A Remedy for What Ails Us
By Hawaii State Senator Will Espero
Part II (of a two part series): Care in Remote Areas
Access to medical care has always been an issue for residents of rural or remote areas. The federal government established health centers and clinics to provide primary medical care for these distant populations. The increasing numbers of people getting their treatment from the clinics, though, has strained their ability to keep afloat. The two aspects most hit are staffing and financing.
Lower pay, mostly from decreasing rates from insurance companies and other payors, make it difficult to recruit young doctors who have heavy student loan debt to repay. Another factor is that medicine is an evolving field, with some treatment becoming more complex and requiring more specialized care than primary care doctors are equipped to provide. Less access to specialists and diagnostics, a much smaller base of colleagues, and greater distances to continuing medical education, are other disadvantages that deter physicians from establishing a practice outside the city.
The Legislature recognized the difficulties rural communities face in meeting their need for health care. This year we passed SB 2542 and HB 2519 to try to keep these vitally necessary centers operating.
SB 2542 helps with the financial crunch these clinics face by creating a process for them to receive supplemental Medicaid payments and modify the range of medical and dental care they render to patients. The $1 million it costs – if the Governor releases the funds at all – has far reaching effects on the ability of health centers in rural and underserved areas to operate. Governor Lingle vetoed the bill. On July 8, the Legislature overrode the veto in light of the serious need for these health centers to be able to continue to provide health care to our neighbor island residents.
HB 2519 attempts to recruit more physicians and dentists to practice in rural areas by repaying part of their student loan over a five year commitment of service. Since young practitioners are under heavy pressure to pay back sizeable student loans, the financial relief from that financial burden may be attractive enough to bring them to the neighbor islands. The Hawaii Health Corps Program will develop a plan including repayment of student loans, stipends, and other incentives for physicians and dentists who agree to work in rural or medically underserved areas of Hawaii. HB 2519 creates the working group to develop a plan for the program. Up to 20 doctors may be chosen each year to participate in the program in areas designated as underserved and rural. A minimum of 20% of the student loan will be repaid over the five year commitment, a substantial financial incentive to practice medicine in underserved areas.
The Legislature took great care to craft the bills in light of the health care crisis on the neighbor islands. Let’s hope the Governor is as concerned for our outer island residents and releases the funds to put the programs into place.
How Technology Can Help
Most of us are familiar with the situation: taking the time and trouble to fill out a medical history form each time you go to a different doctor. Doctors need to know a patient’s prescriptions, drug sensitivities, allergies, blood type, and pre-existing medical conditions when deciding on treatment. Often the patient’s symptoms and condition lead a doctor to order tests to find out additional information before proceeding. Consider how much safer and more efficient it would be if each doctor could see what other doctors had diagnosed, prescribed or ordered as treatment. This could save money and time in eliminating lab tests and other diagnostics dangerous; drug interactions or allergic reactions could be avoided; and treatment could be started sooner. Besides enhancing safety and efficiency, IT is projected to be able to cut $77.8 billion (roughly 4%) off the $2 trillion tab in the nation’s health care industry.
The Kaiser system already uses the electronic medical record so that each doctor can see the patient’s history, and be better able to prescribe treatment for the patient. Being able to view a patient’s complete record at all times keeps costs significantly down and allows care to be rendered much more efficiently.
Health care is one of the last industries to be transformed by information technology (IT). We’re already comfortable with e-tickets when flying, internet shopping, on-line banking, electronic stock buying and selling, distance education, and ordinary business processes like sending documents via e-mail. The lack of standard data exchange in health care contributes to the high costs of health care. Doctors, hospitals, and other providers use systems that are individually tailored to their own needs, and so, patient information stored on these systems are inaccessible between entities.
IT is safer, more efficient, and less expensive than manual or individualized data processing. Michigan’s electronic system caught more than 85,000 prescriptions that generated drug interaction or allergenic alerts, enhancing the safety of medicines taken by patients. Medicaid beneficiaries in Tennessee have their own personalized electronic health record, giving each provider the medical information needed to more carefully and appropriately treat patients. Time spent in intake and history is eliminated, as are errors due to memory and incomplete information. A bill is currently in Congress to require Medicare doctors to prescribe electronically by 2010.
The VMR is not new. Hawaii physician Brian Martin, founder of Martin Information Systems (MIS) and former product architect with WebMD, was one of the pioneers in the field. In 1989, he developed the “virtual medical record” (VMR) and a few years later, a health claims processing system. Diagnostics as well as medical history could be viewed via the VMR, enabling doctors in separate locations to confer and consult while simultaneously viewing patient records. Being able to share information would enable physicians to select the most appropriate and effective course of treatment. The VMR could make treatment more timely, more efficient, and less costly, especially for neighbor island patients, who wouldn’t have to fly to Oahu to see a specialist. Access to a patient’s complete medical record increases patient safety by reducing errors that may arise from drug interactions, allergies, existing conditions, and so forth. Dr. Martin’s claims processing system could also give doctors and providers the prompt payments they’d appreciate, as well as save money lost to possible drug abuse and fraudulent health claims.
Queen’s Task Force 2000 likewise tried in the early 1990s to get doctors comfortable with using technology in their practices. Unfortunately, at the time, the medical field was not yet ready to get on-board with technological advances. Kaiser Health Foundation’s success with its version of electronic patient records is raising the comfort level among health care practitioners, so we should see technology making inroads in health care.
In Japan, Broadband is being used to enable rural health clinics to get diagnostic evaluations made remotely by specialists in city medical centers. The improved access to expert medical care is helping many people living in Japan’s countryside receive the care they need without the expense and time of going to the cities.
IT and Broadband can help Hawaii’s rural and underserved areas secure the medical care they need.
Senator Will Espero represents the 20th Senatorial District (Waipahu, Ewa, Ewa Beach and West Loch) on the Island of Oahu. He also serves as the Chair of the Senate’s Public Safety Committee.