In the past, brevity was lauded. In fact, I myself was praised by my colleagues for the brevity of my notes: they were short and to the point. Times have changed. Brevity can no longer suffice.

I recently wrote an appeal on a case where the insurance company denied a diagnosis of type II myocardial infarction because the doctor documented:

“Elevated troponin. Likely type 2.”

Now, every clinician understands what this means. Yet, the insurance company wrote in their denial that there is no such diagnosis as “Type 2” and denied the DRG, claiming that they therefore overpaid the hospital and were demanding a refund. It was so very obnoxious.

At the same time, the doctor in this case gave the insurance company the knife with which it stabbed the hospital in the back because he did not write two words: “myocardial infarction.”

I had a similar experience: an insurance company actually denied the diagnosis of acute respiratory failure in a kid who got intubated for cardiac arrest in his home. They had the audacity to claim that “airway protection,” which was the reason documented for why the kid had acute respiratory failure, is not a diagnosis. It was one of the most egregious denials I have ever appealed. Again, the clinicians in this case gave the insurance company the knife. Brevity beware.

The Centers for Medicare and Medicaid Services changed the documentation rules in January of this year, de-emphasizing history and examination and strongly emphasizing medical decision making. I lauded the changes.

Finally, I don’t have to worry about documenting silly, irrelevant things like a “review of systems,” and I can focus on what matters: what I feel is wrong with my patient and what I am doing about it. And brevity can no longer suffice.

No longer can we say: “UTI. Continue antibiotics.” No longer can we say: “Elevated troponin, likely type 2.” No longer can we say, “Patient intubated for airway protection.”

We need to answer the questions: how is the UTI? Is it better? Is it worse? How is the patient responding to treatment? Why aren’t you discharging the patient when the vital signs and labs all look good? Why are you admitting the patient to the hospital in the first place?

We need to write, “Elevated troponin is most likely secondary to type 2 myocardial infarction”; we need to write, “Patient intubated and placed on invasive mechanical ventilation due to the inability to maintain an open airway due to acute metabolic encephalopathy.” Brevity in our documentation can no longer be best practice.

When I give lectures to clinician trainees and practicing clinicians alike, I say the same thing: if your documentation is poor, prepare to have a difficult time. This is true when doing a Peer-to-Peer discussion with an insurance company Medical Director, or when appealing a denial, or most distressingly, in a medical malpractice case. Poor documentation hurts everyone involved, and it can even compromise patient care.

Will this likely take more of our time? Yes. And it is essential that we take this extra time to make our documentation as robust as possible. CMS has tried to help by changing the rules so we can take more time on medical decision making. We need to take advantage of this. We can no longer afford to have brief notes that say nothing, just like we absolutely can no longer afford to have a note that is 15 pages long and also say nothing.

We need to up our documentation game to a whole new level. Brevity can no longer cut it, clinicians. Brevity beware.

The post From The Appeals Desk: Brevity Beware appeared first on Medika Life.

Full disclosure: back when Covid was rampant, and our hospital was busting at the seams with Covid patients, I was in full support of everyone having to wear a mask. I believe it definitely helped reduce transmission of the virus, and this saved lives, especially when we did not have a vaccine, and most of our population was still susceptible to the virus.

We are in a different situation now. Vaccines are widely available, and many people have already been vaccinated and boosted (myself included). Most of the adult population has either been vaccinated or have had Covid or both. While cases are rising – and hence my donning a mask every time I go inside – hospitalizations are not rising to the same degree. Things are different now.

What I like most about our current situation is the “live and let live” approach. I recently went shopping, and I was probably one of a small minority who wore a mask. Yet, no one gave me a hard time. No one yelled at me for wearing a mask. No one gave me a dirty look. Those who had masks went on their merry ways, and those without masks did the same.

The same went with me: I did not take anyone who did not wear a mask to task. I didn’t look at them with disdain or think they were “ignorant.” Every person can gauge their own personal risk tolerance, and every person was tolerant of another’s choice with respect to masking in public.

For me, with cases rising in the community, I wear a mask because I don’t want to get sick – with Covid or anything else. If I get sick and can’t work, it puts strain on my colleagues who have to cover my shifts while I’m out. It causes a huge disruption to many people’s lives, and so to protect myself and others, I endure the inconvenience – especially in the hot weather – of wearing a mask.

