Document text
Reliance on evidence, cyberspace urged for medicine By JOHN DARLING Branding American health care as bankrupt and failing, one of principal architects of the Clinton health care plan called on Southern Oregon to pioneer revolutionary changes in health care, especially by using "evidence-based medicine" - treatments proven to work. In a speech Friday to the Medford Rogue Rotary Club, Dr. Paul Ellwood noted recent reports of a 30 percent increase in health care insurance claims by Medford teachers during the first six months of last year. "The claims aren't increasing because teachers are sick more; they're up because employees don't trust the health care system," he said. "As benefits are cut, premiums rise and service remains mediocre, we'll see more and more angry patients." Ellwood is a nationally prominent health care authority (he coined the term health maintenance organization, or HMO) and a prime mover in the 1993 attempt to pass universal health care. He splits his time between the Applegate Valley in the winter and Jackson Hole, Wyo., in warmer months. Ellwood said medical costs rise in part because most doctors use treatments based on what they learned in medical school or what they prescribed for recent patients, rather than committing themselves to evidence-based medicine and then following up with patients to see how treatments actually worked. Evidence-based means what's proven to work in most cases, leading doctors systematically through each step of diagnosis and treatments, he said. With this system in place, insurers would have a set of standards to hold doctors to in paying any claims, he added, linking quality with lower insurance expenses. Ellwood branded the health industry "cybernetically challenged," noting that physicians insist a new patient fill out a paper form, rather using a single, up-to-date electronic medical record (EMR) that would follow each person through life. A healthy health care system would require doctors to keep an "outcomes accountability" database on themselves, so patients could access it and evaluate risks to themselves by learning beforehand which physicians have the most success in dealing with their particular ailment, he said. His idea, he predicted, would be obstructed by "professional abhorrence" of grading. Ellwood related a personal story involving countless phone calls to renew a prescription, only to have the clinic staff forget to call it in to the drug store. He said said improved software could correct such problems - monitoring the drug, reminding staff of expiration dates and e-mailing patients and pharmacies for renewals. A medical ID and clinical warning system could identify and advise a mobile population - even on predilections toward ailments decades before they occur, he said. The system could be keyed to a universal medical ID card, perhaps integrated into the driver's license, he said. Politicians are unlikely to lead in these steps, but the region's CEOs, whose companies pay a huge chunk of medical bills, could unite as they did in Pittsburgh and give hospitals an ultimatum: "Implement specific data collection steps, safety measures and management upgrades or we will restructure our health care purchasing contracts to force it." He said local health industry members should establish an action group to install the missing, vital patient services, and patients should demand evidence-based guidelines, outcome data, a copy of their medical records and e-mail for prescriptions and follow-through. Most of these reforms were contained in a "moderate" bill, written as an alternative to the Clinton universal health care plan when the administration's "totally uncompromising" strategy eventually excluded many voices, including Ellwood's, from the process. "They knew what was best for us," Ellwood said. "And they said they excluded me because I had a conflict of interest - I was a doctor." John Darling is a free-lance writer living in Ashland. E-mail him at [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.