[Med-privacy] WSJ Big Employers Plan Electronic Health Records
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dpeelmd@aol.com
Thu, 30 Nov 2006 10:15:37 -0500
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Comment from Deborah Peel, MD: =E2=80=9CBig employers plan to force their em=
ployees to use electronic medical records and then store those sensitive rec=
ords in a database that they control. This at a time when consumers no longe=
r have a federal right to control who can use and access their sensitive ele=
ctronic medical records or opt=E2=80=93out of electronic systems. This plan=20=
is a prescription for disaster-----employees=E2=80=99 sensitive medical reco=
rds will be held in an employer-controlled database. The information in such=
a database can be used for purposes employees would never agree to and cann=
ot stop. Sensitive medical records in this database can be used to discrimin=
ate against consumers in jobs, insurance coverage, credit, and other key are=
as of life.=E2=80=9D
=20
http://online.wsj.com/article_email/SB116477185099435441-lMyQjAxMDE2NjI0OTcy=
NzkxWj.html=20
=20
Big Employers Plan
Electronic Health Records
=20
By GARY MCWILLIAMS
November 29, 2006; Page B1
=20
Several big employers are about to deliver an electronic jolt to the U.S. he=
alth-care system.
Next week, Intel Corp., Wal-Mart Stores Inc., British Petroleum and others w=
ill disclose a plan to provide digital health records to their employees and=
to store them in a multimillion-dollar-data warehouse linking hospitals, do=
ctors and pharmacies. Their goal: to cut costs by having consumers coordinat=
e their own health care among doctors and hospitals.
=20
Craig R. Barrett, Intel's chairman, calls portable electronic records "the b=
uilding-block to modify the U.S. health industry" into a more responsive and=
cost-conscious system. "I frankly don't think that the industry is capable=20=
of modifying itself," he says.
=20
Next week, the companies will announce their collaboration on a records stan=
dard to kick-start the plan. Later, about 10 employers are expected to chip=20=
in $1.5 million each to construct a data warehouse to store and update the e=
-records.=20
=20
Once in place, the combination would allow consumers and insurers to evaluat=
e price and performance data from millions of employees. Eliminating duplica=
te tests and erroneous or lost information would also slash administrative o=
verhead, which is estimated to account for 40% of medical costs. And electro=
nic prescriptions alone could help prevent the 98,000 serious illnesses or d=
eaths that result annually from prescription mistakes.
=20
=20
ONE DOCTOR'S EXPERIENCE
=20
WSJ columnist Benjamin Brewer, a family practice doctor in Illinois, has wri=
tten about his experience with online patient visits, and how they help buil=
d electronic health records. Click here.
=20
Doctors could also use the records to measure which treatments worked best f=
or chronically ill groups of patients. In addition, once their records are o=
nline, employees could order prescriptions and calculate their out-of-pocket=
medical costs using software that understands their health plans.
=20
Patient medical records -- often hand-written -- are currently strewn among=20=
doctors' offices and hospitals. Computerizing them has long been supported b=
y hospital and doctors' groups, but has foundered on technical and cost grou=
nds. Now, only about 10% of U.S. doctors have a completely electronic record=
-keeping system.
=20
Coalition members believe that giving consumers control over their own recor=
ds would help get around the technical and cost issues. But the idea of port=
able medical records and a massive repository still faces hurdles. Privacy a=
dvocates worry that digital records will be misused by employers and insurer=
s to deny jobs or health-care coverage. The watchdog group Patient Privacy R=
ights Foundation urges employees to shun the approach until there are adequa=
te protections. "The system is leaking information," says Chairwoman Deborah=
C. Peel, a practicing psychiatrist. "Once out there, it's like a Paris Hilt=
on sex video. It's [there] for the millennium."
=20
The coalition expects to apply a combination of market pressure and incentiv=
es to get doctors and hospitals on board. The employers will insist that hea=
lth-care providers adopt electronic records and prescribing as a condition o=
f future business. Retailer Wal-Mart will apply its purchasing power to get=20=
bar codes on products intended for hospitals and clinics. All expect employe=
es to pick doctors willing to use and update their records, though employee=20=
compliance is voluntary. According to the companies, the records will be the=
property of the employees, and the data will be mined by insurers and other=
s only after the patients' identity is stripped off.