Others do not have the same worries and constraints as I do, and that’s fine. We are all living and let living, and this is very refreshing. Perhaps the lack of contention over masks is a result of the fact that indoor mask mandates are now a thing of the past. Perhaps the mask mandate – of which I was indeed very supportive – did more harm than good from an overall societal perspective.

I am willing to concede that I may have been wrong about the importance of mask mandates, not from a viral transmission perspective, but from a social cohesion perspective. As we study the aftermath of this pandemic, hopefully we will learn important lessons on how we can do better the next time a global pandemic reaches our shores.

It is sad that our country has been so divided over the issue of whether to wear a mask in public. Indeed, back in 2018 when I was in Paris on vacation, I would look at people wearing a mask in large crowds with derision. Fast forward to today, if I ever go back to Paris on vacation, I will be one of those people wearing a mask, too. My how times have changed.

The most important thing is that we tolerate each other’s decisions. Whether it is on a plane (where I also still wear a mask), in the mall, in the park, or anywhere else, we should respect each other’s choice to mask or not wear a mask. The “peace of the mask” has been most refreshing.

The post ‘The Peace Of The Mask’ Has Been Most Refreshing appeared first on Medika Life.

Covid has highlighted these systemic craters in the US medical landscape, showing them up for what we have always known them to be. A major impediment to the delivery of effective healthcare across America. We can now contemplate a manned mission to Mars in the next decade but can’t match data between two hospitals separated by less than a mile.

As Covid developed and spread across the US, it became glaringly obvious there were massive constraints in terms of the free sharing of data based on any industry standards. There are none. No standardization exists. An excellent example provided by a colleague highlights this.

A pre-term birth in Texas, at 20 weeks, results in the death of the infant. Our lungs only develop at 23 weeks. The death certificate issued in Texas will list asphyxiation as the cause of death. Arguably, the baby was doing perfectly well until the mother unexpectedly went into labor. So shouldn’t the real cause of death be exactly that, premature labor? Other states think so and may use that as the cause of death.

Researchers delving into preterm deliveries and mortalities associated with it have to manually sift through data from 50 states, account for variances in the way the data is collected and interpreted, and then reformat the data into a system that accounts for all these variables. It is an impossible task. The end result is that the benefits of the actual data collected are lost, permanently.

Identifying disease trends and prevalence, treatment outcomes, drug efficacy, spikes in notifiable diseases and any other use you care to attach to the data become all but impossible. This results in two very distinct outcomes. Poor response times and poor delivery of care based on evidence, the cornerstone of effective medicine. We are drowning our patients and caregivers in a worthless sea of uninterpretable data. It is unsustainable and patently stupid.

Again, in Texas, a doctor friend’s office has one electronic health record. He works with various hospitals in the area. One hospital uses its own proprietary system. The other two hospitals both use Epic. None of them can communicate Covid results to each other without someone manually inputting the result from one system to the other. The duplication, the loss of man-hours, and the lack of transparency simply beggar belief.

When you are forced to resort to Facebook and Twitter to share information about potentially beneficial results in treating your pandemic patients, we know the system is broken. When you cannot medically assess your population at glance, you lose the ability to respond in a timely fashion to threats. You lose the ability to assess the efficacy of treatments across a population. All of which boils down to one simple thing. Poorly managed and mismatched data aggregation resulting from fragmented systems. No standardization.

Towards Standards

Medicine understands and obeys protocols. The practical implementation of treatments functions more effectively within a predetermined set of parameters, created by the industry, for the industry and that evolve along with the industry. The same needs to hold true of the software that endeavors to understand, collect and sort the data the industry produces. Its primary purpose must be to serve the industry.

America’s IT health issues stem directly from its political system and the autonomy enjoyed by states over their own healthcare and health software. It simply promotes fragmented solutions. Add insurance companies, federal systems, and pharma to the mix and the complexity of a “one system for all” solution becomes apparent.

Hospitals who wish to protect their financial models, income streams and other data are loathe to share. Financial motives outweigh the overriding need for open transparency. These are issues that occur within the confines of the same city, and when distances move these treasure troves of data into different states, any hope of meaningful data sharing is all but lost.

To formalize or standardize this turbulent sea of data, the industry must develop a clear and medically relevant set of healthcare data standards. Guidelines that allow national and state-wide access to data for caregivers, patients, stakeholders, and regulatory authorities. It is an insanely simple task, complicated to impossibility by the interference of influences from outside the sphere of healthcare.

