Transcript

Healthcare 360

Announcer: America’s Health Care - The challenges. The promise. The world of health care around us. "Healthcare 360."
Now, from Washington, D.C. - Frank Sesno.

Mr. Sesno: Welcome to Healthcare 360. A panoramic look at the world of health care in America.

Periodically, we’ll come together to explore topic of vital interest to all of us. Those of us on the receiving end of health care, as well as those providing it. We’ll look at what really matters, how it affects your life, your care, your doctor. We’ll gather experts and regular folks to explore what should be the bottom line: How can this country improve the quality of its health care system?

We start with technology, and I’m not talking about biotech or stem cell research here, I’m talking about information, and Health IT, as it’s called, may affect you just as much as the next great scientific breakthrough.

Consider the fact that a study of elderly patients found that one in three received inappropriate medication - some with harmful effects like drug interactions and allergic reactions, or the complications that arise when you try to share information among different doctors, specialists, and hospitals involved in your case. Another study found that more than 15 million harmful medical incidents occur in hospitals every year.

Could this be reduced with better information systems? Well, some are moving to what’s called Personal Health Records, a computerized version of your medical chart. Many say it’s the wave of the future, but along with the promises come reservations. How do I keep my information private? Who owns it? Who’s going to pay for it?

We’ll discuss these issues in a moment, but first, a tale of two physicians who have already faced these questions. One went forward, one did not.

Dr. Benjamin: I needed to find a way to deliver good-quality health care to people who didn’t have a lot of money, and so I needed to find cost-efficient ways and then the Hurricane Katrina came. But, because of experience, I knew that we had to get everything out of there within 48 hours, or it would mildew and we’d lose the ceiling, we’d lose the roof and everything.

Prior to that, we had always said, "I’d like to have electronic records, so that if we ever have a hurricane again, we’d have it." But they were unaffordable. And then when I walked in and saw this, I was just devastated. And I was like, "I wish we had had electronic records," because my employees had said, "we don’t want to dry out records anymore in the sun.” And we’ve got to do it again, because the previous time, we had turned them over and the sun is, like, baking and cooking them, drying them out, trying to make sure they didn’t fade. I even use waterproof ink. To this day, I use waterproof ink.

We spent a lot of time. We spent as much time on the records as we did on the building, trying to dry them out. And even when we opened the building back, we put them in a file cabinet and tried to make sure they were in a metal cabinet. That way, they’d be safe if something happened. Then, New Year’s Eve night, the fire happened, and we lost everything. So all those records we had dried out, we had saved then burned. And so then I was determined, we’ve got to have electronic records. There’s no way we can’t.

This kind of tells me everything about the patient, the entire medical record. One of the neatest things, I think, about it is the fact that I can pull up all of her medications. It’ll tell me I’ve got interactions and to be careful, that these medicines will interact with each other. The yellow is a slight one, where these are a little more serious. The red ones are very serious.

I’d like to be able to use it to improve the care that I give patients. For example, I’d like to pull all - just click a button and say, "you haven’t had your mammogram. It’s due in two days, so you need to get in here." Things that I would have to pull every paper chart before to find that out, and now I can do it with the touch of a button.

Dr. Bentz: We’re - we’ve always billed ourselves as a mom-and-pop entity. I have five children. My children would play on the floor, and my wife helped answer the phone, and it was a family medicine with a capital "F."

Trying to make money in the business of medicine actually did become much more difficult. I personally did not integrate or purchase an EMR - an electronic medical record - primarily because of cost.

You reach a point in your career, and there is an aging physician workforce. There are a lot of people in my shoes that are mid-fifties to mid-sixties, and they’re faced with a decision: “What do you want to do here now?”

Doctor: You’re gonna have to take it easy when you get home.

Dr. Bentz: An electronic medical record costs … $40,000 to $60,000. You need to - there’s a downtime from when you initially start using an electronic medical record. You’ll actually go slower because there’s a learning curve there that you have to - you have to get over. But the questions then becomes, “Does a person in that age group - do you take one that kind of indebtedness, watching what happens with medical reimbursement in general?” And medical reimbursement in general - you could ask - any doctor would tell you that that’s on a downward slope.

Mr. Sesno: Well, such is the state of affairs for many physicians. Now here with me to discuss these issues are four people from across the spectrum: Dr. Carolyn Clancy is director of the government’s Agency for Healthcare Research and Quality, part of HHS. The agency was created in 1989 and funds research to advance the quality of patient care.

Alison Rein is the Assistant Director for Food and Health Policy at the National Consumer League, a leading consumer rights group concerned with, among other things, privacy and protection for consumer rights.

Dr. Alan Merten, President of George Mason University. It’s been spearheading efforts to further the adoption of health IT among doctors, hospitals, pharmacies and others.

And Dr. Greg Bentz. You just saw him in that film there on the job. He joins us, as well.

Thanks for allowing our cameras, Dr. Bentz, to catch up with you at your new post as Chief Medical Officer at INOVA Loudoun Hospital. As you saw, Dr. Bentz was in private practice for many years, and now you’re at the hospital.

Dr. Bentz: All true, sir.

Mr. Sesno: All true, all right. Well, Dr. Clancy, let’s start with you. Establish why this matters. I’m a patient. I’m watching this. I’m glad to hear that some doctors are considering electronic records and some are not. But for me, on a day-to-day basis, I care about whether I’m getting good care. Why does it matter?

Dr. Clancy: You’re absolutely right. But what’s essential to your getting good care is having good information. And if you see more than one doctor, or you have to go to a hospital, or to get a laboratory test, or go pick up a prescription, the more that information connects with each other, the better the care you’re getting.

Mr. Sesno: How many doctors out there are now using this kind of computerized patient medical record system?

Dr. Clancy: Roughly 25 percent…

Mr. Sesno: Just a quarter!

Dr. Clancy: Have something like that.

Mr. Sesno: So not many.

Dr. Clancy: Well, that’s probably a little high…

Mr. Sesno: Oh really?

Dr. Clancy: Because they’re not using all the functionality of the record.

Mr. Sesno: So this is very new?

Dr. Clancy: Yes.

Mr. Sesno: This is an emerging technology in this field?

Dr. Clancy: In terms of its impact on outpatient practice, yes.

Mr. Sesno: Alison Rein, the consumers’ view to all of this?

Ms. Rein: I think our view is essentially that it’s inevitable that we’ll move forward with an electronic transition and that it will be vital to health care delivery and improvement. But we have a lot of concerns about how this is actually implemented, wanting to make sure that the policies are integrated along with the technology.

