What steps would you like to see for healthcare reform? Today we interviewed Dr. Samuel Slonim, an eDoctor client who believes strongly in major changes for the healthcare system. Dr. Slonim attended medical school at the University of Southern California and completed his residency at the San Jose Family Practice. He has owned his own family practice since 1985. His practice website features not only helpful resources for patients, but proposals for healthcare reform based on Dr. Slonim’s recommendations after almost 30 years of family practice experience.
I understand that you are in favor of healthcare reform. What changes would you like to see?
“I think that the best way to reduce unnecessary spending is to have patients pay a percentage for all the care they get. There would be limits or maximums paid for any one service and per patient and family per year. Those with lower incomes would pay a smaller percentage and have smaller limits or maximums. This would lead patients to think about what they are purchasing (office visits, labs, X-rays, medicines, procedures) and have them consider the cost in choosing various alternatives. This way we wouldn’t need formularies, HMO authorizations, etc.
“I’d like to see technology also used to improve access to educational materials for providers and patients and to improve communications between patients and providers and between providers. I would propose someone or organization(s) make a Healthcare IT system that everyone could use – it would be made available for free to everyone. From day one, patient privacy protection would be built in, but also the ability to easily and seamlessly share data. There would be different modules for doctors, hospitals, insurers, pharmacies, laboratories, X-ray providers, and patients, but all would share the same data. Individual users would be able to customize the data and screens to their liking. There would be four main functions: 1) EMR (including e-prescribing), 2) billing, 3) communications, and 4) education.
“One of the problems with the current IT “system” is that different vendors’ programs do not communicate with each other effectively, if at all. They talk about setting up standards but I think it would be difficult due to the complexity of medical information. For example, I read that they want a system to be able to put a patient’s EMR data into a file that could be sent to another system. This would be like scanning a document. Sure, you can import it into your system, but you probably couldn’t use the data in your system – for example, labs scanned in couldn’t be put into a table or graph of a patient’s results over time.
“If a system was made that everyone would use for free, the priorities would be improving quality of care, sharing of information (where relevant), and patient privacy.”
Who should create this universal EMR system?
“This could be government and/or a consortium of businesses. Keep in mind that businesses are looking for ways to control health care spending. I mentioned that the IT software would include billing – imagine the savings just from everyone being on the same billing system. The government is currently giving out around $20 billion in incentive payments for doctors to buy EMRs – I think [a universal EMR] would have been a better use for that $20 billion. Obviously some people don’t trust the government and others wouldn’t trust private businesses. I mentioned that privacy protection would be a major priority. I’d also say that in my experience, most of my patients are more concerned that their information does not get to their physician than they are about privacy leaks. The current communications among health care providers are short of optimal.
“I made my own practice management software by learning how to use and create a data base. One thing I learned is that if you think of something you’d like the data base to do, you will find a way to do it. So I believe this idea can be achieved – there are certainly a lot of smart people in technology out there. If I can imagine this, someone can do it.”
What changes would you like to see for e-prescribing?
“It would be nice to be able to enter medicines without having to enter a pharmacy. This would allow patients to go to any pharmacy – they often change pharmacies, or may travel and forget or run out of medications. This leads to physicians rewriting prescriptions. In the universal IT system I propose, prescriptions would be part of the EMR – once entered, it would also go in the record listing current medicines, documentation of what was prescribed, etc.
“The ability to e-prescribe scheduled drugs would be terrific. I prescribe a fair amount of chronic pain medications and stimulants for ADD. These have to be hand written every month (or write 2 prescriptions once for 2 months). This adds up to a fair amount of time that could be saved if it could be done electronically. I could spend more time with patients and maybe even go home a little earlier!”
How do you think increased use of technology will affect health care?
“I think it has potential. It’s helping some, but has a lot more potential. I’d say it’s a mild to moderate positive at the moment.”
To read more about Dr. Slonim’s vision for healthcare reform, click here.