=20
"We're trying to bring all the right people to the table and show them what=20=
can be done," says Linda M. Dillman, the Wal-Mart executive vice president i=
n charge of the company's budding health-care initiative. A late comer to th=
e health-care debate, Wal-Mart has been criticized for its employee health p=
lans, and it has sought out allies among medical societies and health-care a=
dvocates.
=20
Intel and Wal-Mart came together on the initiative last summer at the sugges=
tion of the Centers for Disease Control and Prevention. Each had been meetin=
g separately with the federal agency to discuss its efforts. Wal-Mart's Ms.=20=
Dillman describes the linkup as a bit of unexpected luck. "There is only so=20=
much you can do internally. To make a difference, you have to reach outside=20=
your own four walls," she says.
=20
Both companies' businesses could benefit from the initiative's success. Inte=
l sells chips that power prescription-writing hand-held PCs as well as giant=
file servers. Wal-Mart, the third-largest pharmacy chain, will soon have 60=
"miniclinics" dispensing basic health-care services, and it is rapidly expa=
nding the business.
=20
Wal-Mart and Intel also share a common enemy: benefit costs. Intel figures i=
ts health-care spending will be as much as a fifth of its research and devel=
opment costs by 2009. Wal-Mart says the costs for its 1.3 million U.S. emplo=
yees, if unchecked, will climb $1 billion annually for the next five years.
=20
While health care in the U.S. has remained paper-based and fragmented. Danis=
h hospitals, pharmacies and general practitioners communicate via a secure,=20=
government-supplied network. Danes can go online to book medical appointment=
s, renew prescriptions, view diagnoses and query their doctors.
=20
At the heart of the Intel-Wal-Mart approach is the belief that if price and=20=
quality measures apply market pressures, technology can duplicate the integr=
ation that government-run health-care systems like the Danish one achieve. T=
he final pieces to the puzzle -- pricing and performance information -- only=
recently started appearing online. The government posts pricing information=
using the fees charged to Medicaid. Groups including Hospital Quality Allia=
nce, Ambulatory Quality Alliance and the Wisconsin Collaborative for Healthc=
are Quality rate hospitals and doctor groups on quality.
=20
"The evidence is beginning to show that what gets measured and reported publ=
icly gets improved faster," says Christopher Queram, president of Wisconsin=20=
Collaborative for Healthcare Quality, which began rating southeast Wisconsin=
hospitals and doctors in 2003.
=20
"If this works, for the first time people and companies will be able to get=20=
a sense of how their doctors are doing so they can steer to or from them," s=
ays Sheldon Greenfield, director of the health-policy research center at the=
University of California, Irvine. Costs will fall when consumers can see "o=
ther doctors are achieving the same outcomes at lower cost. That's going to=20=
eventually affect us," he says.
=20
Suitable quality measures for certain illnesses, such as depression and hear=
t disease, aren't currently available, says Dr. Greenfield. But in other are=
as, such as diabetes, there are widely accepted ways to measure quality -- a=
nd match it to pricing.
=20
The Intel-Wal-Mart plan to offer employees medical records and automatically=
update those records with hospital, doctor and pharmacy detail "is very amb=
itious," says Dr. Greenfield, an adviser to Care Focused Procurement LLC., a=
nonprofit putting together an HMO claims database. "We love the patient as=20=
the agent."
=20
"It has always seemed unusual to me that the medical record is seen as the p=
roperty of the medical system," adds Donald Berwick, chief executive of the=20=
Institute for Health Care Improvement, Cambridge, Mass. Tests are duplicated=
and information lost in the handoff between physicians or clinics. "The bes=
t integrator in the end is the patient," Dr. Berwick says.
