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Mar 18, 2005

Does medical technology really help doctors?


By Kristen Philipkoski

Medical technology was supposed to remove problems caused by fallible humans: inaccurate prescriptions, wrong diagnoses and inappropriate therapies. But recent studies have shown that some technologies have caused more problems than they've solved.

Nevertheless, the Centers for Medicare & Medicaid Services, or CMS, which provides health insurance to seniors and the poor, is giving a few technologies a shot at improving the government organization's dismal track record managing patients with chronic conditions.

Medicare's history of not adequately covering preventive health services has created a culture of patients waiting until things get really bad before they'll head to the hospital. Such acute care is far more expensive than the ongoing maintenance that can fend off emergencies in the first place.

As part of the Medicare Modernization Act of 2003, CMS is sponsoring nine pilot projects involving 180,000 patients and using technologies administrators hope will improve preventive care. Officials anticipate that the program could, for example, help a diabetes patient get to the doctor before she requires a leg amputation, or allow a doctor to begin a new prescription or diet before his patient suffers heart failure.

How expensive is chronic care? Two-thirds of Medicare money ($236.5 billion in 2001) is spent on just 20 percent of those enrolled, according to a 2002 report (.pdf) from Partnership for Solutions, a group that studies chronic health conditions. Everyone in that 20 percent is coping with five or more chronic conditions. The first of the baby boomers officially become seniors in 2011, and it is clear Medicare needs help, particularly in its chronic-care approach.

"This needs to happen anyway," said Sandy Foote, senior adviser for the Chronic Care Improvement Program at CMS.

CMS has chosen patients with chronic-care needs to participate in pilot projects that will implement technologies ranging from automated phone reminder systems and interactive in-home devices that ask patients questions about their health to hospital technologies for physicians.

CMS is paying health-management organizations like McKesson and Health Dialog to deliver technologies to those patients. But if after three years Medicare doesn't see a substantial improvement in health benefits and costs compared to a randomly selected group of about 100,000 control patients, CMS will ask for an unspecified portion of the fees back.

"We're not going to lock into a technology that may very well be outdated soon," Foote said. "We're paying organizations to help people in very individualized, very personalized ways to reduce their health risks, and they can keep refining how they do that."

That means, for example, McKesson is also not bound by the technologies it has chosen to implement. If something looks like it's not benefiting -- or actually is hindering -- patients or physicians, McKesson or any of the other management organizations can nix a technology for one that might work better.

The program sets up an exceptional potential for change and innovation in a hefty, bureaucratic government organization. And recent studies showing the failure of some medical technologies suggest that flexibility might be a good thing.

Two studies published in the March 9 issue of the Journal of the American Medical Association found that technologies designed to make physicians' jobs easier sometimes didn't, and in some cases the tools actually made the doctors' work more difficult.

"The system should not control the process of doing medicine but respond to how the hospital works," said the University of Pennsylvania's Dr. Ross Koppel, the lead author of the JAMA study. "Very often the software designers expect the users to wrap themselves like pretzels around the software, rather than making it respond to the hospital's needs."

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