The e-Health Revolution

How a bipartisan bill from Hillary Clinton and Bill Frist could help jump-start a new kind of health-care reform

By Bill Saporito Monday, June 20, 2005
    • PHOTO-ILLUSTRATION FOR TIME BY C.J. BURTON

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    Driving all this are some frightening statistics. The U.S. is No. 1 in the world in terms of health-care expenditures--a total of $1.8 trillion last year and rising at a rate more than twice as fast as our incomes--yet it ranked no better than 16th in a study of 22 industrialized countries in what medical professionals call outcomes. That's in part because so much of the care delivered is unnecessary--as much as one-third, according to a Dartmouth study--and in part because of the inefficiency of a system in which tens of thousands of patients die each year as a result of medical errors.

    "We have to do this; there is no other choice," says Dr. Alan Wasserman, president of Medical Faculty Associates (MFA), a 270-doctor practice affiliated with George Washington University Hospital in Washington that happens to treat many members of Congress. MFA recently converted to a system made by Allscripts called TouchWorks. Before the conversion, the practice employed 23 people whose sole function was to collect, store and maintain paper files that filled several rooms.

    TouchWorks is vastly more efficient at such mundane medical tasks as booking appointments and renewing prescriptions. About 90% of renewals can be processed within an hour and, because doctors' handwriting has been eliminated, with far greater accuracy. There are enhancements in the back office too. Because automation improves documentation, the group's "lag charges"--the cash tied up in the fee-collection process--have dropped to $1.5 million from $2 million. MFA gets paid in 63 days on average, as opposed to 102 days before TouchWorks.

    At the heart of the TouchWorks system is its "tasking engine," a piece of software modeled after physicians' standard 10-step diagnostic approach. Test results from outside labs pop up on the doctor's screen, allowing him or her to plot, say, cholesterol levels over time and present the information to the patient. If a physician writes a script, the system will flag possible interactions with other drugs the patient is taking or question dosing levels that are out of the norm.

    Automation has also created what Dr. Ryan Bosch, who directed MFA's TouchWorks project, calls stickier patients, borrowing an Internet measure of loyalty. "I spend less time gathering information and more time being proactive," he says. "Delivering good-quality health care is about a relationship."

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