politics and practice based on mindfulness

Saturday, February 28, 2009

integrated vs. integrative health: which comes first?

A source at NIH told me that their share of the stimulus has been allocated within days of the President's announcement.  Basically every approved project in the pipeline will receive funding.  And as I type, staffers at NIH and on the Hill are completing final touches on the design of the much-ballyhooed, national, electronic medical records system.

So much for the yoga principle of reflection before action.

Evaluated  in the context of 2009 medical information technology, the "new" records system will be B.C.  Of course this stone-age system has some advantages.  It will reduce medication error and it will probably be coming soon to a medical center near you.  So let us rejoice in small blessings.

  If you want to get a glimpse of where we need to eventually take the system, that is,  if we are to have uniform, research-based standards of care in the U.S., visit the Harvard Catalyst site.  Catalyst is the portal to an extraordinary bioinformatics system being honed and refined around the ethical practice of computational information gathering [ie: bioinformatics, with a focus on genomic research and clinical records, and collaboration from the Divinity School on ethical guidelines].  Furthermore Catalyst assembles "information from every scientific core into an indexed, searchable data base."  When we realize that Harvard's "scientific core" includes the Medical School, the Dana Farber Cancer Institute,  and 16 leading facilities surrounding Cambridge, we have Harvard's permission to gasp in awe.  And they Twitter!

One question rages on, for me at least.  Can there be integrative (mind-body) care as part of a treatment plan unless we have integrated care (records sharing with patient privacy protection)?  And how can my services be incorporated into the primitive national system that's now in the works?

Patients don't like talking about their alternative care with their PCPs, and until they do, and until we all share and measure outcomes within the same electronic records system, there will be an unconscionable amount of waste in CAM (complementary alternative medicine).  I don't see why Medicare or private insurers should pay for yet another failed, disease-management approach.  CAM has not reduced costs in California where it is widely reimbursed.  Shared information and timely case management would have saved money.  

If you want to read about more CAM practitioners engaging in salutary self-criticism visit one of my favorite stops online The Health Care Blog, and Matthew Holt on the recent meeting on integrative health at the Institutes of Medicine.  Also check out the recent blog entry on employers masochistically funding market inefficiencies.  Because employers have no database to find an insurance program with the best fit, the "invisible hand" of the market fails to operate in medicine (once again!).

In the meantime, let's say a little prayer for all the possibilities that were wasted in this week's panicky rush to approve some -- any -- electronic medical system.  Perhaps it's another sign of lost trust in this society.  Advocates for quality healthcare feel they must sprint headlong to endorse an inadequate information system.  Otherwise the media howl their jeremiads and destroy public goodwill toward a more rational, comprehensive, and thoughtful approach that can't be summarized in a soundbite.

Breathe in, breathe out and say "whatever".