Many patients are alive today thanks to the miracles of American health care and despite the shortcomings of the American health care system. These patients illustrate all that is right with American medicine, but also so much of what is wrong.

Politicians like to say that we have the best health care system in the world, but we do not. What we have is the best medical talent in the world, the best technology, and the best facilities, but the system itself is a mess. The best health care system in the world would not allow nearly 100,000 people to die in hospitals of preventable medical errors. The best system in the world would not leave the United States ranked 28th in the world for infant mortality, in the company of Cuba, Hungary, and Slovakia. And certainly the best system would not give patients barely a coin flip’s chance whether they receive evidence-based, scientifically accepted care.

We spend nearly one and a half times more than the average of all industrialized nations—more than $6,000 for every man, woman, and child. By 2013, that number is projected to be closing in on $11,000 per person as health care costs amount to nearly one fifth of our gross domestic product.

Too many Americans are priced out of health care, and if we allow those projections to come true, the ripple effect will be enormous. We need to get a handle on health care costs while improving outcomes and patients’ experiences. As the Institute of Medicine has reported, as many as 98,000 Americans die in hospitals every year as a result of medical errors.

Each of these is a personal tragedy that causes needless anguish. Every medical error means additional procedures, laboratory tests, admissions, and drugs to the tune of $15 billion per year. Even when there is no explicit error, we frequently spend dollars poorly. Research shows that practice variations account for some regions spending as much as 60% more on Medicare than others, with worse outcomes and worse satisfaction.

Even when every decision is right, fragmentation and poor information systems cause duplication and waste. Our health care system is made up of thousands upon thousands of independent providers, each with its own records and no platform to communicate with each other. Patients see multiple doctors, rarely with anybody other than the patient as the traffic cop.

It is no wonder that 54% of chronic disease patients say they have been sent for duplicate tests or procedures within the last year. It is estimated conservatively that 20% of laboratory tests and x-rays are ordered because the previous results can’t be found. One in seven hospitalizations occurs as a precaution because patient information is unavailable.

As any small business owner will tell you, with health care costs what they are, we do not have the luxury of paying for duplication and waste—but pay we do to the tune of 30 cents on the dollar—or $1,400 per employee per year, which is routinely calculated to be of absolutely no clinical value. That translates into a $515 billion dollar tax on employers and the American people in 2004, and an estimated $7.4 trillion over the next decade. How many times over could we cover the uninsured if we could capture even some of those savings?

Transformation is needed
We need a national commitment to create a health care system as good as the care it can provide. We need a transformation so that delivering the highest quality health care becomes not only the overriding goal of the professionals within the system, but of the system itself.

There is a saying: “Every system is perfectly designed to produce the outcomes it gets.” People are at the heart of health care, as they are at the heart of every system—and people are fallible. There will always be human errors, but the question is whether we have the tools, processes, and incentives to help people excel and minimize mistakes.

We need a system that puts a premium on the quality of the medicine practiced, not just the quantity. We need to use 21st century tools to raise the bar. With more and more Americans being priced out of health insurance, transformation is not a luxury, but a necessity.

When we have a system that uses state-of-the-art technology to reduce medical errors, eliminate unnecessary duplication of services, and promote coordination of care and prevention, then we will have the best health care system in the world.

Wired and Paperless
We need to put in place a fully wired, paperless health care system; standardized measures of information to see how well we are doing, an improved evidence base, and payment practices to get quality and value for our health care dollars.

Right now, we place unreasonable expectations on our doctors, nurses, and other providers. In most cases, the only source of outside information about a patient’s history, current health status, specialist consultants, medications, home medical equipment, or any other vital information is the patient himself. Even when a doctor has access to a relatively complete paper record, how much useful information can be gleaned from it without extensive review? Moreover, a practicing doctor may see more than 25 patients a day just to break even, have only 7 minutes with each patient, and have to run a small business with all the challenges that entails. Somehow, he then needs to find time to read all of the literature to stay informed.

To compound matters, we hang a sword over doctors in the form of potential malpractice suits. One of the results of a system with so little quality control is that we are forced to rely too much on the negligence lawsuit. Instead of helping providers, we assign blame.

Our system requires doctors to treat patients with little information and keep in their heads the entire body of medical knowledge. An electronic health system can help health professionals make more of their skills. Doctors and other health professionals should have all the information they need at the point of care. Imagine if we gave providers access to medical health records and support tools to flag adverse reactions or unnecessary interventions.

I am talking about more than just having electronic health records in every hospital, doctor’s office, and health care facility. Simply changing our current paper-based system to ones and zeroes is like the neighborhood library converting its old card files to electronic card catalogs. It is somewhat easier and more efficient to use, but you still can find books only under that one roof. But think about how research changes when the library down the street links its computerized card catalog to all of the other libraries in the city, let alone to the Library of Congress via the Internet.

Change and Exchange
We need health information exchanges that let our health care providers find all of the patient’s information that the patient chooses to share. It is the exchange, more than simply the electronic health record, that has the capacity to transform health care. Each provider would have a complete record for the patient, so there would be no more duplication of tests and procedures. Computerized decision support systems would catch possible errors and improve the use of evidence-based practice guidelines. Patients would have access to important health information in a way that would allow them to be active participants in their own care. A national health information infrastructure will also be a critical public health tool, helping to respond to disease outbreaks and acts of bioterrorism.

Despite their promise, providers, especially physicians in small practices, have little financial incentive to make substantial information technology investments. The providers need to invest in the technology, train themselves and their staffs how to use it, and figure out new processes for their offices. But when we cut down on procedures, tests, errors, and adverse reactions, the providers do not see the savings. The costs and benefits of the investments are misaligned. In addition, the real value lies in the information exchange, not in isolated electronic health records. But providers are not going to use a new system if they can’t be reasonably confident that the exchange contains the information they need.

So, providers inclined to invest in electronic systems will not really get the benefit unless many of their peers make the same decision. But for the health care community as a whole, it is a no-brainer. The potential returns on health information technology investments are enormous. But we will not be able to get the system we need if we expect providers to make all of the investments. It must be a community-wide undertaking, where all of the stakeholders figure out how they are going to divide up the costs and savings.

Most of all, if the doctors, hospitals, insurers, employers, consumers, and state health agencies are willing to figure out how to invest in the needed technology—and how to design a health information exchange—the federal government may then help pay to build the infrastructure. This should also guarantee faster reimbursement by Medicare, Medicaid, and other insurers to any provider who participates.

But ultimately, we also need a system that prioritizes the quality of care, not just the quantity of care. In fact, a lot of providers take it on the chin by improving quality. They are eating the costs of quality improvement because they are in the business to deliver the best care. If the health care system went electronic, we could improve privacy, protect medical records, decrease medical errors, reduce administrative costs, and speed reimbursement.

Mark A. Chmielinski, RRT, is vice president of clinical services for Home Care of Michigan Inc in Allen Park, Mich. He can be reached via email: mchmielinski@hcmich.com.