several years ago I had an experience
that no physician and certainly no
parent would ever wish to have we were
on a family vacation in a remote
Colorado mountain village and we had
just witnessed our six-year-old son
having a terrible biking accident as I
got to him he lay crumpled at the bottom
of the hill it was clear he had an
abdominal injury and possibly
significant internal bleeding while my
wife scrambled to get coverage for other
three children I picked him up and put
him gently in the back seat of our
minivan to take him to the nearest
emergency room unfortunately there was
no emergency room in this town there was
no CT scanner not even an ambulance and
so I found myself driving 28 miles
through winding roads and two valleys to
the nearest ER I managed to make one
quick phone call to let them know at the
emergency room that I’d be arriving soon
with a critically injured child could
they please have a surgeon and a CT
scanner ready and waiting for us the
line dropped before they answered me and
so I drove on and as I drove I realized
that I was in a sticky situation if
Benjamin suddenly took a turn for the
worst I didn’t have any tools to
resuscitate him with and now I had no
way to communicate with the outside
world so I drove on for what seemed like
an eternity
eventually we emerged from the last
Valley to the emergency room where they
were waiting for us and after filling
out some paperwork and providing some
history Benjamin’s emergency CT scan
showed that indeed he had a significant
injury
he’d ruptured his liver and had
significant internal bleeding a thin
layer of tissue encapsulating the liver
was controlling the bleeding for the
moment and as I sat with the surgeon and
the emergency room doctor my wife
arrived in a borrowed car and we
discussed what to do next
should we take him immediately to the
operating room should we observe him or
despite the gathering storm clouds
overhead should we risk transporting him
to the nearest Children’s Hospital 300
miles away in the end we decided that he
needed to be transported and soon my
wife and son were in the air on their
way to the nearest Children’s Hospital I
stayed behind to pick up the pieces
there ensued a ritual that anyone who
has taken a family member or a loved one
to the hospital is familiar with I
completed paperwork I signed documents I
provided insurance information and
ultimately I requested a copy of the
medical records so that I might have
them and ironically even though I seen
them putting the information into
computers the entire time I was handed a
paper copy of the record in a manila
envelope I was to be the courier of my
son’s critical medical records to the
next doctor and then I began to question
the decision we’d made as a physician I
wanted to know the evidence what was
going to happen next and so I I wondered
could he survive this transport when he
got there would he have emergency
surgery if he was to be observed how
long would it take and so I did what
every good physician does today I sat
down and I googled the answers
and what I found was somewhat reassuring
initially I found several studies that
indicated that observation was the right
way to go and a fairly clear protocol
but when I read the studies I grew more
concerned there were only a dozen or a
few dozen cases in each of these studies
and I realized to my horror that the
plan and the path we’d set Benjamin on
to hopefully save his life was based on
insignificant evidence now I practice
internal medicine and pediatrics but my
specialty is called medical informatics
which is the study of the use of
information in healthcare I spend my
time thinking about what should be in
healthcare and trying to figure out how
to achieve it and in Benjamin’s case
when I called the emergency room I
should have been able to give them a
code to securely access his lifetime
health record so the by the time we
arrived in the emergency room he would
already be registered his medication
dosage is calculated and drawn up and
the CT scanner ready and waiting when we
sat with the physicians to discuss our
plan what to do next we should have been
able to conference in the specialist
from the Children’s Hospital so that
they could review the same films we were
looking at and review the physical exam
and the story to come up with a shared
plan and my wife and I should have had
access to the records so that we could
follow the the threat of communication
among the providers and so that we could
communicate the information that that
only a parent knows to that record and
finally the doctors and they were
excellent physicians who took care of
Benjamin should have had better evidence
to go on rather than a few dozen cases
we know there are thousands of cases
like this in America why weren’t all of
them available to provide the best
evidence for Benjamin’s care so if we
can agree that this is how our health
care system should work why doesn’t it
and how can we change things to make it
work this way now the Institute of
Medicine is a group of the smartest
doctors and health care providers in
America and not too long ago they
suggested that what we needed
was a learning health system a learning
health system is one in which all of the
data gathered from doctor visits
physical exams testing and all of the
treatments given the medications and the
surgeries and all the outcomes that are
observed should be electronic and they
should move to follow the patients so
that wherever the patient gets their
care the records are available and
mistakes can be avoided but in addition
those outcomes can be used to derive new
knowledge to determine what were the
right decisions and how can we get
better over time and delivering care now
if you would argue that we need to
improve the health care delivery system
everyone knows that it’s probably easier
to book a flight or even refinance your
mortgage than it is to get in to see
your doctor and if you’ve ever tried to
request a copy of your medical records
you probably had a similar experience
that I did with Benjamin where you sign
documents in some cases you may even
have to pay for a copy of those records
most Americans don’t realize that the
privacy laws that protect our health
records grant ownership of those records
to the doctors and hospitals not to us
as the patient’s speaking of paying for
things we all know health care costs are
too high but everyone should recognize
that health care costs in America are
more than twice as high as most other
industrialized nations but at least
we’re getting the best health care in
the world for what we’re paying right
that’s actually not true health outcomes
in the United States are poorer than
most other industrialized nations and in
some cases even than some third world
nations recent evidence published showed
that the complexity politicization and
confusion in the health care system has
led it to be now the third leading
killer of Americans behind only cancer
and heart disease that’s the equivalent
of three 737 airplanes falling out of
the sky every day and my colleagues in
medicine are struggling struggling with
all the change that’s going on and the
dramatic amount of political influence
that’s dragging us one way and yet
other and this is compounded by the
evolution of new knowledge which is
coming at us all the time in fact a