Mr. Sesno: What’s your main concern? We mentioned privacy. Is that the main one?

Ms. Rein: It’s privacy, confidentiality, appropriate data use. I mean, we acknowledge that the information is going to have to be shared, but we want there to be certain rules and protocols for how it can be used and shared and only when the patient or their family wants that to happen.

Mr. Sesno: So to boil it down, it’s sort of like an ATM on steroids, right? I mean, if I worry about my ATM card or identity getting stolen, my medical records would be potentially even worse and certainly a lot more private.

Ms. Rein: It is. And consumers have a much higher degree of sensitivity with respect to their medical information than financial information, in part because we don’t have a lot of the safeguards in our system protecting health information.

Mr. Sesno: But why isn’t it mostly, like 95 percent, a great thing? Because if you talk about protecting me, the most basic protection is that when I go to the doctor, he doesn’t screw up my medical records and give me the wrong medication. He can pull everything up, or she can pull everything up and see what I’m all about.

Ms. Rein: I think that that is certainly a laudable goal, and I as a patient would want to see that, but there are a lot of concerns about what else that information could be used for. So right now, we allow discrimination for employment, for health insurance coverage. People are really concerned that their health information could be turned and used against them, and there have been several cases of that.

Mr. Sesno: Dr. Merten, George Mason University is involved in promoting this. What are you learning?

Dr. Merten: Well, I think we’re learning that it’s important and that there are concerns at the same time. I’m a computer scientist, and over the decades, I’ve been struck by how computers have changed so much of what we do and how we act in our society. And it’s amazing that in this one area, probably the most important area where we’re lagging, where we haven’t figured out a way how to address the issues that have been addressed here with respect to privacy and others. But it’s important. Information is power. Information is important. And what we’re trying to do at George Mason University is bring the right people together to address the kind of issues that we’re talking about here.

Mr. Sesno: Dr. Bentz, for the patient, what matters most?

Dr. Bentz: Quality care. And I think the fact that you are - you’re not a horse-and-buggy operation anymore. You’re not a ballpoint-pen operation anymore - that you’re using the state-of-the-art in all of the aspects of health care that gives them confidence when they walk out of the office.

Mr. Sesno: We saw you in your office there, and you told us that in a sense, you, and a lot of doctors like you, can’t afford this.

Dr. Bentz: That’s a - cost is a big issue, and I think - and I’m not alone. I think there are many people, I reiterate, in my age group, who have been in medicine for a number of years, and they have a decision to make. They have to either - you can either - as my father would say, "You can stand there and shuffle your feet and wring your hands, or you can do something about it." I did. I transitioned my patients into a practice that has electronic health records and moved on to an institution that had all of the things I needed to continue to do health care, like palm pilots and all the computer support I could possibly need.

Mr. Sesno: So, Dr. Clancy, let me ask you this question. Again, I’m thinking as a patient here. I’m also thinking as a consumer. I use technology all the time, and I’m fond of saying, every once in a while when something crashes, that I’m standing at the digital divide and I’m about to jump. Because you know, something crashes or shuts down, and it shuts me down. How does that not get - how do you balance the opportunities and the risks of this kind of technology?

Dr. Clancy: Well, I think that’s a really, really important question. And of course, you saw Dr. Benjamin in the opening clip. She’s the same doctor she was before - after - before she was - after Katrina as she was before Katrina - same smart person, same compassion and passion about giving her patients good care. But she doesn’t have their information. So to some extent, that is the critical issue. What kind of care and quality can I provide to the patients who come to me with their problems if I don’t have their information? And the short answer is, "not very good."

So many doctors do worry about the backup problem. “What happens if the server goes down or I lose power,” and so forth. But more and more vendors are getting smart about providing backups for that. So you know, when the veterans hospital left New Orleans, they evacuated their people, and they simply uploaded all the records.

Mr. Sesno: Well, they had all this information living on systems.

Dr. Clancy: Absolutely.

Mr. Sesno: Alison Rein, give us an example of - if there is one at the top of your head - of a concern, of a case where someone’s medical records weren’t properly guarded.

Ms. Rein: The mechanism to track that right now rests with the Office of Civil Rights, which is part of Health & Human Services. And there’s been, I think, 24,000 reports, and not one single violation or penalty has been assessed, so -

Mr. Sesno: So reports of what, of what happening?

Ms. Rein: Well, it’s a mixed bag. So if your data has been misused or if they think there is a violation or breach of the Health Information Portability and Accountability Act.

Mr. Sesno: Let’s figure out when you say “my data,” what’s “my data?”

Ms. Rein: It could be anything. So one really, really touching example is a woman whose - whose mental health information was sent along with the entirety of her medical record, and that piece of it didn’t need to go to get the care that she needed. And now she is completely unable to get that piece removed from her medical record. So every time that medical record gets shared with another institution, they also have her mental health history. And that’s really -

Mr. Sesno: And she doesn’t want that?

Ms. Rein: She doesn’t want it. She has tried - there was an article in "The Wall Street Journal" a couple months ago about her, and she has tried every means of recourse she has. And she can’t get anybody to change it in the system, in part, because the law affords her no protection and no recourse.

Mr. Sesno: Dr. Merten, big issue?

Dr. Merten: But frankly, I mean, these are things we’ve dealt with in so many aspects of our society to try to figure out how to properly use technology and how to protect the consumer. And it’s striking that we’re so far behind in this one area, and I think you’re right - that sometimes, the law isn’t there, but in a sense, we have an obligation to get these systems working.

One of the - my favorite phrase is that more and more consumers today expect both high touch and high tech. They really expect to have the kinds of care and feeding that they need.

Mr. Sesno: Did your patients expect high tech when they came into your office?

Dr. Bentz: They didn’t necessarily expect it, but they always knew they were gonna see me ’cause I was so low.

Mr. Sesno: But you’re not high-tech. You’re a human being.

Dr. Bentz: I’m a human being. And I think if there is one thing that comes out of this - and I think that your point, Alison, was perfectly well-made - and that is they do want both of those things. And we would hope, as a family physician, that the tech doesn’t get in the way of the touch.

Mr. Sesno: So let me throw this question out to all of you then. Let’s take this challenge first. How then can my records - the most intimate details of my life that live on somebody’s computer that can be, with the touch of a button, sent anywhere somebody chooses to send it - be protected? What’s the mechanism for that?

