Time to work on real quality in health care reform

There was a time that when the feds talked about quality in terms of Medicare and Medicaid, they were referring to fraud. If you weren’t stealing, you ran a quality program.

Times have changed, thankfully. It’s still wrong to steal, of course, but today when quality health care is on the table, we’re talking about things like giving the right medicine to the right patient and curing children of infections, not giving infections to them when they come to the hospital.

Kathleen Sebelius, HHS Secretary, talks about Cincinnati Children's impressive use of technology to improve care during a press conference on April 5

There’s nothing specifically about quality in the new health reform law that’s been in the news lately. It was, however, a part of the reauthorization of the State Children’s Health Insurance Program (SCHIP) last year, the first time “quality health care” has been codified, according to our folks at the Child Policy Research Center.

Quality, which has lots of definitions, is on the minds of lots of people.

Kathleen Sebelius, Secretary of Health and Human Services, said we can expect more from her department when it comes to pushing quality. When she visited Cincinnati Children’s last week, she said she was impressed by our use of electronic medical records, “patient portals” to share information among providers and families, and involving parents in many aspects of running the hospital.

“It’s great to see what’s going on here,” she said about our patient safety and family-centered efforts.

She also said that as the biggest payer in health care (Medicare and Medicaid fall under her department) we can expect HHS to use its leverage to push for higher quality and lower costs.

One way they’ll be doing that is through the use of electronic medical records.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was part of last year’s economic stimulus package. It is not just about technology, it’s about improving health care through the exchange of health care information. There is $20 billion set aside to drive the adoption of electronic medical records; payments are scheduled to begin in October.

The law requires doctors and hospitals to show a “meaningful use” of high tech. The final rules have not be written, but we suspect it means that electronic medical records have to be more than fancy word processors. After they capture the data, the providers must use it to advance clinical practices and finally and ultimately, improve outcomes.

Meaningful use also means improving efficiencies, reducing health disparities, engaging parents and families (like using the “patient portals” we demonstrated for Secretary Sebelius) improving care coordination; improving population and public health and ensuring privacy and security.

Health care IT is not the panacea for improving quality. But it is a giant step in the right direction. That’s why we’ve invested tens of millions of dollars in the process.

We look forward to a consistent national approach to quality in health care. We’ve been a leader in the effort for years, with a focus on reducing “serious safety events,” nearly eliminating ventilator-acquired pneumonia and aiming rewards at physicians who improve the condition of their patients and the use of information technology.

There are hurdles to overcome with the use of electronic medical records. The Wall Street Journal reported Tuesday on a study that said patients have said they would lie to their doctors if they knew the information would be part of an electronic medical record and the information could be shared with others.

That’s unfortunate. And while we know patients already lie to their doctors, we don’t want to implement a system that might encourage it. Instead, we point to research we’ve done that shows when information is shared freely among doctors in a collaborative network, patients get better faster. We trust that improved health will trump the other concerns.

But more on that at another time. Today, let’s toast these steps that open the door to real health care reform where better health, not just insurance coverage, can happen for all.

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