DEBATING THE DATA: Is there an entrepreneurial option to primary-care reform?

Medical Post - VOLUME 35, NO. 17, May 4, 1999

DEBATING THE DATA: Is there an entrepreneurial option to primary-care reform?

By Tim Lynch

The reporting of the primary care reform (PCR) experience in Ontario by the Medical Post begs two questions:

1) Is PCR part of an overall strategy to "bureaucratize" medicine by the bureaucratic/pseudo-academic/academic conspiracy that manages health? or

2) Is PCR a Machiavellian plot by the OMA to preserve the status quo for yet another three years?

Regardless, the overall impression gained is that doctors are essentially civil servants with entrepreneurial privileges. Evidently there is a battle between both stakeholder groups for the minds of doctors submitting to the civil-servant model or subscribing to the independent solo-practice model as the only alternative.

We are told the pot of gold at the end of the rainbow is an information system that can be used, essentially by the bureaucratic/pseudo-academic stakeholder interests, to monitor, evaluate, co-ordinate and manage (control) medical practice. But no one seems to be asking: Who owns the data in the first place? Surely an argument can be made that since most of the data being sought is dependent on recording the decisions that doctors make, then doctors own the data.

Admittedly the disorganized sets of data contained in the medical record files of an independent solo practitioner are of little worth and serve largely to justify the role of the medical licensing authorities, should they choose to visit. However, through the marvels of modern information technology, systematic consolidation of such data sets, along with their integration to referral data sets - would constitute a valuable entity, particularly if it were complemented by a synergistic and comprehensive group practice.

The further amalgamation of such groups, along with other health-care outlet alignments, would lead to a medical practice network enterprise independent of government and worth investing in as a 21st century "knowledge-based" corporation.

Understandably, the administration of such a resource would have to serve the audit requirements of a third-party payer. In addition, there would be a need to comply with requirements set down by the professional licensing authorities.

Any other entity wishing to have access to such data should be charged sufficiently so that capital, technical, analytical maintenance and upgraded costs are covered.

In the 21st century the ownership of systematically organized data that is current, relevant, reliable and readable should offer a higher return than investing in, say, office real estate arrangements. The more integrated such data systems are, the more valuable they become and would constitute a large part of the equity value of a 21st century medical practice.

Notwithstanding the federal government¼s desire to fund a large, national health-care information system, experience has shown that such monolithic bureaucratic enterprises are subject to the quality of the data they collect.

Primary-care physicians are the front-line data generators in health. But since they have no ownership in such systems, what incentives are there for physicians to comply with all data-capturing instructions all of the time?

Such a resource is more likely to succeed when those responsible for creating and entering the data have some ownership in its integrity than through publicly funded, eminently bureaucratic institutes, foundations, academic centres of excellence, etc.

It is unfortunate the federal advisers did not recommend a tax incentive scheme to encourage physicians to assume more responsibility for the data they create.

For this to happen, primary care physicians would have to become more entrepreneurial and understand the responsibilities and obligations of data ownership as well as its rewards. Please send comments to: tim@infolynk.on.ca

Tim Lynch is a health-services reimbursement consultant with Info-Lynk Consulting Services in Toronto.

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