Dr. Merten: Well, there’s plenty of technology - that’s used in the financial services industry, that’s used in the airline industry - out there to protect it. There’s various firewalls. There’s various ways of keeping that information protected. I think sometimes, in this area specifically, we have so many different players: the physicians are a player. The hospitals are a player, the pharmacists - and I think that the locus of responsibility and the locus of who pays for it isn’t as clear.

Dr. Clancy: And if I could just pick up on one word. There are a lot of good technological solutions, but it’s ultimately got to be about trust. Individuals have to be able to trust that the information about them won’t be disclosed without their permission.

Mr. Sesno: They are going to build that trust, though, it seems based on their experience and the experience of others - they hear stories like this, they’re going to have a hard time trusting, right?

Dr. Clancy: Well, that’s correct. And that’s why over the past year, we’ve been actually supporting a contract that has gone out and talked to folks in over 17 states and brought them together to try to make sure that we can build this trust into it, because a big part of the power of this information-sharing isn’t just wiring Dr. Bentz’s or Dr. Benjamin’s office. It’s actually being able to make sure that as you move from one part of the health care system to another, your information follows you. So you saw Dr. Benjamin saying, "It’s so great that I know all the medications." You have no idea how many times, if a patient who sees multiple physicians, this is not knowable.

Mr. Sesno: Well - or how about this? You know, somebody’s out skydiving in Montana or something...

Dr. Clancy: Exactly.

Mr. Sesno: And something goes wrong with the parachute, and they find themselves in an emergency room somewhere, unable to communicate what their condition is...

Dr. Clancy: That’s exactly it.

Mr. Sesno: Is the idea - you know, they’re from Connecticut or something - that the physician can pull up and see the full breadth of their medical condition?

Dr. Clancy: Ultimately, that is what we’re trying to build. We’re not there yet, but I think we will get there.

Mr. Sesno: How far are we from that?

Dr. Clancy: Well, the president set a goal for the nation that the majority of Americans would have an electronic health record by 2014. And I would say we’re making very good progress.

Dr. Merten: But technology-wise, we could be there much sooner than that. I think it’s the trust in the systems.

Dr. Clancy: And without that trust, we should stop talking about this.

Mr. Sesno: I mean, the irony is you can drive your car into any, you know, repair shop anyplace. They check the VIN number or just scan it, and they can see when you had your last oil change. But if I need an oil change, I need more help than that. How much does all this cost, and who’s paying for it?

Dr. Clancy: That’s a really good question. Right now, there is a pretty big expectation that physicians, hospitals and others will be bearing a big part of the burden of the cost. I think it’s real important, though, to be clear about what we are buying here. Some part of it is the hardware and software, but vendors and others will tell you that’s about a third of the answer. The rest is, how do you change your practice? And I think Dr. Bentz said it very, very well earlier. Do I want to do this at this point in my career? If I’m a young doc and I like playing with new toys, this is fun. This is cool. In fact, I probably arrived with my own handheld computer.

Mr. Sesno: Mm-hmm.

Dr. Clancy: But the real value of the technology isn’t just having that electronic medical record. It’s actually reworking the practice, whether you’re in a small practice, large one or in a hospital to get the value out of it.

Mr. Sesno: Allison, what should consumers be - If Dr. Bentz were to tell his patients, "Okay, I’m going electronic. I’m going to take all your records ... all that stuff I have ... that’s been occupying all this wall-space and file cabinet space, and making electronic now."  What should consumers be engaging by way of conversation and question here?

Ms. Rein: I think that it’s most important for the consumer to understand to what extent they can and cannot control who their information goes to, what pieces of it...

Mr. Sesno: So I want to know where you’re sending that?

Ms. Rein: Yeah. I want to know where you’re sending it. I want to know what part of my record you’re sending. And right now, we don’t have - the technology exists to do that, but we don’t have a broad framework or policy infrastructure to say. And so I think a lot of the reluctance - certainly, cost is a factor. Certainly, some interoperability technology issues are a factor. But there are a lot of people in all of the different stakeholder groups in health care who would really like a better road map for where all of this is leading, because in a state of not knowing, they’re sort of paralyzed.

Mr. Sesno: So what would - give me a few questions that you’d literally put to your doctor. Where are my records going?

Ms. Rein: Where are my records going?

Mr. Sesno: That’s the one that you mentioned.

Ms. Rein: Are you going to ask me for my consent before you release it for any of the things that you’re going to - wherever it’s going to flow?

Mr. Sesno: Right.

Ms. Rein: And then if somebody wants to use it for something else, are you gonna come back to me and get my authorization for that something else, which wasn’t the original...

Mr. Sesno: Okay, Dr. Bentz, what’s the doctor...

Dr. Bentz: Well, there are - I mean, we don’t release anyone’s medical information without their authorization, even very simple things that albeit now on paper. I believe the laws - and I’m not an attorney - but the laws are that if you’re in the loop, if you’re - if I have a patient and a cardiologist is also seeing that patient, that we don’t need any further authorization to do that. But we’re very adamant. We don’t let anything go out of our office without someone’s - we don’t give information to a mother’s son if he’s 18. If he’s 18, he’s a - he’s no longer a minor, and they get upset. "He’s my son!"

Mr. Sesno: Dr. Clancy, last word to you. Define Success.

Dr. Clancy: Success is when Americans can go in to see a physician, go to a hospital and know that they’re gonna get high-quality care. We can’t get there without using the value of Health IT.

Mr. Sesno: And do you think this Health IT can address some of those issues that I pointed out earlier - these accidental medications, accidental deaths, some of this miscommunication that’s leading to negative consequences?

Dr. Clancy: It is a vital tool to getting us to the kind of safe, high-quality care that all of us want for ourselves.

Mr. Sesno: Okay. Thanks to all of you.
But what do we do about all this? How do we get there? When you discuss Health IT, you’re talking about a universe of technology - some referenced here - everything from e-mail and PDA’s to telemedicine, the ability to actually perform surgery - actually perform surgery - from a remote location. So now we look at an innovation in two vastly different settings - a physician operating something he calls a micro-practice, a doctor’s office so small, he freely hands out his e-mail and cell phone number. And by the way, he does the billing and the scheduling himself, too...and a multimillion-dollar enterprise that’s changing the paradigm of emergency medical care.

Dr. S. Moore: Behind me, are a bank of terminals that give us access to the vital sign information.