Politics, law, legislation, profits, and privacy issues notwithstanding, the ever-increasing fragmentation needs to be addressed now. Not by outside parties, but by those who intimately understand the inner workings of the industry. We may be divided geographically and politically, but our physiology and susceptibility to illness remain a global shared constant.

This is the foundation we need to build from, never losing sight of the end goal. The effective and timely delivery of meaningful care for patients. They are, after all, the reason the industry exists.

Past Failures and Present Day Winners

Remember Google Health and Microsoft’s brave version. They were going to conquer health and change the world. It’s been a decade. Neither has achieved much, not even a perceptible dent or scratch on the surface of healthcare in the US, and this failure is telling.

Change cannot be driven by agents outside of the industry. Patients can also not impact this eco-system in a meaningful way. It is the caregivers that matter most, the individuals who use the systems, day in and day out, in the pursuit of their noble cause. These are the individuals who can and must demand standardization, who must enforce conformity for the data they produce to enable the amazing benefits we currently blithely ignore.

Oklahoma has done things right. Their medical system functions incredibly efficiently. Built by doctors for doctors, it has served the state well and this system, along with others can provide hugely valuable insights into a real-world working model for efficient medical data sharing.

In much the same way Android and Apple can both access the internet and the data it contains, despite their glaringly different operating systems, healthcare needs to set about creating its own intranet. Call it Mednet or Healthnet, it really doesn’t matter. Just build it. It is medicines “Field of Dreams” moment. Build it and they will come.

Tomorrow

Ask me what I see for medicine, ten years from now and you better have a chair handy. Essentially it is this.

Medicine is a trailblazer when it comes to embracing new technologies, often an early adopter and equally often, an innovator. In ten years and possibly far sooner, your smartwatch will save your life. Data it collects will be fed back via a secure network to your healthcare provider. Automated triggers will be enacted allowing your doctor to schedule medical interventions, adjust medication dosages and monitor your overall health.

This streamlining of services will only become possible once the healthcare industry develops those standards we were discussing. That way Apple and Android will know exactly how to connect to healthcare’s internet. Standardized protocols matter. They enable the rapid development of supporting software, products, and services.

Imagine in 2020, if we’d been able to pick up by location, spikes in body temperature for covid infected Americans. Arguably, millions of infectious people could have been isolated or quarantined within hours. Time matters, responses matter. Both require standardized data. We need to use the impetus covid has provided to make work of this.

Trust

That elusive commodity we have come to take for granted. Any system is only as good as the data it can collect and without widescale adoption, the system fails. Trust plays an integral part in the delivery of effective healthcare. Compromise the ability of the public to trust and you are lost, Again, covid has provided a rude wake-up call, vaccines being the casualty in this instance.

Wide-scale abuse of patient data is prevalent in the industry, accompanied by unethical practices, including the illegal harvesting of patient DNA. These practices need to be vigorously outlawed and policed to restore public faith. To restore trust.

Take Facebook and Apple as an excellent analogy. Facebook enjoys almost no trust in the public mind relating to its data collection and use. It’s one of the reasons I don’t use the Facebook platform, but I happily let Apple intrude on my life. The difference. Trust.

[This article was written by Founding Medika Editor Robert Tuner, PhD., one year ago. It’s an insightful piece and as we look toward HIMSS 2022, consider what – if anything – has changed.]

The post How Fragmentation in U.S. Health Care Disrupts Standardized Medical Data appeared first on Medika Life.

But this question misses the mark. In pandemic simulations and doomsday movies during the past decade, the frequent premise is that humanity can count on science to save it; if only humans could allow ourselves to be saved. Covid-19 response in the U.S. played out along similar lines: we were able to leverage technologies that had been studied for years and then rapidly deploy them in real-world conditions, only to have our pandemic response sabotaged by poor communications, inept leadership, ill-prepared support systems, and political partisanship.

Trust in messaging became a casualty of our media-rich culture, which can spew out both accurate information and biased tropes.

It is reasonable to assume that we have sufficient incentives for scientific investment and that the progress we make in the coming years will rise to meet the pandemic threat. Companies have seen that leveraging mRNA and other technologies to deliver vaccines for mega-demand moments like a pandemic can be profitable. Such preparation provides a gateway to a bonanza that fuels investor wealth and vaccine pipelines for many other diseases.