newly minted board-certified physician
who takes the time to read a journal
article to journal articles every night
and remembers everything they read will
be more than 1,200 years behind after
their only their first year in practice
that’s a lot of new information to take
in so recognizing these challenges the
2009 stimulus legislation included the
30 billion dollar investment for
modernizing America’s health care system
and the vision was to create an
interstate highway system for health
information unfortunately what has
happened is every doctor in hospital now
has a very expensive electronic health
record but they don’t talk to one
another very often and so rather than
the interstate highway system for health
information what we have is everyone has
a very expensive car that only drives on
the proprietary toll roads owned and
operated by the vendors themselves
fortunately something different happened
here in Oklahoma a group of healthcare
stakeholders at about that same time
came together doctors hospitals state
and local agencies universities and
tribes employers to discuss what was
going on with health outcomes in
Oklahoma and why were they so poor and
to evaluate the cost of health care in
Oklahoma and understand why they were
rising and every single person who
attended that first meeting committed
themselves to planning a better way of
delivering care for Oklahomans and in
that meeting everyone agreed to invest
the time and effort in building
something that no one organization could
build to build something that was larger
than any one of us and that became my
health access network thousand overall a
thousand individuals have invested more
than ten thousand hours of their
volunteer time to envision design and
build this network which is a nonprofit
organization unencumbered by vendor
relationships that securely exchanges
health information for Oklahomans from
one place to another connecting more
than 1500
locations of care right here everyday
patients enter emergency rooms see their
doctors and clinics or admitted to the
hospital where their records are now
available from all of their other
doctors and sites of care this avoids
errors improves quality and reduces
costs and this investment in
infrastructure is already starting to
pay off in 2012 a group of 200 primary
care doctors here in Oklahoma partnered
with local insurers and Medicare and
Medicaid to begin delivering care in a
new way to focus on population health
and prevention and comprehensive primary
care and the insurers for their part
agreed to pay for that care differently
the results have been striking in each
of the last three years health care
costs have gone down by 5 to 7 percent
and quality is improved altogether over
a hundred million dollars have been
saved by just those 200 primary care
doctors the results of that have been
rewarded by expanding that program
statewide now nearly 700 doctors in
Oklahoma are participating in an
expanded version of the program and
hundreds of thousands of new patients
will get the benefit of it they will
bring nearly half a billion dollars in
to bolster our primary care
infrastructure in both urban and rural
areas and if current trends hold quality
will improve and nearly twice as much
money will be saved
my health has also recently been named
as the hub for our accountable health
communities program here in Oklahoma
which links for the first time health
care providers with social service
agencies to help those vulnerable
patients among us who have significant
health issues but they can’t focus on
addressing their health issues because
they don’t have enough food to eat or
transportation or safe housing to live
in in addition my health is working
together with the George Kaiser Family
Foundation and early childhood
intervention programs in our community
to connect them together to one another
and to the health care delivery system
so that we might coordinate those
services and improve them over time to
get the best results for our vulnerable
children so we’ve improved the delivery
of services we’ve laid some foundation
for the learning health system but we
haven’t achieved it yet because remember
the learning health system gives back we
have to study what information we’re
exchanging so that we can derive new
conclusions about how to improve what
we’re doing and I’m proud to say that my
health is supporting a number of
research studies at this point to help
physicians do a better job of taking in
all the complexity of the information
and turning it into improved health
outcomes and it helped the severely
now it would seem that we’ve built a
close approximation to a learning health
system here in Oklahoma or at least the
beginnings but is that enough take a
look at this map this map shows the home
addresses of everyone who’s received
care in Oklahoma over the last five
years and what you’ll observe is that
more than a hundred thousand people
don’t even live in Oklahoma and yet a
receive care here that means that
important part of their health history
is locked away here in an a system in
Oklahoma and we need to get that record
to them to where they receive care the
same is true of course for Oklahomans we
receive care in lots of places around
the country now I’m happy to say that at
about the same time my health was being
built other communities and regions were
building similar organizations and 50 of
those organizations have come together
now to create something called the
strategic health information exchange
collaborative which altogether covers
more than 200 million Americans securely
exchanging their health records every
day and these organizations have
committed themselves to realizing the
vision of the interstate highway system
for health information we’ve rolled out
a program called the patient centered
data home in which patients who get care
far from home can count on those records
coming back to where they live to the
network nearest to their doctors and
also so that when they are an emergency
situation their records can be accessed
immediately by doctors trying to save
this network is already active more than
ten states are involved and hundreds of
thousands of patients have already
benefited
so we’re well on our way as a nation to
having a learning health system first by
having local communities come together
develop the trust required the policies
and the technology to exchange the data
securely and then to begin to work
together with other communities who have
done the same thing to build the
patient-centered data home we’re well on
our way to having a learning health
system in America but now it’s your turn
as patients as family members as
caregivers it’s time to start asking
your doctors and hospitals whether
they’re a part of the network whether
they’re able to access all of your
medications instead of just the ones you
remember to tell them about whether
they’re able to deliver care to you
comprehensively and not duplicate what
you’ve already received and whether
they’re sharing your records with the
network so that if you have an emergency
situation far from home those emergency
room doctors can save your life as well
it’s time that we began to expect more
from our health care delivery system
doctors and patients alike I know that
Benjamin and I do thank you very much
[Applause] [Music]