Woman: Okay, this is the patient’s live feed. They’ve just returned from the operating room from open-heart surgery. These first two lines is their EKG

Dr. S. Moore: We have the ability to access labs, our pharmaceuticals that we’re giving to the patients, have an ability to zoom in with cameras that are in the room in order to look at settings on monitors and settings on I.V. pumps that are delivering medications.

Woman: And this is real time. This is what’s happening to the patient now.

Man: When the bedside nurse decides she needs help, all she has to do is hit a button on the wall within the hospital or the patient’s room, and we are available to camera in and assess the patient.

Dr. S. Moore: I think the patient really gets an opportunity to have an extra pair of eyes looking at their case.

Woman: When the patient’s vital signs exceed or go below this baseline, it sends us an alert. Yellow are cautionary, and reds are the ones we need to respond to.

Dr. Betadpur: I can give you instances where we have intervened and made a big difference in patient outcome, especially in complicated cases -  of a patient who has had an acute bleed and we were there to pick up on that, or was in impending respiratory, and we were able to assess that. And for the provider, it certainly is satisfying to be able to be at the bedside, virtually be at the bedside, within 15 seconds of being called.

Nurse Kules: One day, I received an alert on my sentry alert screen for a patient whose oxygen was decreasing. I went into the room by live feed and found out it was even lower and that he was in severe respiratory distress. And within a minute, the nurse responded to the bedside, was able to clear his airway by suctioning and his oxygen went back up to 100%.

Dr. Geoly: I manage my kidney transplant patients. So in the morning, when I’m in my office, I log in to INOVA, and all the transplant data is online. So if I want to see a lab test on a patient from 1995, I can see that. Over the years, we’ve added different functionalities so that in the year 2000, we added transcription. So I can see any transcriptions -  histories and physicals, discharge summaries, operative notes, anatomic pathology and it’s eminently accessible down to x-rays at the primary care physician’s desk. All they need is an Internet connection. All the physicians at INOVA have is INOVA data. We haven’t quite worked out the protocol to bring in data from outside sources into INOVA’s database, if we do that at all.

Dr. Moore: You’ve got my e-mail already?

Woman: I’ve got your e-mail at home, yeah.

Dr. Moore: As a business model, this practice works because the information technology allows me to work with a lower staffing ratio. Therefore, the overhead’s down, so I don’t have to drive the productivity to a number of visits, the throughput that most practices need to make payroll. In many practices unfortunately, this drive for productivity to make ends meet, to pay the overhead and have a reasonable take-home, is a painful pressure.

What we have in the converse now is doctors who are thrilled at what they do, enjoying it immensely, as I am in my practice. That’s been just a huge turnaround for me.

Dr. Moore: I mean, if that’s a potent steroid, then the risk for you...

Dr. Moore: My practice is very small. I’m able to deliver same-day access, hand out my cell phone number, use electronic systems for reliability and outreach. People remark to me all the time about how little they have to wait around, how quickly they can get in...

Dr. Moore: Do you want to do 10:00?

Woman: Yep, that’s good.

Dr. Moore: How pleased they are that I share information with them, look things up on the Internet.

Dr. Moore: By the way, do you ever go on here and take a look at this?

Woman: The only thing that’s bothering me is when I cough.

Dr. Moore: I can come to work after I drop my daughter off at 9:00 and get home by 5:30 and be there with my kids and family. So I have a sustainable practice. I’m delivering the care at the level that I always hoped to in terms of the quality and the relationship.

Woman: (Thanks.)

Dr. Moore: (See you.)

Woman: (Bye-bye.)

Mr. Sesno: Well, loving your work and being efficient at it, too - you can’t argue with that. So joining me now to discuss the potential of this Health IT, four - three new guests -

Terry Davis, a registered nurse and Director of Patient Care at an EICU at INOVA Health Care System in Northern Virginia. That’s the off-site intensive care unit just profiled at the beginning of our taped report there...

Dr. Gregg Meyer is medical director of the Massachusetts General Physicians Organization, a group that strives to improve patient care, promote medical education and protect the financial stability of its members...

And Dave deBronkart. He joins us, as well. He’s actually experienced this new health care system in a very personal way - as a patient. He was recently diagnosed with kidney cancer, but because of the electronic systems his primary care physician and radiologist used, he was able to begin treatment earlier. And in the world of cancer, every day counts.

So let’s start with you. Thank you very much for coming in and for sharing this story. How did Health IT connect with you in this way to find those very important extra days and weeks?

Mr. deBronkart: Well, I’ve been using the PatientSite system at Beth Israel Deaconess in Boston for

Mr. Sesno: PatientSite?

Mr. deBronkart: PatientSite is the name of the web site. It’s a secure system where I can go in, and instead of sending information loosely on the Internet where it can be eavesdropped and snooped, I can go in behind a firewall and see the actual medical records...

Mr. Sesno: Mm-hmm.

Mr. deBronkart: My lab test results, radiology reports and so on.

Mr. Sesno: All your own records?

Mr. deBronkart: Yes. Uh-huh. Exactly. Exactly.

Mr. Sesno: Okay. Mm-hmm.

Mr. deBronkart: You know, and that carries a certain responsibility with it because you know, I’m not a doctor. I need to be responsible about what I’m looking at and reading questions - asking questions. So what happened with me just a month ago is that I was already set to have my annual physical with the doctor, but I had a few symptoms that I wanted to bring up. So using their secure e-mail, I was able to ask him those questions, and he told me to go ahead and set up some follow-up appointments without waiting for the physical.

Mr. Sesno: So to expedite that whole process...

Mr. deBronkart: Yes. Exactly.

Mr. Sesno: Based on the information that you yourself had gotten from your own computerized records?

Mr. deBronkart: Well, in that case, it was just, "I’m having a problem with my shoulder."

Mr. Sesno: Uh-huh.

Mr. deBronkart: "I’ve had something going on with my knee," um, a variety of things like that.

Mr. Sesno: Did you end up starting your cancer treatment earlier than you might have otherwise?

Mr. deBronkart: Well, what happened was one of the follow-up appointments we set up in advance was a shoulder x-ray. And so two days after my physical, I had the shoulder x-ray, and they said, "Hey, there’s a spot on your lung." And that led to, within a week, diagnosing that I had kidney cancer. I had no symptoms. Heaven only knows when I would have actually had that detected. And because I didn’t have to wait two months for my appointment for the shoulder x-ray, I was able to get the - get the diagnosis and the treatment started.

Mr. Sesno: Dr. Meyer, this is a remarkable example of a patient more involved with his own care, seeing information that’s available through this kind of technology, taking action and maybe buying some very important time.