And the interconnected nature of our world combined with the increased destabilization of our ecosystems will all but ensure that another dangerous pandemic will evade and outpace our early detection systems. As such, we can expect infectious disease research to be a priority for the foreseeable future.

What is needed to encourage industry transformation?

So the question is not what we need to do to encourage scientific innovation to meet the moment. The question is whether we have the incentives, policies, and promotional reach in place to address three other building blocks to responding to a pandemic threat.

First we need the ability to scale down the size of vaccine production systems while scaling up production capacity. Akin to microprocessor power, think of it this way: if an mRNA vaccine facility now takes 12–18 months to set up and is the size of an IKEA store, is it possible to achieve faster set up times of production modules around the world, with smaller footprints producing more vaccine output?

The short answer is quite possibly yes. And with the acceleration of vaccine discovery, other points in the drug delivery value chain such as clinical trials and distribution processes will need to evolve as well. Technology platforms and processes are coming together to deliver this kind of sea change, but incentives and policies will be needed to nurture these new approaches so we don’t slide back to safe, status quo pre-pandemic operating models.

Most important, we need to evolve the way these technologies can be available equitably and used in a range of settings, from wealthy countries to emerging markets.

Second, we must have more responsive systems to meet the far-reaching disruption caused by a pandemic. This goes beyond funding and incentives for stockpiling PPE. In the U.S. we need more triage and flex capacity to manage demand on health systems in different parts of the country so that our hospital systems can handle surges and our critical care workers can remain protected.

Better response could mean activating FEMA and National Guard units much earlier, but it could also mean pushing incentives to the general public to follow health guidelines sooner, go to field clinics instead of hospitals, or tune in to health news channels that are run by a consortium of outlets rather than relying on one source of information only.

Internationally, we must work to shore up disease surveillance in other countries to identify and contain regional outbreaks before they become global.

Are we prepared for the next pandemic?

Achieving a better response to the next pandemic response also means getting another major piece right: early and rapid testing and better contact tracing. This is where there’s a powerful opportunity to improve government supply procurement and purchasing power to generate demand and drive down costs so that consumers and health systems do not see rapid, reliable testing as a barrier, but a pathway to maintaining a normal life.

Here’s the most important point: no amount of scientific innovation or streamlined systems will help us if we don’t begin tackling the structural and societal issues that are fueling widespread, entrenched resistance to public health mandates. How we view governments, institutions, social norms and risk are the biggest drivers to how we respond individually and collectively to the next pandemic. Or for that matter, how we respond to the greatest public health threat we all face: climate change.

If we want to consider solutions that stick, perhaps we should look at the Space Race for lessons. The Moonshot fueled a national push for STEM education that may have helped deliver many of the big tech breakthroughs of the late 20th century. We need to train a “WE” generation to replace the “ME” generation that has placed such heavy reliance on individual decision-making. That luxury resulted in high rates of infection for many at the hands of a few.

Covid-19 is a catalyst for change

Using Covid-19 as a catalyst, now is the time we should be creating incentives to build public health education and appreciation at the earliest ages, first with the generation of kids who have missed so much from the past two years. Now is the time to figure out how we create better communications processes — assessing and rewarding the channels that are most beneficial versus those that are detrimental.

And right now is when we should invest in more creative partnerships that foster collaboration between schools of public health, journalism, and government. Town halls sponsored by a mix of trusted local and national groups can encourage greater dialog about the role of science, public health, and policy in the 21st century.

These are the building blocks for confronting the next pandemic. We have the incentives and potential to meet the scientific challenges, scale our response, and improve our systems. But if we can’t change human nature, we don’t stand a chance.

The post Focusing on Essential Change for the Next Pandemic and Beyond appeared first on Medika Life.

Six in 10 American adults have a chronic disease, and a significant percentage of these conditions could be prevented with lifestyle change. Studies suggest that up to 90% of type 2 diabetes, 80% of coronary artery disease, 70% of stroke and 70% of colon cancer are potentially preventable through a reduction in five key lifestyle risk factors: unhealthy diet, inadequate physical activity, overweight, smoking and excess alcohol consumption.

Considering the unhealthy habits many of us picked up during the pandemic (decreased exercise, increased snacking, heavier drinking), compounded by stress and loss of sleep, we can expect a further surge in chronic disease — and the associated personal and financial costs.