=20
Write to Gary McWilliams at gary.mcwilliams@wsj.com
=20
________________________________________________________________________
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<div>
<div class=3DSection1>
<div class=3DMsoNormal><FONT face=3DArial size=3D2><SPAN style=3D"FONT-SIZE:=
10pt">Comment from Deborah Peel, MD: =E2=80=9CBig employers plan to force t=
heir employees to use electronic medical records and then store those sensit=
ive records in a database that they control. This at a time when consumers n=
o longer have a federal right to control who can use and access their sensit=
ive electronic medical records or opt=E2=80=93out of electronic systems. Thi=
s plan is a prescription for disaster-----employees=E2=80=99 sensitive medic=
al records will be held in an employer-controlled database. The information=20=
in such a database can be used for purposes employees would never agree to a=
nd cannot stop. Sensitive medical records in this database can be used to di=
scriminate against consumers in jobs, insurance coverage, credit, and other=20=
key areas of life.=E2=80=9D<?xml:namespace prefix =3D o ns =3D "urn:schemas-=
microsoft-com:office:office" /><o:p></o:p></SPAN></FONT></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D2><SPAN style=3D"FONT-SIZE:=
10pt"><o:p> </o:p></SPAN></FONT></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D2><SPAN style=3D"FONT-SIZE:=
10pt"><A title=3Dhttp://online.wsj.com/article_email/SB116477185099435441-l=
MyQjAxMDE2NjI0OTcyNzkxWj.html href=3D"http://online.wsj.com/article_email/SB=
116477185099435441-lMyQjAxMDE2NjI0OTcyNzkxWj.html">http://online.wsj.com/art=
icle_email/SB116477185099435441-lMyQjAxMDE2NjI0OTcyNzkxWj.html</A> <o:p></o:=
p></SPAN></FONT></div>
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<H1 style=3D"MARGIN: 0in 0in 0pt"><B><FONT face=3D"Times New Roman" size=3D5=
><SPAN style=3D"FONT-SIZE: 18pt">Big Employers Plan<br>
Electronic Health Records</SPAN></FONT></B></H1>
<H1 style=3D"MARGIN: 0in 0in 0pt"><B><FONT face=3D"Times New Roman" size=3D5=
><SPAN style=3D"FONT-SIZE: 18pt"><o:p></o:p></SPAN></FONT></B> </H1>
<div class=3DMsoNormal><B><FONT face=3DArial size=3D1><SPAN style=3D"FONT-WE=
IGHT: bold; FONT-SIZE: 9pt"><SPAN id=3Dbyl>By GARY MCWILLIAMS<br>
</SPAN></FONT></B><SPAN class=3Datime1><B><I><FONT face=3D"Times New Roman"=20=
size=3D1><SPAN style=3D"FONT-WEIGHT: bold; FONT-SIZE: 9pt">November 29, 2006=
; Page <SPAN class=3Dcorrection id=3D"">B1</SPAN></SPAN></FONT></I=
></B></SPAN></SPAN></div>
<div class=3DMsoNormal><SPAN style=3D"FONT-WEIGHT: bold; FONT-SIZE: 9pt"><SP=
AN class=3Datime1><B><I><FONT face=3D"Times New Roman" size=3D1><SPAN style=
=3D"FONT-WEIGHT: bold; FONT-SIZE: 9pt"></SPAN></SPAN></FONT></I></B></SPAN><=
B><FONT size=3D1><SPAN style=3D"FONT-WEIGHT: bold; FONT-SIZE: 9pt"><o:p></o:=
p></SPAN></FONT></B> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Several big employers are about to deliver an electronic jolt=
to the <?xml:namespace prefix =3D st1 ns =3D "urn:schemas-microsoft-com:off=
ice:smarttags" /><st1:country-region w:st=3D"on"><st1:place w:st=3D"on">U.S.=
</st1:place></st1:country-region> health-care system.<o:p></o:p></SPAN></FON=
T></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Next week, <A title=3Dhttp://online.wsj.com/quotes/main.html?=
type=3Ddjn&symbol=3Dintc href=3D"http://online.wsj.com/quotes/main.html?=
type=3Ddjn&symbol=3Dintc">Intel</A> Corp., <A title=3Dhttp://online.wsj.=
com/quotes/main.html?type=3Ddjn&symbol=3Dwmt href=3D"http://online.wsj.c=
om/quotes/main.html?type=3Ddjn&symbol=3Dwmt"><SPAN class=3Dcorrection id=
=3D"">Wal-Mart</SPAN> Stores</A> Inc., <A title=3Dhttp://online.wsj.com/quot=
es/main.html?type=3Ddjn&symbol=3Dbp href=3D"http://online.wsj.com/quotes=
/main.html?type=3Ddjn&symbol=3Dbp">British Petroleum</A> and others will=
disclose a plan to provide digital health records to their employees and to=
