Donald M. Berwick has been coordinating radical health care changes for fifteen years through his Institute for Healthcare Improvement (IHI). He was feted last night at a dinner by the Jewish Alliance for Law & Social Action, where it seemed like the entire leadership of the formidable Boston-area medical industry turned out to honor him: Harvard and Tufts medical schools, Children’s Hospital, Brigham and Women’s Hospital, Blue Cross Blue Shield, and many, many others. Berwick says the health care field could:
Move all records to digital media and “put paper records in the museum along with the typewriter.” While Berwick did not address security and privacy issues in his talk, these have been dealt with in legislation (HIPAA) and are the subject of much study already.
Give individuals control over their health care records.
Eliminate most of the errors and improve the rate of satisfaction. (He estimates that half of all patients currently fail to get proper treatment.)
Put data about treatment centers online, so that choosing where to have surgery would be as easy as online shopping.
First, the lower costs and efficiencies would allow health care to reach more people, to the point where universal health care is achievable. The 1993 Clinton plan failed because it was simply an extension of the old ways of thinking that failed. Berwick offers new–but solidly backed–thinking.
Not only would Americans have access to health care, but Berwick wants the same level of care offered to the whole world. Once you declare that medical treatment is a right for Americans (or any other country), you have to admit that it’s a universal human right. And Berwick says that it’s feasible–as well as morally necessary–for rich countries to fund this universal right.
Moreover, the patient becomes the center of the treatment in Berwick’s vision. Currently, patients are objects moved mechanistically through a system that exists to serve itself (not the patients, and certainly not the doctors or other staff). That’s why visiting hours are artificially restricted, waiting rooms are the stuff of anxious hours, and few patients have the information to make informed decisions about major treatment options. Berwick thinks the system can be tailored to each patient’s needs, with lower costs and better results.
At 17% of the gross national product and growing, health care is a problem we’ve got to grapple with at its roots. Technology can help. But health care also reminds us that any positive technological change has to be linked to a vision of whom technology is serving and what they deserve.