What American healthcare trends mean to China

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By Harry Greenspun (China Daily)
Updated: 2009-07-08 07:43

In my position as chief medical officer for Perot Systems, I have traveled extensively in the US discussing healthcare. Recently, I had the opportunity of visiting several cities in China. While there, I was struck by the similar challenges our countries face, as well as the proposed solutions.

China and the US both are technologically advanced nations. We have outstanding capabilities in terms of providing care for those who have access to care, but with the economic pressures in the world today, we are experiencing obstacles getting that care to all citizens. With this challenge comes an enormous opportunity, and from my perspective, our nations will seize this opportunity only with a committed investment in a national health IT infrastructure.

Today, the US is challenged by three critical issues in healthcare: escalating costs, variable quality and uneven access to medical care. Currently, healthcare represents 17.6 percent of GDP, and without intervention, it is expected to rise to 20.3 percent by 2018. Despite this extraordinary level of spending, the quality of care patients get is below what is available in many other nations that spend far less.

About 47 million Americans lack health insurance, which is often a benefit of employment. The current global economic downturn further exacerbates this problem. As people lose their jobs and their insurance cover, they cannot afford the increasingly expensive medical care they need, highlighting the link between health and economics.

When US President Barack Obama took office, he quickly moved to accelerate the pace of healthcare reform as part of addressing the economic crisis. The American Recovery and Reinvestment Act (ARRA), commonly referred to as the "stimulus package", dedicates $787 billion to expand public health insurance, build medical infrastructure, support medical research, advance prevention and wellness programs and other critical programs.

Despite clear evidence of the benefits of using electronic health records (EHRs), including higher quality of care, lower costs, reduced risk of errors and improved efficiency, few doctors and hospitals have adopted them. Citing disruptions in workflow, technical challenges, lack of interoperability and cost, less than 20 percent of doctors and hospitals have EHRs, and only a fraction of those actually use them to their full extent. Moreover, even those considering implanting EHRs now lack capital to purchase them.

In response, ARRA set aside incentive payments for physicians and hospitals to become "meaningful users" of EHRs. While the specifics are still evolving, they revolve around clinical decision support, computerized order entry, public reporting of quality metrics and exchange of patient information among hospitals and providers. The aim is to initially capture and exchange data to promote better, more efficient care, which in turn will lead to improved outcomes, lower cost and greater value.

The focus in Washington has now shifted to broader healthcare reform, with alternatives for lowering costs, improving public health and covering the uninsured dominating the debate.

Just as in the US, China's healthcare costs have soared because advances in diagnosis and treatment require more expensive tests, procedures and pharmaceuticals. Despite tremendous economic growth in recent years, healthcare costs continue to outpace income, while the ranks of the uninsured grow. An expanding and increasingly mobile population further strains overcrowded facilities amid a myriad of potential public health threats.

To address these needs, China is allocating 850 billion yuan ($124 billion) to embark on sweeping healthcare reforms in order to increase the number and quality of facilities, expand insurance coverage, reform pharmaceutical distribution, improve public health and modernize hospitals. Central to these efforts is to expand the use and impact of health IT.

I was fortunate to visit a number of hospitals that offer some of the best demonstrations of the ability of IT to transform healthcare. In Xiangya Number 2 Hospital in Changsha, capital of Hunan province, patients entering the hospital are greeted with scrolling displays that clearly identify the costs of drugs and procedures, as well as the qualifications of physicians. Traditional and Western medical practices are seamlessly integrated. Upstairs, a sophisticated command center directs emergency services to the most appropriate facility, while coordinating responses to public health threats.

In the gleaming sunlight-filled People's Hospital in Wuxi, Jiangsu province, patients are quickly and efficiently shepherded through clinics via electronic notification and EHRs, while safety is enhanced with pharmacy robots and bar-code identification to ensure that the right patient receives the right medicine at the right time.

At the Shandong Provincial Hospital in Jinan, an advanced telemedicine facility allows specialists to enjoy virtual visits to patients across the province and even across the country, permitting essentially face-to-face conversations with patients while viewing diagnostic images, laboratory data and medical records.

In Chengdu, capital of Sichuan province, which is still rebuilding after last year's devastating earthquake, city leaders and HuaXi Hospital are working to establish a regional healthcare technology platform to dramatically improve care to city residents.

My trip coincided with the early stages of what ultimately became the A(H1N1) pandemic, highlighting the need for automated systems to detect and track the outbreaks. The US and China both see the value in leveraging electronic medical records to control outbreaks and combat bio-terrorism.

While my hosts across China proudly demonstrated their advances, all of them asked me the same question: How can we lower our costs, improve our quality, serve more people and improve the health of our country? The answer I gave them is the same answer I give in the US. With government leadership and support, hospitals and doctors must rapidly expand their use of IT systems to understand how care is being delivered, use that information to improve quality and efficiency and achieve better outcomes to lower costs and permit expanded access to care.

I left China with a deep appreciation for the advances these facilities have worked so hard to achieve, as well as the challenges that lie ahead. The dialogue we opened was incredibly productive. You face some of the problems we have solved, while you have solved many of the problems we face. There is much we can learn from each other.

The author is chief medical officer of Perot Systems. He served as co-chair of Healthcare Information Management Systems Society providing recommendations to the Barack Obama administration.

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