Are new digital networks part of the cure?

Introduction

GREENVILLE, Miss. — These days, Debra Richardson, a 53-year-old former schoolteacher with diabetes and other chronic diseases, spends a lot of time thinking about how to turn around her deteriorating health.

She monitors her blood sugar every day. She watches the time so she won’t miss taking her pills. And she regularly attends meetings on how to eat more nutritious foods — all of which her doctors can track with a computerized medical records system.

“Right now I’m trying to get this blood pressure and this sugar kind of controlled,” said Richardson, who hopes the new digital network set up by the Delta Health Alliance, a public health organization in Mississippi, will help her get healthier and stay that way.

The alliance is one of 15 medical groups nationwide taking part in a $220 million government program designed to show how digital records technology promotes better health care and cuts costs. Twelve of the 15 centers awarded grants — some rural and others in major cities — will focus at least partly on diabetes, a disease that is both debilitating and expensive to treat.

The federal grants reflect a growing view that technology, including everyday tools such as cell phones and computers, can help change behaviors and poor health habits that lead to chronic illness. In some cases, technology’s advocates argue, seemingly simple solutions such as sending an email reminder to patients about taking the next dose can help.

The grants also offer an early test of a $27 billion gamble by the Obama administration that medical records technology can achieve specific cost reductions and health improvements, critical tenets of health reform.

Hopes are high. In Mississippi, the alliance aims to reduce blood sugar levels in at least one of four patients with diabetes, increase the numbers of people who take their medications as directed and cut the cost of their care by 10 percent – all within the next three years. In Tulsa, Okla., which has the nation’s highest rate of heart disease, another group is hoping that its $12 million grant will reduce preventable hospital visits by 10 percent while saving patients and taxpayers $11 million a year.

“If these [projects] work, they’ll have enormous lessons of all kinds,” said David Blumenthal, the government’s top medical technology officer. Blumenthal, a physician, said in an interview that he believes the benefits will be greatest for people suffering from chronic diseases.

‘Pioneering Communities’

Officials also hope the programs will drum up support for the Obama administration’s broader push to get medical professionals to switch from paper records to digital systems. The administration hopes to create an electronic medical record for every American by 2014.

Many experts contend digital systems not only will help doctors cut costs, but also improve care by reducing medical errors and waste. However, critics argue that the benefits are being oversold and that the stimulus plan provides a windfall to the technology industry. Others are calling for tighter government oversight to make sure that computerized systems marketed are safe and perform as promised.

Recipients of the federal “beacon” grants range from the Minnesota-based Mayo Clinic, a pioneer in digital medical recordkeeping, to the University of Hawaii at Hilo. The Hawaii group hopes to improve care for people with conditions such as diabetes, high blood pressure and obesity who live in rural areas with shortages of doctors.

Though approaches vary, the government is counting on a significant return in savings and improvement in patients’ health for the approximately $15 million it will be investing in each of the beacon programs over the next three years.

“These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records,” Vice President Joe Biden said when announcing the awards in May.

More than 130 health centers and other groups applied for the beacon grants and recipients were chosen based on a review by a panel of health experts. Two more grants will be awarded in coming months. The centers are being given three years to achieve their goals, though it’s not clear what happens if they fail to meet them.

There’s little doubt that finding new methods to combat chronic illness—and preventing people from succumbing to them—can significantly lower the nation’s health care bill. Nationwide, the rate of diabetes, the nation’s fifth deadliest disease, has more than doubled over the past two decades. In 2007, the disease cost about $174 billion in direct costs and lost productivity, according to government records.

Several of the beacon programs hope that sharing of medical information via computer can spot problems before they lead to expensive medical encounters. Among the things the Indiana Health Information Exchange hopes to do with its $16 million grant is improve communication between patients recently released from hospitals and their doctors. The idea is to reduce costly complications that can land the patient back in the hospital.

The Rocky Mountain Health Maintenance Organization in Grand Junction, Colo., plans to use its nearly $12 million grant to build links between the electronic record systems for 12 hospitals and 700 physicians in western Colorado. The group hopes to send doctors email alerts advising them when patients fail to follow their instructions by, for instance, not refilling their prescriptions on time. That might delay a patient’s recovery or lead to more costly treatment.

“You have a clear way of showing how costs can be avoided with better data,” said Patrick Gordon, director of the Rocky Mountain program.

But Will it Work?

Yet not everyone is persuaded that government officials can count on cost savings, or that economies the programs achieve can be replicated across the country.

“This is not as easy as it sounds,” said Cynthia Dunn, a health information technology consultant who has worked with a number of small medical practices. Part of the challenge, Dunn said, is that a lot of factors contribute to the success of digital medical systems and that many areas of the country are behind in adopting the technology.

Others point out that programs targeting specific diseases in the hopes of saving money have sometimes suffered from mixed results.

In 1997, Florida officials adopted one of the nation’s earliest and most ambitious disease management projects for low-income people on Medicaid.

Florida officials touted the program, which initially took aim at diabetes and asthma as a big money-saver, but were disappointed several years later when legislative auditors found the predicted savings largely failed to materialize.

Disease management remains controversial even as it has blossomed into a huge billion-dollar industry, with its own trade association and adherents among some of the nation’s largest health care plans.

In 2005, a Congressional Budget Office report found “insufficient evidence” to conclude the programs reduce health spending. And a 2009 study in the Journal of the American Medical Association questioned whether Medicare disease management programs led to fewer hospital admissions and lowered costs.

In Mississippi, some are skeptical that technology alone can overcome diabetes, obesity and high blood pressure, which are more common in the Delta region than almost anywhere else in the country. Nearly a third of residents are obese and more than one and 10 adults have diabetes, according to the federal Centers for Disease Control and Prevention.

“I think it’s a pretty big leap between EMRs [electronic medical records] and health disparities,” said Lynne Cossman, a sociologist at Mississippi State University who has studied the problem in the state. “There are a lot of things that have to happen in between the use of the technology and reducing the actual health disparities.”

Mississippi is also one of the poorest areas in the country, with more than 1 in 5 people living below the poverty line. Factories have shut down, abandoned buildings are a common sight and unemployment rates are high even in a good economy.

Nutrition is another challenge. Fried and greasy food are staples of the local diet and healthier food is often so hard to come by that some have called the region a “food desert.”

Though policymakers in Washington envision patients with greater access and control of their medical records, some people in the Delta are unlikely to do so anytime soon because they don’t have computers at home.

Still, with the new money, the Delta Health Alliance expects at least 70 percent of the region’s approximately 400 doctors—most of whom practice solo or in small groups—to go digital. They have already helped set up more than 100 doctors and nurses in the region. Though some are skeptical about the impact on the community, others are hopeful the new systems can make a difference.

“When this thing finally gets perfected we’ll have a lot of access to records and subsequently I think care will be better,” said Dominick Trinca, a Greenville family practice doctor who uses a digital records system.

Whether the technology will ultimately be enough to help patients such as Richardson is still unclear. Her problems started more than 10 years ago after a blood vessel burst in her head. She gained weight and now struggles with conditions such as high blood pressure and sleep apnea as well as her diabetes.

Though she hopes the new computer systems will help her doctors keep better track of her health, Richardson knows her biggest problem isn’t something technology can fix. It’s her diet.

“I want to get back to decent health,” she said. “That’s what I want to do.”