The Jackson Hole Group proposes that the exchange of medical information via a two-way electronic pathway between physicians and patients would improve health care quality.By Tyler Chin, AMNews staff. Nov. 11, 2002. Additional information The way to improve health care and lower costs is to redesign the system around the patients, physicians and other professionals who use information technologies, according to a new proposal from the Jackson Hole Group. The proposal, called Heroic Pathways, revolves around two elements. The first is a voluntary system of portable personal EMRs that would be owned and controlled by patients, who could carry the records to any doctor or hospital, said Paul Ellwood, MD, founder of the Jackson Hole Group, an informal but influential group of physicians, academics and industry executives who help shape health system debate. Second, patients would arrange for a physician or medical group to exchange information and relevant medical advice via a two-way electronic "health information pathway," said Dr. Ellwood, a pediatrician and neurologist. Using the pathway, for example, patients and physicians would be able to access decision-support software tools or information on evidence-based medicine and could also measure quality and outcomes. Doctors could transmit alerts about drug recalls, send appointment reminders or ask patients if their treatment was effective, he added. "The whole idea is to create an information highway, if you will, between the patient and the doctor that is buttressed by an abundance of information about the patient's medical history so that no one has to search through a piece of paper to find that out," Dr. Ellwood said. The pieces that make up Heroic Pathways are not new. Patients can already request office appointments or prescription refills, and pay for consultations over the Internet. Unlike the Jackson Hole Group's proposal, though, those services are "rarely backed up by electronic medical record systems and even more rarely backed up by any sort of a decision-support system," Dr. Ellwood said. Another difference is that the Jackson Hole Group's proposal puts all those elements "together as a package to produce a better and more efficient health system," said Jack Lewin, MD, executive vice president and chief executive of the California Medical Assn. Dr. Lewin, a Heroic Pathways supporter, was among the nearly 30 people who met in September in Jackson Hole, Wyo., to discuss the idea. "It will allow us wonderful new opportunities to improve quality, increase physician and patient choice, and improve the patient-physician relationship, if we do it right," Dr. Lewin said. "It obviously could be implemented in a way that further complicates the health care system, but there's no doubt that a paperless system will save America probably 20% of our current health care spending. We must move in that direction because we need every dollar we can save in the system to deal with the problems of the uninsured, uncompensated care and to invest in improving the system for everybody." The Jackson Hole Group plans to meet again to further discuss the proposal and determine how to get the industry to implement it, Dr. Ellwood said. Significant hurdles will have to be overcome before that happens, he acknowledged. Those include cost and what Dr. Ellwood calls "vendor lock," the propensity of software companies to sell proprietary information systems that don't talk to products made by competitors. One way to overcome that challenge is to consider using the electronic medical records system of the Veterans Health Administration as a starting point because "it's in the public domain and anyone can use it," Dr. Ellwood said. Another barrier is the relatively small percentage of doctors who have EMR systems. But their numbers could increase if patients adopted personal EMRs, which could either encourage or force physicians to get their own systems, Dr. Ellwood said. |
