I just got back from the HIMSS meeting —  a huge trade show of health care IT vendors and hospitals. Health care IT is now dead sexy for politicos because they can all agree that it’s the solution to our problems. But the mood amongst attendees is good because hospitals are now on a huge building boom in both bricks and mortar, capital equipment and IT — which you the taxpayer will pick up in the form of more Medicare spending. Everyone’s doing very well thank you, and now the government is talking about exchanging data between health care organizations as the way to improve care, and its point man David Brailer (a good guy by the way, despite his employers) is talking about it alot.

Unfortunately the government isn’t doing much about it other than giving a few contracts for demonstration projects, trying to corral data standards, and giving vendors something new to talk about ( the buzz word is “inter-operability”). While no money is being spent by the government here, the big organizations that resemble single payer systems (e.g. Kaiser Permanente) are spending a lot on getting IT tools into clinicians’ hands, but 80% of American docs practice in small organizations and are largely being left behind. Meanwhile the biggest integrated healthcare system of all, the UK’s NHS, is doing a whole lot. The UK is creating a longitudinal health record for every citizen, connecting every doctor and hospital to the central “spine” and — despite some inevitable problems — will be reaping the benefits of health care data interoperability long after we’re still talking about it. (BTW despite the fear of “government health care” lots of American vendors are doing very nicely thank-you out of the UK’s Connecting for Health project, including some Republicans even if their wives and business rivals apparently don’t approve of that universal health care guff at home).

I heard a talk from a Brit and a Canadian on their somewhat similar national health care IT plans. They are light years ahead of us in health care IT, especially at the physician level and they started further ahead. In fact lots of countries by 2002 had 80–95% of physicians using electronic medical records (EMR) at primary care level, and virtually all of them got there by some kind of socialized/single payer approach, or at least had the government mandate and pay for the technology. In the US we are at about 25% of docs using an EMR , if you count it generously. And that’s not an accident.

Of course there’s another side to this. Although I didn’t see it, former Oregon governor John Kitzhaber (an MD by the way) gave a talk preparing, it seems, for a long-shot run at the Democrat nomination in 2008.

Kitzhaber, a Democrat, spoke frankly about the state of the U.S. healthcare system while telling about his new venture, "The Archimedes Movement." Launched last month, the project seeks to transform the U.S. healthcare system by forcing Congress to defend current practices and policies that run contradictorily to the goals of better and more efficient healthcare. He told of how an Oregon man died after the state paid more than $1 million for his treatment in a hospital intensive-care unit when he suffered complications from seizures that occurred when the state stopped providing the $14 per day in prescription drugs that the man needed to manage his chronic health conditions. "That should not be acceptable to any of us," Kitzhaber said as the audience applauded.

With the Archimedes Movement, Kitzhaber said participants will start from scratch to develop a plan determining how best to use the $6.3 billion in tax dollars that are currently allocated for the healthcare of Oregon's 3.6 million residents. He said the goal is to reallocate existing public resources to universally provide a basic set of healthcare services with the objective being "to produce healthy citizens, not finance healthcare delivery."

Of course no other industrialized nation would understand why this talk had to be given, or why the guy was cut off from his cheap drug and needed to be given expensive care later — although we’re starting to hear lots of those stories from the Part D debacle.

This lays bear the other half of the IT fallacy. Even if we get all the information we ever need, nothing will change in the health care system if the incentives are for providers to do too much to those with insurance and for insurers to get out of the business of insuring the sick. But to get away from that you need some type of government regulation and redistribution of resources from the healthy to the sick. And as evidenced by Bush’s speech yesterday about extending HSAs, we are thinking of heading in completely the opposite direction. If you want more on why that’s a bad idea, see my earlier piece called Much, much more on HSAs.