WASHINGTON, Oct. 19 (UPI) -- Market forces are not likely to push U.S. healthcare into an integrated system anchored by electronic recordkeeping, a new report from U.S. health consultancy Capgemini concludes.
Beyond that, there also are payment and structural issues that need to be resolved -- how to identify patients and how to allow secure access to records -- before healthcare providers will be ready or able to embrace the concept.
Healthcare in the United States remains local and personal. Physicians, hospitals and other providers employ networks to varying degrees, but when push comes to shove, they operate with a strong sense of independence.
Most healthcare executives, on the other hand, are ready to explore e-records. They understand the benefits in terms of quality of care, reduction in medical errors and potential cost savings, but they also want to know more about the standardization of technology and data so providers can share data electronically, more about protecting patient privacy, and more about who is going to pay for what.
"I think the government is going to have to start it off," Lewis Redd, Capgemini's national health practice leader, told UPI's HealthBiz.
So far, the Department of Health and Human Services, through Dr. David J. Brailer, the National Health Information Technology coordinator, has chosen a bottoms-up approach -- beginning the system at the local and regional levels.
Redd told HealthBiz, however, he expects Brailer's approach will be "increasingly prescriptive ... to get industry moving in the right direction," along the same pathway. As soon as the direction is set, vendors for the technology and services required to make e-records a reality will be able to focus their products on the goal.
The Capgemini analysis said, however, there needs to be private and public funding incentives for providers to buy into a concept that could change the way they do business significantly.
"Individual hospital systems and managed-care companies cannot be expected to foot the bill," the Capgemini report said. "Rather, society as a whole will need to be involved through incentives, such as Medicare and Medicaid reimbursements, and tax policy will be needed to complement direct investment by managed care companies, employers and others."
Most Americans do not favor establishing a single, personal identifier, but an e-records system will depend on one central way of identifying patients, so data can be made secure but transferrable.
"What you have today is a different numbering system used by virtually every provider," Redd said. "Each has some algorithm that assigns patient ID numbers. Even within delivery systems, there are different patient IDs."
Healthcare has backed away from using Social Security numbers -- California law bans their use out of concern about identity theft -- but Redd said a system based on SS numbers might be the most practical and easily obtained. The report suggests states should take another look at this issue, which will have to be resolved early on.
HHS has backed pilot projects and has issued contracts to standardize industry language, but the industry has not yet seen the strong data it prefers showing successful return on investment for such a huge capital outlay as IT.
Some large providers, such as Kaiser Permanente, have taken the lead -- already are putting such systems in place -- knowing it will provide the ability to quickly and efficiently track patients, resulting in better care and cost efficiencies.
Millions of dollars, however, easily can be spent on IT systems and such an investment remains a major obstacle for physician practices and even some hospital systems.
LATE NOVEMBER FOR FINAL USP DRUG GUIDELINES DRAFT
U.S. Pharmacopeia expects its expert committee will take a final vote on Draft Model Guidelines for the 2006 Medicare drug benefit by the end of November, forwarding the results to the Centers for Medicare and Medicaid Services for its comments and recommendations.
Dr. Roger Williams, USP executive vice president, told a briefing for reporters Tuesday the committee still is sorting through more than 1,100 public comments on the guidelines, which health plans and pharmacy benefit managers will use to develop drug formularies for the Part D benefit.
The briefing was somewhat a surprise -- perhaps USP felt a need for an update to answer criticisms and concerns over the process.
The guidelines, though voluntary, have drawn controversy from the pharmaceutical industry and PBMs over their structure and how many drugs ultimately would be included. Pharmaceutical companies want more drugs included -- PBMs like to limit formularies to entice patients toward using the most cost efficient medication that works.
Williams said he thinks the committee, of which he is a member, has "done an excellent job" creating a framework "that will stand the test of time."
When asked to respond to criticism from the pharmaceutical industry that USP should scrap the draft and start over, Williams said "to start from scratch would be counterproductive at this time" and noted the tight timeframe for getting the draft finalized before the end of the year.
"There is no covered Part D drug that will not be accommodated by the drug guidelines," Williams told reporters.
The USP committee has conducted 16 of 20 consultations required by CMS as part of its contract, with most being done with healthcare industry groups to get their targeted recommendations and comments.
Williams said the controversy surrounding the structure of the guidelines still is under review and no final decisions have been made. USP must work within the Medicare Modernization Act in maintaining minimum offerings, but there have been calls for more substantive changes in how drugs are categorized.
USP officials insisted science would be the ultimate arbitrator in decisions about what is or is not included. The actual formulary decisions, however, are up to the drug plan vendors and CMS.
One industry expert told HealthBiz he thought USP left the door open to adding more drugs and did not address whether the issue of cost -- an important factor for plans in their ability to affordable drug coverage -- was an integral part of the deliberations.
EUROPEAN GENERIC BONANZA
Europe's generic drug industry expects to reap big rewards from an increased emphasis on reducing healthcare costs and expiring U.S. patent protection on some blockbuster drugs.
Consultancy Frost & Sullivan's latest report estimates the European generics market will grow from $10.9 billion to $21.2 billion by 2010.
Price controls by European governments are key to holding down costs, and Frost & Sullivan said use of generics in Europe saved nearly $25 billion over brand-name medications in 2003.
The report said although the Netherlands and the United Kingdom have well-established generic markets, France also is making gains, while in Italy generics are catching on a bit more slowly.
New European Union legislation, expected next year to streamline the regulatory process, also is expected to carry generics more quickly through the development and approval process.