store them in a <SPAN class=3Dcorrection id=3D"">multimillion-dollar-data</=
SPAN> warehouse linking hospitals, doctors and pharmacies. Their goal: to cu=
t costs by having consumers coordinate their own health care among doctors a=
nd hospitals.<o:p></o:p></SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3></FONT> </di=
v>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3>Craig R. Barrett,=
Intel's chairman, calls portable electronic records "the building-block to=20=
modify the <st1:country-region w:st=3D"on"><st1:place w:st=3D"on">U.S.</st1:=
place></st1:country-region> health industry" into a more responsive and cost=
-conscious system. "I frankly don't think that the industry is capable of mo=
difying itself," he says.</FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3></FONT> </di=
v>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Next week, the companies will announce their collaboration on=
a records standard to kick-start the plan. Later, about 10 employers are ex=
pected to chip in $1.5 million each to construct a data warehouse to store a=
nd update the e-records. </SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Once in place, the combination would allow consumers and insu=
rers to evaluate price and performance data from millions of employees. Elim=
inating duplicate tests and erroneous or lost information would also slash a=
dministrative overhead, which is estimated to account for 40% of medical cos=
ts. And electronic prescriptions alone could help prevent the 98,000 serious=
illnesses or deaths that result annually from prescription mistakes.<o:p></=
o:p></SPAN></FONT></div>
<div class=3DMsoNormal><SPAN class=3Db13><FONT face=3DArial size=3D3><SPAN s=
tyle=3D"FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></SPAN></div>
<div class=3DMsoNormal><SPAN class=3Db13><FONT face=3DArial size=3D3><SPAN s=
tyle=3D"FONT-SIZE: 12pt"><o:p></o:p></SPAN></FONT></SPAN></div>
<div class=3DMsoNormal><SPAN class=3Db13><FONT face=3DArial size=3D3><SPAN s=
tyle=3D"FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></SPAN></div>
<div class=3DMsoNormal><SPAN class=3Db13><FONT face=3DArial size=3D3><SPAN s=
tyle=3D"FONT-SIZE: 12pt">ONE DOCTOR'S EXPERIENCE</SPAN></FONT></SPAN><o:p></=
o:p></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D1><SPAN style=3D"FONT-SIZE:=
4pt"> <o:p></o:p></SPAN></FONT></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D3><SPAN style=3D"FONT-SIZE:=
12pt">WSJ columnist Benjamin Brewer, a family practice doctor in <st1:State=
w:st=3D"on"><st1:place w:st=3D"on">Illinois</st1:place></st1:State>, has wr=
itten about his experience with online patient visits, and how they help bui=
ld electronic health records. Click <A title=3Dhttp://online.wsj.com/article=
/SB115490123782128151.html?mod=3DUS-Business-News href=3D"http://online.wsj.=
com/article/SB115490123782128151.html?mod=3DUS-Business-News">here</A>.</SPA=
N></FONT></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D3><SPAN style=3D"FONT-SIZE:=
12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Doctors could also use the records to measure which treatment=
s worked best for chronically ill groups of patients. In addition, once thei=
r records are online, employees could order prescriptions and calculate thei=
r out-of-pocket medical costs using software that understands their health p=
lans.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Patient medical records -- often hand-written -- are currentl=
y strewn among doctors' offices and hospitals. Computerizing them has long b=
een supported by hospital and doctors' groups, but has foundered on technica=
l and cost grounds. Now, only about 10% of <st1:country-region w:st=3D"on"><=
st1:place w:st=3D"on">U.S.</st1:place></st1:country-region> doctors have a c=
ompletely electronic record-keeping system.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Coalition members believe that giving consumers control over=20=
