Cures for an Ailing System

Some of these "quality report cards" provide data on preventive services, such as the percentage of age-eligible women receiving mammograms or Pap smears. Others focus directly on life-and-death matters, including mortality rates after serious illness or high-risk surgeries. Performance can vary enormously. In the several states now reporting risk-adjusted mortality rates following coronary-artery bypass surgery, for example, top-performing surgeons often have mortality rates half those of the lowest performers.

With such striking differences, one might expect quality report cards to play a key role in medical decision-making. Yet patients rarely use them, and many doctors question their reliability, especially when data pertain to individual physicians. Doctors also worry that calling public attention to inadequacies will impede professional efforts to improve care. Nonetheless, quality report cards work: repeatedly we see that when poor quality of care is made public, providers intensify efforts to improve it.

So how do we take the best advantage of this medical Zagat's? Most important, we stay the course. Yes, work must continue to improve fairness and accuracy, but shedding sunlight on medical practice is unquestionably healthy medicine for patients.
—Arnold M. Epstein, M.D. Chair of the Department of Health Care Policy and Management at Harvard School of Public Health and professor of Medicine at Harvard Medical School and Brigham and Women's Hospital

Wire American Medicine
Polls show that most Americans think their doctors routinely use computers to care for them. After all, this is supposed to be the most technologically advanced medical-care system in the world. But when it comes to patients' records, the great majority of U.S. doctors still rely on technology that predates the printing press: scrawled, often illegible notes that have an uncanny tendency to go missing just when they're needed most.

Experts believe that if hospitals and doctors used electronic health records (EHRs)—systems that store and manage patients' medical information—they could vastly improve the quality of care and reduce costs. For example, such records would routinely warn doctors against giving medicines to patients who are allergic. In the typical paper-based record, it can be hard to find test results—leading to unnecessary repeat tests, and costs. President Bush is so convinced of the value of EHRs that he wants all doctors to adopt them by 2014.

But progress has been slow. The first reason is money. To wire our entire health-care system would cost an estimated $160 billion, and many small physician practices and hospitals are balking. They also fear that installing EHRs will disrupt their work and increase malpractice liability.