In 2009, when more than $35 billion was invested in expanding national electronic health record (EHR) uptake, one of many advantages touted was its value as a tool for managing population health. This promise has failed to materialize due to a chaotic rollout of non-communicating systems. Today, as we confront COVID-19, the coronavirus wreaking international havoc, the need for such a tool is exquisitely evident.
How could we do better? Real-time population-based clinical data is exactly what single-payer health insurance, or Medicare for all, would give us.
Why, after more than two decades into the EHR era, are we still light years behind other industrialized countries with respect to having standardized clinical data available to public health officials? Our health databases are a mess. None of the EHR systems communicate with one another – because they’re not designed to do so. It’s not advantageous in our market-based health care system for companies or health care providers. Even if every EHR vendor agreed to share data tomorrow, the difficulties involved with managing confidentiality and merging information would require months to years of work.
How did we get here? The answer is simple: profit and lack of transparency. Our health care system is built on profit and creates enormous disincentives to share data across EHR systems (“ interoperability”). Health plans are interested in retaining their patients; sharing data may risk losing them to other plans. None of the companies peddling EHRs make data sharing a priority. Even organizations using the same EHR platform cannot readily share data. Thus, we have a deeply fractured health care system that includes only part of our population, cannot readily analyze population-based data, and does not place top priority on the nation’s health.
What is the answer? Universal single-payer health care, or Medicare for all, would resolve the issue. It would cover everyone with the same high-quality health care regardless of income, and provide exactly the kind of timely clinical data needed to monitor and improve health. This kind of database is pivotal for disease outbreak investigation and containment. Our public health infrastructure is stymied by the lack of data needed to keep emerging infections at bay.
Taiwan is an excellent example of epidemic control when the entire population is covered by universal single-payer health care. A small but populous nation with significant routine travel to and from mainland China (2.7 million visitors from China last year), Taiwan was expected to have the second-highest number of COVID-19 cases. However, as of March 14, 2020, they reported only 50 cases and one death. How did they manage this impressive pandemic control feat? Taiwan used its population-based EHR data, along with their immigration and customs databases, to identify and manage cases. They looked for cases that could have been missed, using their national health insurance database to find patients with severe respiratory symptoms who tested negative for influenza, and then tested them for COVID-19.
Truly universal health care is not only a moral imperative, it is key to economic success and national safety. Our public health is at great risk, especially today. Medicare for all would have provided the data we so desperately need to track and intercede with COVID-19. It would reduce the severity of coronavirus. There would be universal first-dollar insurance — so nobody would face financial barriers to getting needed diagnosis and care. And, all doctors would use the same billing system, assuring that critical diagnostic data is quickly conveyed to public health authorities in a format that is immediately useful to track the epidemic and guide control strategies. Medicare for all is a crucial step to our nation’s health.
Rani Marx is director, Initiative for Slow Medicine.
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