their own records would help get around the technical and cost issues. But t=
he idea of portable medical records and a massive repository still faces hur=
dles. Privacy advocates worry that digital records will be misused by employ=
ers and insurers to deny jobs or health-care coverage. The watchdog group Pa=
tient Privacy Rights Foundation urges employees to shun the approach until t=
here are adequate protections. "The system is leaking information," says Cha=
irwoman Deborah C. Peel, a practicing psychiatrist. "Once out there, it's li=
ke a Paris Hilton sex video. It's [there] for the millennium."</SPAN></FONT>=
</div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">The coalition expects to apply a combination of market pressu=
re and incentives to get doctors and hospitals on board. The employers will=20=
insist that health-care providers adopt electronic records and prescribing a=
s a condition of future business. Retailer <SPAN class=3Dcorrection id=3D"">=
Wal-Mart</SPAN> will apply its purchasing power to get bar codes on products=
intended for hospitals and clinics. All expect employees to pick doctors wi=
lling to use and update their records, though employee compliance is volunta=
ry. According to the companies, the records will be the property of the empl=
oyees, and the data will be mined by insurers and others only after the pati=
ents' identity is stripped off.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"We're trying to bring all the right people to the table and=20=
show them what can be done," says Linda M. <SPAN class=3Dcorrection id=3D"">=
Dillman</SPAN>, the <SPAN class=3Dcorrection id=3D"">Wal-Mart</SPAN> executi=
ve vice president in charge of the company's budding health-care initiative.=
A late comer to the health-care debate, <SPAN class=3Dcorrection id=3D"">Wa=
l-Mart</SPAN> has been criticized for its employee health plans, and it has=20=
sought out allies among medical societies and health-care advocates.</SPAN><=
/FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Intel and <SPAN class=3Dcorrection id=3D"">Wal-Mart</SPAN> ca=
me together on the initiative last summer at the suggestion of the Centers f=
or Disease Control and Prevention. Each had been meeting separately with the=
federal agency to discuss its efforts. <SPAN class=3Dcorrection id=3D"">Wal=
-Mart</SPAN>'s Ms. <SPAN class=3Dcorrection id=3D"">Dillman</SPAN> describes=
the <SPAN class=3Dcorrection id=3D"">linkup</SPAN> as a bit of unexpected l=
uck. "There is only so much you can do internally. To make a difference, you=
have to reach outside your own four walls," she says.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Both companies' businesses could benefit from the initiative'=
s success. Intel sells chips that power prescription-writing hand-held PCs a=
s well as giant file servers. <SPAN class=3Dcorrection id=3D"">Wal-Mart</SPA=
N>, the third-largest pharmacy chain, will soon have 60 "<SPAN class=3Dcorre=
ction id=3D"">miniclinics</SPAN>" dispensing basic health-care services, and=
it is rapidly expanding the business.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><SPAN class=3Dcorrection id=3D"">Wal-Mart</SPAN> and Intel al=
so share a common enemy: benefit costs. Intel figures its health-care spendi=
ng will be as much as a fifth of its research and development costs by 2009.=
<SPAN class=3Dcorrection id=3D"">Wal-Mart</SPAN> says the costs for its 1.3=
million <st1:country-region w:st=3D"on"><st1:place w:st=3D"on">U.S.</st1:pl=
ace></st1:country-region> employees, if unchecked, will climb $1 billion ann=
ually for the next five years.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">While health care in the <st1:country-region w:st=3D"on"><st1=
:place w:st=3D"on">U.S.</st1:place></st1:country-region> has remained paper-=
based and fragmented. Danish hospitals, pharmacies and general practitioners=
communicate via a secure, government-supplied network. Danes can go online=20=
