Wall Street Journal Profiles Harvard Professor’s ‘Mission’ to Reform Health Care System
The Wall Street Journal today profiles Dr. Donald Berwick, a professor at Harvard Medical School, who is on a "mission" to "re-engineer a health care system he considers rife with errors, waste and delay." Instead of the current standard of "one-on-one" doctor's office visits, which Berwick believes causes appointment delays that can prevent sick patients from receiving necessary treatment, he would like to implement a system based on "quality-control techniques" that are common to other industries. Berwick advocates treating patients in groups and using e-mail or telephone conferences to answer questions and teach patients about disease prevention. Access to one-on-one consultations should be used for patients who need care immediately, according to Berwick. "The health-care encounter as a face-to-face act is a dinosaur," Berwick said. He also advocates providing patients with readily accessible, comprehensive electronic medical records. Through the Institute for Healthcare Improvement, which Berwick established in 1991, he has persuaded dozens of hospitals and hundreds of medical practices to launch pilot projects employing his ideas. In early 2001, the Robert Wood Johnson Foundation chose IHI to run its $20 million "Pursuing Perfection" campaign aimed at reducing medical errors and improving the quality of care using some of Berwick's techniques. The IHI has recruited ThedaCare Inc., an Appleton, Wis.-based complex of three hospitals and 23 outpatient clinics, and Tallahassee Memorial Hospital, a 770-bed hospital, for projects. Tallahassee Memorial's program, which began a few months ago, allows physicians to enter prescriptions into a computer. The system is designed to alert physicians about potential drug interactions and to reduce hand writing errors.
Berwick acknowledges that his ideas are "daring," and he faces a "formidable foe" -- the status quo among more than 5,000 hospitals and 600,000 physicians nationwide. Nancy Dickey, a physician and past president of the American Medical Association, said, "A huge part of patient symptoms and illnesses would respond better to more face-to-face time," adding, "[Patients] would not respond to e-mails or telephone calls." In addition, many insurers refuse to pay for group patient visits because they are considered "non-standard procedures." Insurers have indicated that they would reimburse physicians between $10 and $15 for an e-mail consultation, but a recent survey by Deloitte Consulting and Fulcrum Analytics found that doctors expected to be paid on average $57 for a 15-minute e-mail exchange. In addition, many doctors are opposed to consulting patients over the phone or via e-mail, saying that "serious medical problems" could be missed (Wysocki, Wall Street Journal, 5/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.