"Why is Hawaiian care so efficient? No one really knows. "

Intriguing article by Gardiner Harris, "In Hawaii’s Health System, Lessons for Lawmakers", New York Times, (October 16, 2009) (available online here) What do you think? Remember this: Hawaii's top three medical providers are adopting electronic medical records — years ahead of most mainland counterparts.

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.

Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. In one example, Hawaii has the nation’s highest incidence of breast cancer but the lowest death rate from the disease. Why is Hawaiian care so efficient? No one really knows.

Would a nationwide EMR help reduce fatal drug overdoses?

Liz Szabo wrote an interesting article for USA today (scroll down for the link). The focus of her article is how prescription drugs have now become the biggest cause of fatal drug overdoses. The article explains that a patient could travel between states to obtain duplicate prescriptions. A solution for this problem could be a nationwide effort to communicate prescriptions, in other words an interoperable electronic medical records system. Here's an excerpt:

Debra Jones didn't begin taking painkillers to get high. Jones, 50, was trying to relieve chronic pain caused by rheumatoid arthritis.

Yet after taking the painkiller Percocet safely for 10 years, the stay-at-home mother of three became addicted after a friend suggested that crushing her pills could bring faster relief. It worked. The rush of medication also gave her more energy. Over time, she began to rely on that energy boost to get through the day. She began taking six or seven pills a day instead of the three to four a day as prescribed...

"The biggest and fastest-growing part of America's drug problem is prescription drug abuse," says Robert DuPont, a former White House drug czar and a former director of the National Institute on Drug Abuse. "The statistics are unmistakable." About 120,000 Americans a year go to the emergency room after overdosing on opioid painkillers, says Laxmaiah Manchikanti, chief executive officer and board chairman for the American Society of Interventional Pain Physicians...

Many doctors say that preventing abuse requires a national effort. Although 39 states have electronic databases to track narcotics prescriptions, none share that information fully with other states, Manchikanti says. So patients who get narcotics in one state may be able to cross the state line to get more.

A nationwide system of electronic medical records also would help, Zvara says, because doctors in different hospitals and clinics would easily be able to measure how many narcotics doses a patient has had.

 Source:  Liz Szabo, Prescriptions are now the biggest cause of fatal drug overdoses, USAToday, Section: Money, p. 8b (October 1, 2009) (available here)