using Epic Systems software and technology services. This is a $3 billion investment to automate records for its 8.4 million members in eight regions serving nine states and Washington, DC. It will integrate patients’ clinical medical records with appointment scheduling, registration, and billing systems across all of Kaiser’s regions. When the system is complete it will provide the ability for Kaiser physicians to have instant access to patients’ medical records; e-messaging capability; computerized order entry; e-prescribing; and treatment guidelines and alerts regarding incorrect medication dosage or dangerous interactions. System alerts will catch abnormal results, negative trends, chronic problems, and dangerous drug and procedure combinations. In the future, patients will be able to access parts of their records online, including test results, immunization history, and current medications. Patients will be able to book appointments, make payments, and send messages to their doctors. The system also will create standardized data for quality improvement efforts and performance benchmarks once it is running. Although the system has not yet completed, Kaiser has achieved some exciting results. In Ohio, a Kaiser Permanente pilot program that used computers to track heart disease care and treatment showed a 30 percent reduction in the death rate in three years. In Southern California, Kaiser Permanente saw a 31 percent reduction in the death rate for renal disease by using a systematic approach to care3, 4. Also, Kaiser removed Vioxx as a medication for our patients before the FDA pulled it7. Financially, for the first six months of 2005, Kaiser’s net profit margin reached about 6 percent, as operating revenues year-over-year increased to $15.5 billion from $13.9 billion, and net income grew to $915 million from $839 million4. Furthermore, in California, Kaiser’s members pay 25% less than those in New York area7. 

 

 

Although we need to wait to see the real impacts of Kaiser’s HealthConnect system on the quality and cost of health care, the preliminary results still exhibit the power of IT to transform US health care system. 

 

 

参考文献：

 

1. Kahn J., et al. The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals. Health Affairs, 2005, 24(6): 1629 – 1639.

 

2. The health care cost crisis in Wisconsin: an economic development prognosis. Wisconsin Economic Summit IV, Health Care Work Group, 2003.

 

3. Benfell C. Doctors go digital: Caregivers hope electronic records will boost health care, reduce errors, curt costs. Santa Rosa Press-Democrat, Feb 13, 2006.

 

4. Cowan M. Health care heal thyself…now! Business Empowered, Jan, 2006. 

 

5. Kaiser Family Foundation, Agency for Healthcare Research and Quality, Harvard School of Public Health. National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2004).

 

6. Meza P. Righting the health care crisis. Optimize Magazine, Nov, 2005.

 

7. Thompson A. Kaiser bucks the HMO trends: company offers new approach to health care. NBC Nightly News, Dec 20, 2004