How are we going to address this growing problem before it overwhelms our health care system, our economy, and our ability to compete and lead the world by the power of our example?

A lack of primary prevention

Much of the problem lies in the expectation that our existing health care infrastructure is going to solve this problem. Physicians don’t have the training or time to create personalized habit-change plans and ensure that patients follow them, nor are they adequately reimbursed for practicing lifestyle medicine.

While medical education is shifting to incorporate more behavior-change best practices into curricula, most physicians — aside from the key role they play in preventive screenings and identifying patients at risk — continue to focus on sick care rather than on keeping healthy people healthy.

The lack of primary prevention and consistent support for incremental habit change for healthy people represents a massive structural hole in our health care system and our society in general. And it’s a hole that physicians cannot and should not be expected to fill on their own.

The one-on-one personal coaching needed to help individuals achieve long-term successful habit change requires greater frequency of contact than is possible with typical health provider relationships, and although behavior change clearly results in long-term cost savings, it does not fit the fee-for-service model that most providers still operate under.

An opportunity for insurers and payers

The savings do, however, represent an opportunity to introduce the needed paradigm shift via insurers and corporate payers, who currently bear a large share of the cost of managing expensive chronic conditions once they have developed.

The front line in this battle should not be when patients are in the hospital dealing with symptoms, but much earlier — before unhealthy habits have had a chance to negatively affect people’s health.

Insurers and payers certainly recognize the value of promoting a healthier workforce, and they frequently offer preventive health programs for their members and employees. However, traditional health improvement and prevention efforts tend to be one-size-fits-all curriculum-oriented programs — modeled on our learning and education system — that rely on participants’ own motivation to find what works for them and stick with it. Unfortunately, it’s human nature to look for quick-fix solutions, particularly when it comes to lifestyle change and losing weight.

Many people give up if they don’t see the results they want right away. Traditional efforts also rely heavily on willpower, which is rarely enough when it comes to the complex issue of weight loss. An effective plan must also take into account a wide range of individual circumstances and characteristics, including the person’s medical history, genetics, social determinants, personality, intrinsic goals, readiness to change, and many other factors.

Habits are by definition cultivated over time, and sustainable behavior change requires one-size-fits-one coaching and support — in the context of a trusting personal relationship — to build confidence in making small incremental changes and keep individuals engaged, motivated and accountable over the long term. Fortunately, support for habit change is a role that lends itself well to a virtual environment, with telehealth coaching sessions complemented by smart remote monitoring tools such as fitness trackers and smart scales, along with the right gaming and curated social health community. This makes participation more convenient and accessible for employees while reducing costs for payers.

A new partner in health

In short, support for habit change is a task best suited to a new and different type of health specialist that insurers and payers can partner with to overcome lifestyle-related chronic disease. Just as there are many physician and allied health subspecialties that address the diverse aspects of diagnosis and treatment of various illnesses and health conditions, we should look to embrace a new (and virtual) front line of healthy habit change providers that can address primary prevention and effective habit change — working with and alongside physicians and the existing “sick care” infrastructure.

It’s time to fill that structural gap. The health of our families, neighbors, and country is at stake

The post Treating Lifestyles . The Structural Gap in Patient Care appeared first on Medika Life.

It is increasingly difficult, if not bordering on impossible, in today’s America to find decent mental health care. Therapists are in short supply and spoilt for choice. They can cherry-pick patients from the long waiting lists of people requiring their help and insurers are reticent to pay for care.

In my colleague’s case, she had the added burden of wanting to find a Korean-speaking therapist who would not only be able to speak her native tongue but more importantly, would understand the dynamic of an Asian family.

She turned to the Employee Assistance Program (EAP) offered by her employer to try and secure the services of a therapist. Although she has now established contact with one, the process was onerous, time-consuming and a far cry from ideal.

The therapist she found isn’t Asian and doesnt speak Korean — according to the American Psychology Association, only 5% of psychologists in America are Asian. He also isn’t covered by her insurer but she is left with no other choice and has decided to commit.

Not everyone does. Providing family therapy is a complex process and it requires a clear understanding of the interpersonal dynamics at play. Asian families differ from Mexican families in the same way that White American families differ from African-American families or European families. It’s a cultural thing.

To provide effective treatment the therapist has to be intimately versed in the family’s culture and traditions. Jewish people look for Jewish therapists, Irish Americans look for therapists with Irish backgrounds, and so on. This raises the question, what happens when you are presented with a system like her EAP that doesn’t have the flexibility to address these elements? The answer is simple.

