Frist foresees technology advances as health care confronts challenges

BOSTON Fast-rising health care costs, the patient self-care movement, extended life spans and unsustainable growth in the costs of Medicare will drive an explosion of new technology, electronic communications and other innovations in health care over the next decade, one of the nation’s highest-profile lawmakers said here Sunday.

Former Republican Senator Bill Frist of Tennessee, who served as Senate majority leader from 2003 to 2007, addressed NACDS members at the opening general session Sunday. Speaking on health care reform and the outlook for the U.S. health system, Frist laid out a possible future scenario for how health care might be delivered, tracked and paid for in the year 2015.

Frist cited looming advances in medicine like nanotechnology, health information technology, e-prescribing and patient self-care, and how those advances will play out in improving the health and lifespan of a hypothetical patient named he named Rodney.

One such advance, he said, is likely to be a tiny computer chip, about the size of a grain of rice, that within a few years could be implanted under a patient’s skin to monitor blood glucose levels, heart rate, blood pressure and other current conditions in real time, and communicate that information to an uplink for physicians and patients themselves.

"It would inconspicuously and instantaneously monitor things like blood sugar, heart rhythm, and even blood pressure, amazingly enough," said Frist. The data-driven monitoring device could even "ping" a patient’s cell phone to deliver a warning when his or her blood glucose goes over safe levels.

"It’s monitored wirelessly, anonymously and continuously," Frist told NACDS attendees. That capability enhances to ability of his hypothetical patient of the future, Rodney, to do "an excellent job of his own self-care."

In addition, he said, "Rodney’s community-based retail pharmacist provides him with his pharmacy services. Why? In large part because he trusts her. He knows that is the person he can go to to get the information."

That pharmacist of the future’s ability to handle that "huge responsibility," in Frist’s words, will be due in large part because pharmacy leaders today, at NACDS and elsewhere, will do the "hard work" in assuring "that there would be appropriate compensation for the value added to the quality of health care" by pharmacists performing disease management, drug therapy oversight and other services.

The former Senate leader acknowledged the advances community pharmacy has made in promoting electronic prescribing and other health information technology initiatives. Buy physicians remain, by and large, an impediment to progress on those fronts, he agreed. At this point, said Frist, only about 16 percent of physicians use electronic medical records and e-prescribing.

"What is going to happen…to attract doctors to use electronic medical records? They’re going to have to see that better documentation actually improves the quality of care. They’re going to have to see that fewer systems errors occur. They’re going to have to realize that for the first time, they can be at home and go to their IPod or their computer, and be able to access patients’ records. They’re going to see reduced costs. It’s going to have to hit their pocketbook.

"Patients today prefer providers that use electronic health records, it’s been shown in a recent Rand study," Frist said. Under new and still-emerging pay-for-performance standards, he added, "It may well be that people who engage in electronic health records or e-prescribing will be reimbursed more in the future to accelerate innovation and change."

And while evidence-based medicine "is still slow to come," Frist noted, he remains a strong proponent of fostering preventive care, prescription drug therapy and competition in all aspects of health care delivery as a tool to lower and hold down costs. During his tenure as Senate majority leader, he said, "We tried to inject competition, a little bit, into our Medicare system…because health premiums are rising three times faster than wages today."

The fast-rising costs in health care—which have grown at roughly two-and-a-half times the gross domestic product over much of the past three decades—"simply cannot be sustained over time," Frist asserted.