The Apixio Blog

Quality is Both the Problem and the Solution to Our Healthcare System’s Ills

It’s a sad paradox that the Unites States leads the world in GDP, scientific discovery, and innovation, but lags in the delivery of healthcare. According to the OECD, the U.S. spends almost twice as much on healthcare delivery than countries like Canada, Germany, Sweden, and the U.K. Despite the 2x spending, the outcomes we achieve are much poorer. We rank dead last amongst developed countries according to the Commonwealth Fund’s overall healthcare metric. For some individual indicators we lag even developing countries, for example, we rank 26th out of all countries in infant mortality, behind Slovakia, Greece, Portugal, and Hungary.

Why do we have such poor healthcare outcomes?

So what gives? How can we develop some of the world’s most innovative medicines and medical technologies, be a GDP-producing powerhouse, and outspend everyone on healthcare, but still end up with some of the poorest health care amongst our peers?

This is not an easy question to answer, as the endless political debate around recent healthcare reform has demonstrated. The problems with our healthcare system are deeply rooted in a myriad of issues ranging from simple access to care, to overpriced pharmaceuticals, to large bureaucracies that have been created to navigate the complex and confusing labyrinth of billing and payment pathways.

The Underlying Factor: A Lack of Focus on Quality Care

There is one factor, though, which underlies all these problems: a lack of focus on quality of care. If we can drive higher quality outcomes, the efficiency of healthcare will follow and our overall metrics will rise. We need to tackle the foundation of quality care – an accurate and comprehensive patient record.

Now, I know this is a bold statement. The U.S. has historically tried to attack the quality problem in a different way, by improving access to care. The ACA, the first fundamental healthcare reform to be enacted in more than 50 years, is a good starting point to help address the access issues, but still arguably does not go far enough and has only shifted the cost burden, not eliminated it. Time will tell if the phased changes will foster the kind of universal-like access the ACA’s creators intended.

The Problem of Access to Information

Still, access to information is as important as access to care, and can have a profound impact on the quality of care delivered. Countries like Canada, the UK and Japan run national health care plans with a common healthcare data system that provides riches of data access. Access to information about the individual is more readily available to help the physician have a better understanding about the individual’s health history – enabling more directed and timely care. In other words, better quality outcomes.

In the U.S., access to a more robust clinical record has also been a problem many have tried to tackle, to little success. Our clinical records, or complete clinical record, is largely inaccessible to the physicians developing our care plans and treating us. As much of 80% of it is strewn about in many different Electronic Health Record Systems (EHRs) that don’t talk to each other, or stored away at different locations in scanned, faxed, or handwritten documents, virtually impossible to locate, read, and fully utilize in directing care.

When It Comes to Data, Healthcare is Living in the Dark Ages

The fact is, when it comes to data, healthcare is living in the dark ages. Imagine the impact on delivering better quality healthcare if there were a better understanding of the true state of the patient, a complete and robust profile of each individual. With cognitive computing platforms like Apixio’s Iris platform, this is becoming a lived actuality. Computers can extract, read and make use of all that messy unstructured data that physicians and nurses have written down about a patient. Access to a complete patient profile can enable earlier interventions and deeper understandings about an individual’s health and wellness, and deliver a level of quality care this country has paid for but still hasn’t received.

By focusing on what can accelerate quality care delivery we can drive down costs and increase the health and wellness of our country, and push our population’s health ranking right next to our GDP, #1.