You are provided sub-standard levels of care or at worst, no care at all as the recommendations are not suited to the patient. This is a system that works partially, but that is built to enforce racial and cultural biases, not intentionally, but consequentially. Before you go off on the racial bandwagon, it is very doubtful that the creators of this system purposely designed it this way.

It merely suffers from a poor or inadequate design that is further restricted by an inability to evolve or adapt to the fluid landscape it inhabits.

The issue here, in terms of the systems we deploy in healthcare, is primarily a discriminatory one, based on cultural ignorance or a conscious decision to focus on the predominantly white American patient model for developing solutions.

This raises another question. Which other systems do we currently use that have been developed using white middle-class American patients as a baseline? Which products are currently being developed that will further enforce this systemic bias? New technology-based solutions that promote cultural disparities in healthcare and reduce access to care?

I can assure you these are in development as we speak, with most developers blithely unaware of the consequences of their chosen data set or model.

The Rainbow Society of Modern Day America

America is a melting pot of cultures, colors, and religions. A human stew, each ingredient having contributed to the growth of the country and each one as deserving of proper medical care as the other. To ignore this is to ignore the very fabric of what once made America great. Diversity is a strength, shared under one flag. That’s the theory.

In practice, things look bleak. Racism and cultural discrimination permeate American healthcare, in much the same way they permeate American society. Healthcare is, arguably, simply an extension of the society it serves, so this shouldn’t come as a surprise to anyone.

Don’t take my word for it, speak to someone of color if you’re white, or read one of the many excellent articles on the topic from people that experience health disparities first hand. This week, Asian-Americans experienced the brunt of this evil, next week the Hispanic community may be up.

This ugly undercurrent flows continuously through modern-day America, thinly disguised beneath an increasingly tenuous veneer of civility. I dislike the term “racism”, but for the purposes of this article, it will suffice and I raise this point for one simple reason.

If we have inherent racism and bias being exhibited by providers, unintentional or otherwise,, and we then add the burden of racially or culturally biased systems to the equation, what chance do these groups stand of accessing fair and equitable care?

Systems and people are not the same things. Systems are easily fixed if the desire and motivation exist. We can easily begin assessing software and digital health solutions for inbuilt biases that may inadvertently discriminate against certain communities. We can examine entrenched systems and develop guidelines for new systems.

Well-built, robust systems are designed to evolve and expand beyond their original parameters. Staid, old, and inflexible solutions will simply fall by the wayside. For instance, simply broadening the societal scope under which products are developed to account for cultural differences would directly and immediately benefit patient outcomes.

It’s a complicated world, where solutions cannot be everything to everyone. Issues around race and culture have to be considered alongside age, sex, and other complex criteria that affect our ability to deliver care. Where patient-facing technology is deployed, inclusivity must be maximized and where certain demographics are left incapable of accessing these solutions, alternatives must be provided.

We no longer have the excuse of ignorance on our side. Healthcare is aware of its failings and it is aware of the steps needed to address these issues. The problem, as I see it, is that this is not the only ill that hangs over American Healthcare. Other issues, equally pressing and equally as important to the delivery of effective care, also need to be addressed.

It is a question of priorities, of repairing other systems that are not fit for purpose. Where the issues of addressing cultural and racial disparities fit into the jigsaw puzzle of an industry barely holding together under the stresses of a pandemic and logistical demands, remains to be seen.

But address them we must. The mechanisms I refer to can and do result in death. Take the simple, but terrible example of mortality rates among black American women in childbirth. Racism and discrimination have no place in our house, and it’s time to draw a line and rid the industry of biases.

Perhaps the most important thing we can do for future generations of patients is to screen healthcare students for racial bias. A purge, forced on us by our current inability to respond to the underrepresented voices clamoring for care and basic dignity.

The post We Have Inadvertently Built Cultural Discrimination Into Our Healthcare Systems appeared first on Medika Life.

We’ve got vaccines. Getting vaccinated is another matter.

It is amazing how one aspect of our response to COVID-19 appears fueled by light-speed technology, while another seems to be powered by a spinning hamster wheel. It’s curious that we can do great things in the lab to save lives, but we can’t effectively or efficiently coordinate the delivery of information, care, or medicines to consumers.

