IT Support Of Healthcare Quality Key To ReformIT Support Of Healthcare Quality Key To Reform

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Four years ago this week, then-Tennessee governor Philip Bredesen took the stage at the World Health Care Congress in Washington, D.C., and chastised federal officials and the health IT industry for moving too slowly. "Enough with the grants, enough with the conferences, enough with the pilot programs," the Nashville Democrat said then.

"I think we've just been letting a thousand flowers bloom. It's time to put that behind us," Bredesen, a Democrat who once co-chaired the National Governors Association's State Alliance for e-Health, explained shortly thereafter. "Let's pick some area, let's move forward with it and make stuff happen." (He personally favored e-prescribing because it represented a relatively painless way of getting IT into a physician's office.)

Bredesen, who left office in January after serving two four-year terms, is somewhat pleased with the progress made since 2007, but still thinks the healthcare industry could use a kick in the pants. "There's still a lot of talking going on," Bredesen said Wednesday at the Microsoft Connected Health Conference in Chicago, when reminded of his earlier comments.

"Pilot projects are popular because they're easy to do," Bredesen said. What's not easy to do is to revamp the nation's bloated, inefficient and occasionally dangerous system that costs Americans $2.5 trillion annually.

"I really think the breakthrough piece has got to be a serious attention to quality," said Bredesen, who laid out his proposal for shaking up healthcare in a 2010 book, Fresh Medicine: How to Fix Reform and Build a Sustainable Health Care System. Finding the right ways to measure quality "will open up the doors to innovative payment systems," according to Bredesen, a former health insurance executive.

The former governor believes the $27 billion federal program for hospitals and physicians to demonstrate meaningful use of electronic health records (EHRs) is a step in the right direction. "That, for me, is right on the cusp," Bredesen said. He said it may lead to better and lower-cost healthcare for a few years, but after that, he's uncertain. "When [the subsidies] come to an end, what's going to happen then?" Bredesen wonders. "The jury's out on that one."

He said the EHR "is a tool, it's not a solution in itself," but one that could spur a lot of positive changes. "The one thing that's missing now is a good, clear interface," Bredesen said, reiterating comments he made during a keynote address to the 2007 Healthcare Information and Management Systems Society (HIMSS) conference. With today's technology, he believes interoperability of health information is feasible--and long overdue.

"We've got to pull a long way back from healthcare as a vast collection of un-integrated providers," Bredesen said Wednesday, paraphrasing from his book. "Part of it is economic and part of it is technological." Ultimately, the focus in healthcare has to shift from the provider to the patient, he added.

Bredesen, however, is no fan of accountable care organizations (ACOs), as defined in a recent U.S. Department of Health and Human Services proposal. He is concerned that ACOs may be "too weak to cause fundamental changes" in healthcare. The consolidation that a shift toward ACOs is likely to spur in local markets may end up raising costs, according to Bredesen. "When you own the market, you set the prices," he said.