Dr. Meyer: These vignettes, and I think this story that you just heard, really illustrate the fact that technology makes me a better doctor. And right now, one of the most dangerous things in health care is a pen in the hand of a doctor with poor handwriting. And yet, I know that none of my patients have had a misread prescription for 13 years.

Mr. Sesno: Because...

Dr. Meyer: And that’s because I was blessed to practice in the military system. And I’m now at Mass General in Boston, and we have these types of electronic systems. They not only give me information when I need it, they also help me make better decisions in terms of alerting me to things, like drug interactions and allergies - the kind of information you saw in the beginning. And they help me communication better with my patients as well.

Mr. Sesno: Better with your patients - so that you can say, "Get going on something," or "Don’t worry about something else."

Dr. Meyer: And there’s a big barrier, I think, for patients to pick up the phone and call their doctor.

Mr. Sesno: It’s hard to get through. Doctors are busy.

Dr. Meyer: And yet we now live in an age where we’re so used to communicating with each other in other ways, and we really need medicine to catch up with that. And the secure portal that you heard about that’s being used at Beth Israel, and we have another portal at Mass General - very similar - allow us to communicate with our patients in a much more asynchronous way, a way where they can leave a message for me. I can get back to them, and for non-urgent issues, it’s just a better way to handle that communication.

Mr. Sesno: Now you mentioned that when you were in the military, you didn’t handwrite prescriptions. That was all electronic then. The military has been this way for quite some time.

Dr. Meyer: The military and the VA systems really have been leaders in these technologies.

Mr. Sesno: So why is the rest of our medical system lagging so far behind?

Dr. Meyer: You know, part of it is that these technologies are expensive, and you heard a little bit about that from Dr. Bentz earlier. In addition to that, though, there are barriers to adopting these practices, and you heard about that as well in terms of physicians spending the time to get up on these records. And one of the things that we have to be cognizant of - that part of it is having a great seed, is having a good technology and a good intervention and now vendors and other producing systems that work for doctors.

But another part of it is the soil - it’s having the culture of physicians ready to accept these technologies and really take the time to use them and to exploit them fully to the benefit of both ourselves and our patients.

Mr. Sesno: Terry Davis, you know, we think about nursing, and we think about Florence Nightingale and Clara Barton and all these wonderful people. We also know that if we’ve ever been into the hospital, probably the people we deal with the most in the hospital on a day-in and day-out basis is the nursing staff.

Nurse Davis: Mm-hmm.

Mr. Sesno: How does this change the way nursing is done, the way care is delivered on that day-in, day-out basis from your perspective?

Nurse Davis: I would say that what the EICU has been able to do is to put in an additional layer of care for the patient out there. It hasn’t replaced any of the nursing that’s already taken place in the hospital. But because we get continuous feed of patient vital signs and condition, we can back up the nurses in the hospital and the physicians in the hospital. At night, when our intensivist physicians come in, they’re actually able to treat patients through the night, where I would say years ago, as I practiced at the bedside, there were times at night you didn’t always have a physician available. They were available, but available by phone.

Mr. Sesno: Well, explain to us how this works. We saw in that video - we saw the camera pan over, and presumably, somebody’s actually telling the patient that the camera’s on now, or it’s not big brother who’s watching. It’s big doctor who’s watching, right?

Nurse Davis: Right.

Mr. Sesno: So you’re told, but what exactly is going on there?

Nurse Davis: What’s happening is we will get continuous vital sign feed over to the remote site that we’re in, and we will respond to those changes in patient status. And the camera is a tool in order to get into the room. It’s an assessment tool. So we’ll use the verbal technology and the video technology to go in the room and actually see the patient and assess the patient. If there is a medical team at the bedside, our physician will work with the physician at the bedside to make decisions about the patient’s care. So you have nurses watching 24/7 and physicians watching during the night shift to back up the hospital.

Mr. Sesno: And that information can be - if you needed a super-specialist, can that information be transmitted to somebody in some remote corner of the country who happens to be specializing in...

Nurse Davis: Well, we actually - the intensivist is considered the super-specialist in an intensive care unit. If you look at the leapfrog initiatives, it said that if you have an intensivist in an I.C.U., you can improve mortality rates by 40%. So the intensivist really is your intensive care specialist. So they are -

Mr. Sesno: Any of your patients have a problem with that camera in the room?

Nurse Davis: I would say we’ve seen over 20,000 patients, and we’ve only had four that had concerns about the camera.

Mr. Sesno: How would you feel about that?

Mr. deBronkart: No problem with me.

Mr. Sesno: Right. Right. If you’re gonna help me, I’ll take it. Sure.
Does this change the patient-doctor relationship? As you bring more and more technology into the equation, does that alter the -I see everybody’s nodding their heads.

Dr. Meyer: Yeah. As a physician, I’d say, I think it does. But I think it really can do so in an enhancing way. And that is is that it has a potential, really, to free up time, to really do that mixture as you heard about earlier. Patients want high tech, but they need high touch. They need me not only to be aware of things and not only communicate with them, but they need my presence as well, and they need me to examine them in all those important parts of caring. And the truth of the matter is is that pushing away some of these more superfluous parts of the way we communicate with patients and handling them through e-mail or triaging them with nurses that are answering those messages and refilling those prescriptions, allows me time to spend time really being their doctor.

Mr. Sesno: Dave?

Mr. deBronkart: Yeah. Absolutely. It’s changed the relationship that I have with this primary doctor compared to others that I’ve had in the past. I actually have the experience of more high touch because I have much more frequent interactions with my physician.

Mr. Sesno: Yeah. I know that when we went through and a relative was very sick - a relative of mine - and I had to deal with the doctor, the only way I really had to communicate was to try pick up the phone and call. And getting that callback was a very difficult and actually very frustrating thing, presumably because the doc was so busy, but there really was no other way to communicate. Now the flip side of that might be - I don’t know if you’re ever inundated by e-mail - I am - can you get so much as a doc, that you can’t even cope with it all?

Dr. Meyer: You can. And I think one of the things that’s important here is to really - to put a system around this. So just opening up your e-mail account or giving someone your cell phone number isn’t enough. It’s really to make sure that you have the ability to respond to messages promptly, to triage those messages and really, to let people know of when maybe an e-mail isn’t so appropriate - for example, for an urgent medical condition - and a phone call directly to the doctor or to the doctor’s office is. And so in and of itself, I think that technology is very helpful, but you have to wrap a system around it for it to work as well as it ought to.