It’s part of a pattern that shows not enough thought has been given to the most basic coordination of information. After almost 11 months of dealing with the virus, we are still scrambling. At the outset of the pandemic, it was a mad dash to secure personal protective equipment for our frontline healthcare providers, essential workers, and households. Then we saw a run on toilet paper and other supermarket supplies, with the images of empty store shelves a stark reminder of how demand could quickly outstrip the capacity of our supply chains. Now, we are confounded by the frustration of scheduling COVID-19 vaccine appointments or having them canceled when there isn’t enough vaccine to administer.

Bottom line: our health information and delivery systems are not structured to prioritize consumers. Trying to secure a vaccine appointment is like swimming upstream, a tension-generating reminder of the fact that the health system isn’t set up to cater to patients.

Health system communications aren’t even modern. “It’s no secret that many providers and payers relied heavily on the use of fax machines and printed documentation,” said Paul Joiner, chief operating officer of health information network Availity, in a recent interview with Healthcare IT News. As the pandemic “disrupted operations for payers and providers, with many employees and staff members working from home, the willingness to collaborate advanced significantly,” Joiner added. “The old way of sending transactions, clinical documentation, and policy changes transformed overnight.”

And yet, many doctors continue to defend the use of the fax machine, citing HIPAA regulations and concerns of malware or ransomware. This continues to act as a stumbling block in an ailing system, where information needs to be put to active use directing and supporting action as part of an interventional medical care movement that people with health risks desperately need. People are at risk of dying, yet fax machines putt-putt along, alive and well.

What keeps consumers and patients from life-extending essentials is a failure of coordinating and communicating information; in a sense, weaponizing it against disease. Effectively sharing information helped power the innovation that resulted in novel vaccines. However, failing to coordinate how information is inputted, accessed, and applied fuels the anxiety we’re all feeling right now as people who should be protected from Covid-19 — those with life-threatening medical conditions, schoolteachers, people 65 and older, and others — struggle to get vaccinated.

Driving innovation is not the underlying problem; it is organizing information.

Most product shortages are created by poor planning colliding with public need, or worse, people panicking. Forget about moving pills, ampules, or devices on massive pallets from around the world to patients’ hospital bedsides. We have to reimagine how we move people’s medical information off paper charts and onto cloud-based systems so that health professionals — from providers to epidemiologists — can better serve patients with the needed level of coordination and urgency.

Now, as we rebuild our economic system, we have the opportunity to revisit how we coordinate the organization and delivery of healthcare that comprises 18 percent of the United States gross domestic product (GDP).

If we rally our information, tech muscle, and energies toward this one public health challenge alone, it will translate into billions in savings from reduced hospital costs, physician visits, and insurance bills, lifting the burden on taxpayers — both employers and families. It will also save people’s lives.

Remove the Information Sword of Damocles From Patient Care

To incentivize overhauling our health information systems, we need to make medical information available to consumers. That means upping the ante on cybersecurity to protect consumers and advance their health needs. It does not mean using data against them by denying consumers long-term care and coverage.

Many people shy away from confronting health challenges or sharing their personal data for fear their medical records will be held over them like the sword of Damocles. Is penalizing people for being unhealthy at one stage in their life journey worth punishing them in the future? Isn’t helping them to get healthy the ultimate win-win-win, reducing costs and waste and keeping them alive longer?

Information cannot be a vehicle for medical exclusion but should be a means to create healthier people and provide them with better, well-coordinated care.

Let us look at COVID-19 as a wake-up call. At some point, employers and insurers will find that encouraging self-care and disease intervention is a savvy, responsible business model. Digital health tools are readily available to support this. Telemedicine, health apps, remote monitoring tools, and other AI-based technologies contribute to healthier people who can access targeted medicines and individualized dosing.

It may be anathema to the holders of the system’s information keys to place consumers in the driver’s seat of wellness and self-care by giving them access to their own information. That’s got to change. “You cannot deliver on the promise of digital transformation with traditional IT,” reminds Edward W. Marx, chief digital officer, Tech Mahindra Health & Life Sciences, who also served as the chief information officer at Cleveland Clinic.

While we remember our supermarket runs for toilet paper, continue to stockpile masks and gloves, and struggle to set up our appointments for vaccination, we need to look beyond these snafus at what drives the system — information. COVID-19 reinforces that information technology is the foundation for countless public health solutions. It’s time we acted on that realization.

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