to book medical appointments, renew prescriptions, view diagnoses and query=20=
their doctors.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">At the heart of the Intel-<SPAN class=3Dcorrection id=3D"">Wa=
l-Mart</SPAN> approach is the belief that if price and quality measures appl=
y market pressures, technology can duplicate the integration that government=
-run health-care systems like the Danish one achieve. The final pieces to th=
e puzzle -- pricing and performance information -- only recently started app=
earing online. The government posts pricing information using the fees charg=
ed to Medicaid. Groups including Hospital Quality Alliance, Ambulatory Quali=
ty Alliance and the Wisconsin Collaborative for <SPAN class=3Dcorrection id=
=3D"">Healthcare</SPAN> Quality rate hospitals and doctor groups on quality.=
</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"The evidence is beginning to show that what gets measured an=
d reported publicly gets improved faster," says Christopher <SPAN class=3Dco=
rrection id=3D"">Queram</SPAN>, president of Wisconsin Collaborative for <SP=
AN class=3Dcorrection id=3D"">Healthcare</SPAN> Quality, which began rating=20=
southeast <st1:place w:st=3D"on">Wisconsin</st1:place> hospitals and doctors=
in 2003.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"If this works, for the first time people and companies will=20=
be able to get a sense of how their doctors are doing so they can steer to o=
r from them," says Sheldon Greenfield, director of the health-policy researc=
h center at the <st1:PlaceType w:st=3D"on">University</st1:PlaceType> of <st=
1:PlaceName w:st=3D"on">California</st1:PlaceName>, <st1:City w:st=3D"on"><s=
t1:place w:st=3D"on">Irvine</st1:place></st1:City>. Costs will fall when con=
sumers can see "other doctors are achieving the same outcomes at lower cost.=
That's going to eventually affect us," he says.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Suitable quality measures for certain illnesses, such as depr=
ession and heart disease, aren't currently available, says Dr. Greenfield. B=
ut in other areas, such as diabetes, there are widely accepted ways to measu=
re quality -- and match it to pricing.</SPAN></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">The Intel-<SPAN class=3Dcorrection id=3D"">Wal-Mart</SPAN> pl=
an to offer employees medical records and automatically update those records=
with hospital, doctor and pharmacy detail "is very ambitious," says Dr. Gre=
enfield, an adviser to Care Focused Procurement <SPAN class=3Dcorrection id=
=3D"">LLC</SPAN>., a nonprofit putting together an <SPAN class=3Dcorrection=20=
id=3D"">HMO</SPAN> claims database. "We love the patient as the agent."</SPA=
N></FONT></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"It has always seemed unusual to me that the medical record i=
s seen as the property of the medical system," adds Donald Berwick, chief ex=
ecutive of the Institute for Health Care Improvement, <st1:place w:st=3D"on"=
><st1:City w:st=3D"on">Cambridge</st1:City>, <st1:State w:st=3D"on">Mass.</s=
t1:State></st1:place> Tests are duplicated and information lost in the <SPAN=
class=3Dcorrection id=3D"">handoff</SPAN> between physicians or clinics. "T=
he best integrator in the end is the patient," Dr. Berwick says.</SPAN></FON=
T></div>
<div class=3Dtimes><FONT face=3D"Times New Roman" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><o:p></o:p></SPAN></FONT> </div>
<div class=3Dtimes><B><FONT face=3D"Times New Roman" size=3D3><SPAN style=
=3D"FONT-WEIGHT: bold; FONT-SIZE: 12pt">Write to </SPAN></FONT></B>Gary McWi=
lliams at <A title=3Dmailto:gary.mcwilliams@wsj.com href=3D"mailto:gary.mcwi=
lliams@wsj.com">gary.mcwilliams@wsj.com</A><o:p></o:p></div>
<div class=3DMsoNormal><FONT face=3DArial size=3D2><SPAN style=3D"FONT-SIZE:=
10pt"><o:p> </o:p></SPAN></FONT></div>
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