Mr. Sesno: What do you think - and I want to keep coming back to this question of what the patient can or should be saying to his or her doc in terms of this kind of technology that exists, how it works for that individual patient and how they can incorporate it into their lives?
Dave, you’ve already done that.

Mr. deBronkart: Mm-hmm.

Mr. Sesno: So what should people be talking to their doctors about?

Mr. deBronkart: In my case - first of all, I’m not a doctor, so I can’t say what somebody should be -

Mr. Sesno: No, no, no.

Mr. beBronkart: I’m saying from a patient’s perspective. From my perspective, if I have just little aches and pains or symptoms that start up, you know, usually, those disappear on their own. But when it gets to the point where something’s not going away on its own, I - you know, you face the question about at what point do you pick up the phone, or at what point do you decide to get in contact with the doctor? And just knowing that I can do that in a way that won’t interrupt their day and they’ll have the freedom to reply when they feel it’s appropriate, I actually interact more often. And I say - I list out, "Here’s what’s going on. What do you think?"

Mr. Sesno: Terry.

Nurse Davis: Ask me the question again. I was listening to him.

Mr. Sesno: No. What should patients - what kind of conversation should patients initiate with their doctors or with their nursing staff if they’ve got someone in a hospital or they’re in a hospital by way of communicating and using these technologies?

Nurse Davis: I would say I’d like to know how they really feel day to day. Do they like that extra person coming in the room? It appears that they do from what we’ve seen. They’re usually waving at us when the camera turns around. But you know, how does it make them feel? What would they like to see differently? Would it help if we had a 2-way video? Those kinds of things. Because really, it’s the feedback that we get from the patients and the users that help us do it better.

Mr. Sesno: And finally, I’d like to ask you this. We talk a lot about disparities in health care delivery. Rural - people who live in rural areas may have many, many miles between them and their doctor or hospital or whatever. Thinking of rural America, thinking of inner-city America, what kind of prospects does this sort of technology offer?

Dr. Meyer: You know, I think you really hit on one of the big issues, and I think that is whether or not the digital divide, which plays out in many sectors of our life, is gonna play out writ large in health care. And I think that it also has the opportunity, though, to change that. So for example, my parents live in a very rural area of upstate New York along the Vermont border. And the ability to go to a facility near them and if need be, to do a telemedicine consult with a specialist in Boston is something that’s very real now. And so in some ways, we’ve been able to use this information technology to kind of cross some of those bridges much faster than we otherwise would. And one can think of the way that we’ve had telecommunications evolve. Many parts of America waited for years to have phone lines to be strung through their areas. But now with digital technology and with wireless, we can get to them quicker. We need to do the same kind of thing with health care.

Mr. Sesno: And, Dave, very quickly, was it easy or difficult for you to learn how to navigate PatientSite and find your records and make sense of it all?

Mr. deBronkart: Moderate.

Mr. Sesno: Moderate. You had to spend some time doing that?

Mr. deBronkart: Yes.

Mr. Sesno: Was there anybody to help you, or were you winging it?

Mr. deBronkart: I could have asked for help. They have a support link on the page, but I’m the kind of guy, I like to dig around myself.

Mr. Sesno: Are you a super-technology kind of guy?

Mr. deBronkart: I’m more than average.

Mr. Sesno: More than average. But it’s a kind of thing you think that most people could get their brains around?

Mr. deBronkart: Especially with some help. Now different Web sites work different ways.

Mr. Sesno: All right, so navigating the navigation, that’s something to keep an eye on, too. Thanks to all of you.
Well, sometimes it is the simple solution that shines. You might say that that of Mi Via - Spanish for "my way" - that’s exactly what it offers migrant farm workers on the west coast. We were talking about rural care a moment ago. Well, what about this case? Unlike the personal health record systems employed by hospitals, insurance companies and the like, the participants in Mi Via actually own their own data, and they get to control who sees it from Sonoma country, California.

Woman: Here we have this huge population that come from Mexico, move, migrate along this path. You know, our community comes together and provides medical care. We have this mobile van. We have the clinic. And their information leaves - it gets stuck behind.

(SPEAKING SPANISH)

Ms. Alcantar: What I do is I bring a program called Mi Via, which is an online medical record, and we have everything that your normal chart would have - like doctor visits, dental visits, medications that you’re on, allergies, family history. I mean, we have it all in there.

Woman: Seal 14.

Ms. Tomascewski: Our population tends to - you know, to travel and Mi Via - if you have Internet access, you can access their chart.

Ms. Alcantar: It’s kind of nice to have information all together, so you’re not going to different clinics and you know, having double procedures on you or finding out that one medication doesn’t work when one clinic already found that out.

Ms. Stovall: So that if they were seen by a primary care clinic here and sent to a specialist, both sites would be able to have access and add to that information.

Ms. Allen: And this is what the beauty of the Mi Via program is - that as a patient, you have a portable health record. You have access to it. Your providers have access to it, and you always can have this information readily available.

Ms. Soloman: I feel the government’s role is to perhaps focus on the privacy issue and protect the privacy of consumers using this technology. 70 percent of people surveyed about personal health records did not want their employers to be the owner of their record or give them the PHR, and the same thing with the insurance industry.

Ms. Ficco: And unfortunately, the systems that hospitals are investing in and doctors’ offices tend to be proprietary in nature...

Woman: Can I get your name?

Ms. Ficco: And not easy to automatically share and transfer that information. They’re all trying to figure out how to interoperate and transfer information easily. And yet, the Mi Via’s the perfect vehicle for doing that.

(SPEAKING SPANISH)

Ms. Stovall: Just by giving them this tool and teaching them their rights, as far as having access to their health information, it brings them into a loop that they didn’t even know was there. With Diabetes, by giving them the tool to keep track of their blood sugars - makes them pay more attention to their blood sugars, makes them pay more attention to their diet - which affects their blood sugar - and it brings them into the process. Whereas, before, a lot of times it was just, show up the doctor. Tell me what I need to do. Maybe I’ll do it and maybe I won’t. But if I have to become part, or if I am given a tool to become part of the process, I will engage more so.

Ms. Soloman: The technology is way ahead of policy. Frankly, you know, we’re afraid of our insurance companies. I don’t want my insurance company knowing if I’m monitoring my high blood pressure. Our feeling is that there’s a way to partner with these organizations but still keep the control of the personal health record in the hands of the consumer.

Mr. Sesno: "In the hands of the consumer." Can the individual control his or her health records when they live on computers? Should they?

