SM: Are you doing anything with electronic health records?
TM: We believe that a far more effective way to create the broad, automated records needed is to automate information outside the office and present it as a package to a treating physician. Our model has the ability to do that. We are doing that today for Aetna. We deliver care alerts as part of the check-in process for the patient.
SM: How do the physicians’ practice management systems play into this? For example, in Menlo Park the Stanford Medical Clinic System just rolled out Epic, a system that allows all providers to access patient medical records. Is that a competitive system, or would you interface with it?
TM: In a situation like that there are a variety of use cases. If your provider is using the Epic system at the Stanford Medical clinic as well as at their own practice, then they are effectively functioning within the same electronic medical records system. In that scenario, we do not play a role on the clinical side. That represents a very small part of the care delivered.
An example of a more typical scenario would be a patient from Bakersfield who has come into Stanford for treatment while working with a specialist as part of that process. Now you have a situation in which an element of that patient’s record is in Epic, but the majority of it is scattered around Bakersfield among multiple treating physicians.
In that scenario we play a role. When that patient shows up in your physician’s office, we would bring — if there were an aggregator — we would present that information about that patient and make it available to your physician at the time of check-in. The physician would end up looking at both Epic for the things that happened at Stanford and a separate personal health record for all the things that happened at Bakersfield.
SM: Do the insurance companies, which are providing you with information, have access to things like MRIs and ultrasounds? Epic has access to all of that and can circulate all of that information within the Stanford system.
TM: Yes, with some caveats. Part of the challenge in health care is that in terms of interoperability, it is easy to conceive how great it is going to be when we eventually have it, but it is a whole lot more complicated to bring out than anyone thought it would be. We all talk about the elements that go into a complete medical record and a completely interoperable system. Computers are very unforgiving. Everything must be done precisely; otherwise, it does not work. Part of our challenge in that industry is pursuing a model that is not scalable. A new biomarker for a drug or a new medical best-practice treatment technique requires a new standard or new data element. Each of the EMR vendors has to re-write its applications to accept that new biomarker or best-practice treatment. That can be a 15-year process for some vendors.
We talk about personalized medicine, but I think we have some issues. I have been very active in Washington trying to educate folks on [Capitol] Hill. If we are not careful, we will not be able to handle personalization.
One of the concerns on the Hill right now is that there is not enough cost savings in the reform bill. The Senate is trying to figure out more ways to put cost savings into the bill. Payment reform is something that everyone likes to talk about also something but has enormous implications for the architecture that is going to be required from healthcare IT (HIT) and the infrastructure. EMRs and clearinghouses do not have the mechanisms to do payment reform. If we all have to agree and set standards before we do payment reform, then we are going to be talking about this ten years from now.
SM: Do you have a payment reform model?
TM: We have the ability to implement payment reform right now. We have proposed an amendment that would modify the EMR stimulus bill to allow for partial or progressive payments for implementing systems that directly target quality problems and enable new payment mechanisms. We still have a lot of work to do to figure out how this infrastructure needs to work. We believe that we have successfully demonstrated a different model to the market. We also believe that it can be a key component to fixing healthcare automation.