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Governments go through plenty of convolutions when deciding their place in the electronic world.
No government wants its computer system to be obsolete overnight. Or to spend hundreds of thousands of dollars on new technology only to find the system inadequate for the state’s needs. But on the limited budgets that state governments have to work with, it is easy for any of those scary scenarios to become reality.
"States don’t have the knowledge and wherewithal to address these problems," explains Tina Nye, chief operating officer for Schaller Anderson, a medical consulting firm in Phoenix. "For example, [requests for proposal] often are obsolete when the time comes for implementation."
There is no alternative but to take a stand. States must get in the electronic pool with everyone else, make the best decisions they can with their limited resources, then live with the consequences. Ms. Nye told members of the Fifth Annual Congress on Managed Medicaid and Medicare that the Internet, intranet, and wireless communications have forced the medical community and governments to adapt to the new technologies.
"Eight years ago, there were 50 Web sites," she said. "Now there are 170 new Web sites every hour."
In 2000, Ms. Nye said, 52 million people in the United States went to the Internet for medical information. But millions of others who could be well-served by the Internet have no access to it.
As with any technology, she said, there are many economic barriers and they must be overcome. There is a large imbalance now, she added, saying that 100% of payers are doing business on the Internet, but the rest of the U.S. population, the Medicare population, the Medicaid population, and providers are nowhere near that figure. Those with the least amount of computer knowledge, including the Medicaid population, will be expected to learn to use and access information through the Internet in order to function in society, Ms. Nye said. Slightly higher use of computers and the Internet, she added, comes from the Medicare population, though that figure is now only 18% to 20%. "It is not that significant."
Companies and governments "must adapt core, basic business processes to the Internet," Ms. Nye said.
"We must educate ourselves and who we work with." Providers must adapt to electronic enrollment information, eligibility information, economic information, and how to collect and receive payments electronically. She said consumers must learn to check and change their eligibility information in order to function well within the system.
Simplification is key, whether it is governments or businesses choosing
the best system for their needs or whether it is consumers using the electronic system to their advantage. One e-health guru looked into the future for consumers and pondered about what it is and what it should be.
"Why can’t [the system] work like an ATM?" wondered Clive Riddle, president and creator of Managed Care On-Line, which offers managed care information over the Internet. "You have a card, you put it in and make your choices. We’re in the Stone Age."
With the number of seniors in the United States getting higher every day, Mr. Riddle said providers should be more forward-looking than they are. "CEOs say, Those [consumers] are not plugged in.’ But that is only partially true. The perception is that seniors do not use the Internet, but they are the fastest-growing group of users."
Government is often way behind the electronic pace, according to Steven Lutzky, chief of the Office on Disabilities and Aging for the District of Columbia Department of Health. "Are we innovators? Benchmarkers? In the states, we’re benchwarmers."
But as the future unwinds, Mr. Lutzky foresaw e-health as "supercharging case managers, helping them to do their jobs much better.
"PalmPilots especially will be helpful to case managers as they make their rounds, shrugging off the excess heft and worries about theft that go with visits to high-crime areas." He also advised state health workers to not develop their own software for e-health.
"States should buy their own systems, then distribute them to providers so that all platforms can communicate. If not, you’ll end up with a tower of Babel," he said. "Medicaid should be the driving force to get all [proposed] systems to committee and everything should be HIPAA-compliant."