With me now to continue our exploration of Health IT is Geoff Brown. He’s Chief Information Officer of Information Technology at INOVA Health System. He oversees the use of that off-site ICU system you saw in our report earlier in the program.

Steve Wojcik is Vice President for Public Policy at the National Business Group on Health. Their members include some of the nation’s largest employers and health care companies.

Deven McGraw: Chief Operating Officer of the National Partnership for Women & Families, a nonprofit organization that promotes women’s rights, fairness in the workplace and quality health care for families.

And Dr. Rob Kolodner is the Interim National Coordinator for Health IT at the Department of Health & Human Services. Some call him the "health IT czar." He’s the government’s point person in the effort to modernize the nation’s Health Care IT system.
Well, "Czar," welcome to you. Thanks for joining us.

So let’s - if you’re the czar, let’s start with this. I mean, really profound, important questions raised in that tape and actually throughout the program. These medical records are fabulous. They can save lives. They can transmit information. But we want to know whether we control them, how we control them and who owns them. What is the answer to that?

Dr. Kolodner: Well, when it comes to electrons, ownership is kind of a funny term to use. Certainly, both the providers and the consumer have rights to that information, and therefore, both have access to it.

Mr. Sesno: And as a patient, do I own my records?

Dr. Kolodner: You own it in the sense that you should have a copy. Your provider owns it in the sense that they generated it and for a number of reasons - including legal reasons - they need to have a copy, too. So in a sense, both of you have it. Ownership, as I say, with electronic information, is kind of an out-of-date type of term.

Mr. Sesno: Let me go to 20,000 feet here for a minute. Okay. Do I need to worry about my health care provider sending that information to an insurance company, to my employer?

Dr. Kolodner: I think that you should know what the policy is, and if you don’t want that information to flow, that you should have say in where that information goes and doesn’t go.

Mr. Sesno: Geoff Brown, what’s the answer from your perspective?

Mr. Brown: Well, from my perspective, it really is - the owner is the health system, the physician practice, whoever controls the input of that information. One of the things you’re gonna hear about over time is the interoperability. You’re gonna hear a lot about standards. And right now, there is a hodgepodge of various standards being utilized, so -

Mr. Sesno: Now let’s back up, though. Let’s define that. Interoperability - big word, big term - but what it means is...

Mr. Brown: What it really means is the ability to link with all these various applications, whether it be your physician office, whether it be the health system, the hospital, and you being able to access it in a way that it is indexed in a fashion that you can read it, recognize it in the exchange of - from a communication standpoint with your provider.

Mr. Sesno: So in other words, everybody can get on the same system, find the same information, navigate their way around.

Mr. Brown: That’s correct.

Mr. Sesno: The systems talk to one another. That’s not happening now?

Mr. Brown: No, it’s not. It certainly happens within the walls of organizations, but when you start thinking about sharing it outside of that walls with other groups, areas, individual systems, that doesn’t happen.

Mr. Sesno: So for example, what we saw in the tape - Mi Via - great system. It looks like they’re out in Sonoma County. They’re working with all - with these workers. The information, the data is there. Is that not transmittable necessarily elsewhere?

Mr. Brown: I like to use the analogy of languages. You have English. You have Spanish. You have Italian. I think that the reality is all of these applications were not designed together. They were developed commercially by individuals, individual companies and organizations, and so as a result of that, you have a variety of things we call databases, or languages, that they actually operate in. What we’re talking about on the interoperability standard is taking away so that they all will learn and recognize the English language, the Spanish language as one.

Mr. Sesno: Deven McGraw, what are you advocating?

Ms. McGraw: We’re - you know, I really like this Mi Via example, actually, because it really is probably the strongest consumer control model there is out there of electronic health records, because in this case, the migrant workers - who are often transient, who often flow to wherever the work is - they’re bringing their record with them. And so in some ways, some of these interoperability issues that Geoff just brought up are perhaps less important, although, I’m - he’s the technology guy. I think in terms of policies and what might be best for the patient. But the patient is bringing the record to the provider, which is a different model than if I show up in a hospital, and I need to depend on the hospital that saw me last year or the doctor that sees me regularly to be the transmitter of those records. "I’ve got the record. Here it is," or "Here’s how you can access it, and I’ve just given you permission."

Mr. Sesno: So you wonder if that’s maybe even the model. That, you know, if that’s my record and it’s about me, why shouldn’t I be able to have that on some encrypted, encoded card or whatever that I’m traveling around with? It’s updated every time I go to my doc. And if I go to a hospital, if I go to another doctor or if I’ve got this skydiving thing I was talking to you about, somebody can swipe that card and see what I’m all about.

Dr. Kolodner: Well, that’s one model. The - another way to think about it is that these are islands of information that need to exchange it, so that it may be a PHR to an electronic health record - personal health record - to an electronic health record. It may be an electronic health record to an electronic health record. Your information needs to be in key places that are providing you service, whether it’s the laboratory or the pharmacy or the doctor’s office or your personal health record, and maybe it’s in all of them. And I may have a personal health record, and yet, it may also reside in something that the provider is using.

Mr. Sesno: Steve Wojcik, what’s the business angle to this?

Mr. Wojcik: Well, we’re kind of on the side of the consumers. We believe that people need to be more engaged in their health care. So one way to do it is to have ownership of your personal health records. Obviously, we also would like to see the interconnectedness that both Geoff and Bob talked about.

Mr. Sesno: Do you have some examples you point to as to sort of what we should be striving for?

Mr. Wojcik: Well, you know, in the cell phone industry, there are three major carriers, many different types of cell phones, a lot of different types of systems and software. And you can talk to anybody and exchange information with anybody, no matter what kind of equipment you’re using and what your carrier is. And so we’d like to see that in health care, too.

Mr. Sesno: So I went to the store the other day to buy a DVD that I could record on, and there’s DVD-RW and DVD-R and DVD -

Mr. Wojcik: That’s right.

Mr. Sesno: And then I brought one home, and it recorded on my machine, but it wouldn’t record on somebody else’s. Is this sort of what’s happening writ large or some of what’s out there now with these medical records, that we’ve got to standardize these things and get these to all interoperate - is that what this is all about?

Dr. Kolodner: The standardization is fundamental in being able to move the information back and forth, and we don’t have those standards now. In fact, it’s worse than whether it’s a DVD plus or minus or RW. It’s, you’ve got a DVD here, and you’ve got a floppy disk here, and you’ve got, you know, an L.P. record.

Mr. Sesno: Well, you’re the I.T. Czar. What are you doing about it?

Dr. Kolodner: Well, that - what we’re actually doing now is working with the communities to establish standards that meet the needs of both consumers and providers and the rest of the health care sector, so that we, in fact, do have this inter - achieve this interoperability and then using that as the basis for certification of various electronic health records and ultimately, the various networks. So these standards are fundamental in order to achieve that interoperability.

Mr. Sesno: Let me ask the three of you. You’ve got the Czar sitting here. What do you want from government? What does the government - the federal government - need to be providing to protect people’s medical records and information, but also move this forward so that it can be very effective?

Mr. Brown: Deven, you go first.

Ms. McGraw: Okay. I like what someone said in an earlier panel - "a road map for moving forward." And not just a set of sort of steps that we’ll take to get there, but also some overarching principles and standards to guide us for getting there - a clear statement about the need to keep these records private and to have security standards in place, to have transparent policies that people are aware of - that’s what I think the government’s key role is.

Mr. Sesno: People are aware of and can understand.

Ms. McGraw: Absolutely.

Mr. Brown: You know, I definitely agree with that, and I think that, you know, just sort of going back to the earlier point - health records are very much like what we experienced when you started seeing credit agencies come up.

Mr. Sesno: Mm-hmm.

Mr. Brown: There was - you know, various providers had various platforms and that type of thing. But at some point, there was a standard developed to report, on some frequency, access to your information. There was method put in place to identify your debt ratios and those type of things. And that industry got together, and they defined a set of rules, standards, reporting criteria, et cetera. That’s really what we’re looking for from the federal government to sort of help us move forward in some of those areas.

Mr. Sesno: Are you saying that you’re looking from him and from the federal government - requirements, standards, mandates? Would they have teeth to come in and inspect your systems and audit your systems?

Mr. Brown: Well, I cringe when you say "mandates." But I would say - I would say to some degree -

Mr. Sesno: You don’t.

Ms. McGraw: Sounds good to me.

Mr. Sesno: You want mandates?

Mr. McGraw: Absolutely.

Mr. Sesno: Why?

Ms. McGraw: Well, because again - and Dr. Clancy brought this up in an earlier panel - trust in the system is key to having all of this work, and if patients don’t think that their information is gonna be protected, then they won’t use it.

Mr. Sesno: So, Geoff Brown, what’s wrong with that - mandates?

Mr. Brown: There’s nothing wrong with that. However, the reality is we’re in - we’re in a - we have various levels of development that has to take place through this process. And again, when you talk about a mandate, you know, not everyone has the fiscal capability to do it. The support structure is really not there. An example of that might be, we’re asking physicians to consult online. There are movements now to incent them to sit down and respond to patient requests, patient information, but currently, we don’t reimburse them for that. You’re starting to see some of the providers come into play. You’re starting to see some other mechanisms.

Mr. Sesno: Interesting point. Interesting point. So you’re the physician. You’re spending your time responding to people’s e-mails and questions, but you’re not paid for that.

Mr. Brown: Right.

Mr. Sesno: What do you do about that?

Mr. Wojcik: Well, I think getting back to that - we would like to join and we are joining with the government as the largest payer of health care - through the Medicare program, the federal employees program and others - joining together to promote the adoption of Health IT in our contracts with hospitals and doctors and whoever provides the care and the coverage for the people that are covered by a government program or by employers. We’re definitely willing to pay, and there are many different programs right now that do - are starting out to paying for providing incentives for the adoption of Health IT, but not just the adoption, but the use and the demonstrated improvement in care. Employers are very much willing to pay for the results of improved care and more affordable health care.

Mr. Sesno: Dr. Kolodner, you came - before you were in this job that you’ve got now. You were at the VA The VA has emerged as a model of this use of technology.

Dr. Kolodner: Yes.

Mr. Sesno: Talk about how the VA works. I’m a patient. I’m a vet. I get my care there. What’s happening to me and my records?

Dr. Kolodner: Okay. I think one of the fundamental things is first of all, that Health IT is not about technology. It’s about transforming health and care, so health care is one part of that. VA has undergone that change. The quality improvements that VA has, the safety improvements - some of which are attributable to the health IT that’s there, and - but health IT needs more than that. So you have performance measures and quality accountability. Together, VA has undergone that transformation and is now able to give some of the highest quality care to our nation’s veterans.

Mr. Sesno: And can you actually measure the difference that this has made in the quality of care?

Dr. Kolodner: Yes, we can.

Mr. Sesno: How?

Dr. Kolodner: We have a variety of measures that we use in terms of outcomes. We have some process measures, such as, "Have you done certain things for patients with conditions?" But we’re now seeing things such as decreased number of deaths in individuals with chronic lung disease who received the immunizations.

Mr. Sesno: And how did the technology provide a window on that?

Dr. Kolodner: Because it’s impossible for a provider, with the number of patients you have and the number of things to keep in mind, for you to do everything every time for a patient. And that gap causes a quality gap. The computer ends up being a reminder right at the point of care to say, "Hey, this patient needs this immunization or needs this test.”

Mr. Sesno: "At a crucial time."

Dr. Klonder: “At a crucial time.” And the provider can do it and therefore, provide the better quality care. We’re seeing a decrease in the number of amputations in patients with diabetes as a result.

Mr. Sesno: As a result, so it makes a real difference, and the VA’s been leading the way.

Well, to all of you, thanks very much - an eye on the consumer, an eye on the computer, an eye on - bottom line - better medicine all around. Thanks.

Well, as in just about everything, technology can make a huge difference in the way we work, speed, efficiency, information - all of it moving faster to more people. In the case of medicine, that’s mostly a good thing, as long as these issues of cost, coordination and privacy are taken care of. On balance, we’re better off with more information. It’s always been that way. Managing its flow and its uses is the tricky part. So "watch this space," as they say, because there will be more technology in your medicine, more ways for doctors and patients to communicate. The key is to understand what and where the information is, how to keep it secure and what you can do with it. The difference, then, is seeing what it can do in everybody’s care.

We hope this program has shed some light on this topic. If you have questions, go to our web site at www.healthcare360.org.

And we want to say as we sign off here, a special thanks to Dave deBronkart for joining us and all the best in his fight against his cancer. I’m Frank Sesno. Stay well.

Announcer: Healthcare 360 is produced in association with the George Mason University School of Management, the George Mason University College of Health and Human Services and the Agency for Healthcare Research and Quality, part of the U.S. Department of Health & Human Services.