L&M doctor envisions 'passport' to better system of health care

New London - Dr. Frank Maletz envisions a day when everyone will carry a personal health care information card that could be swiped whenever and wherever they access medical services, instantly conveying up-to-date information about their prescriptions, whether they've had their appendix out and the results of their last blood test.

It would be, he believes, an enhancement of the electronic medical records systems now being incorporated in medical practices and hospitals that would, among other advantages, foster a more portable, seamless and cost-effective health care system, which now consumes what many believe is an unsustainable 16 percent of Gross Domestic Product.

"How many pregnancy tests do we do on 45-year-old women who don't have a uterus, or CT scans on people who've already had their appendix out?" asked Maletz, an orthopedic surgeon who practices at Lawrence & Memorial Hospital in New London and has offices in Waterford.

The health information card - what Maletz calls a "computerized health passport" - is just one facet of a bigger idea Maletz has conceived to redesign the nation's health care system to reduce redundancy and costs and shift the focus toward wellness promotion instead of treating illness.

Over the past two years, Maletz, an East Lyme resident, has been promoting his "Healthspital" concept - a play on the word "hospital" that conveys the notion of the community hospital as a center of wellness education, promotion and sensible allocation of health services. He's presented his ideas in a cover article in a 2011 issue of "The Futurist," the magazine of the World Future Society, essentially an international think tank club he belongs to, on a web site he created, www.healthspital.org, and in meetings with hospital officials locally and elsewhere in the state.

In July, "Healthspital" will go before another audience, building on the national dialogue about health care and health insurance that led to the passage of the Affordable Care Act in 2010 and continuing debate about its merits. Maletz has accepted an invitation to speak at the international conference of the World Future Society July 27-29 in Toronto, sharing the agenda with others focusing on the future of health care, as well as those addressing such heady topics as "Mindseums: Neurofeedback and Virtual Museums," and "The Dream-Do Nexus."

"This model was developed over my 26 years of experience," said Maletz, showing a large colorful chart, neatly hand drawn that represents what a "Healthspital" would be like.

He said elements of "healthspital" exist, "but the system is fragmented. This is putting it all together. At hospitals, we do not take care of health, we take care of sickness and prepare you to die. We have to focus on prevention strategies."

The new system he envisions would start by addressing the five main drivers of rising health care costs: care of chronic illnesses such as diabetes; excessive care provided by specialists when a less complex treatment by a generalist would be equally effective; redundancy and lack of coordination of care among a single patient's various doctors; lack of knowledge and follow-through on effective prevention and wellness strategies; and expensive and futile end-of-life care.

It would accomplish this through expanded use of information technology to access experts and monitor a person's heart rate or other indicators remotely, so crises that now turn into expensive emergency room visits could be averted. It would transform hospitals into health learning centers for their communities. And it would foster frank discussions and practical decision-making about end-of-life care.

"We've got to talk about that," he said. "The amount of care we provide in the last six months of life, most of us are totally unprepared for. We now spend 80 percent of Medicare dollars on futile, fruitless care in the last six months."

He cited one recent example from his own practice. An elderly patient with dementia was brought to his office by a relative for a hip replacement. Given the person's condition and age, he said, he didn't think an operation was prudent, given the demanding physical therapy requirements after the operation to ensure its success. Ultimately, the patient's relative agreed, and another, less invasive treatment was agreed upon.

"I just saved the health care system over $10,000," he said. "That's not withdrawing care, that's being rational."

"Healthspital," Maletz said, basically takes these five cost drivers and builds a new system from them. Given the challenges facing the nation's health care system, he said, what's needed is a "creative paradigm shift," not more Band-Aid approaches that don't address the core issues, or "rehashing of the same old problems without solutions.

Maletz said he isn't looking to sell his idea or profit from it in any way, but he hopes it will spark discussion and be adopted by an organization willing to take it on as a pilot project. Before he retires, he said, he'd like to leave some legacy that would have a positive impact on the field where that has been his life's work.

"I'm 60 years old, and I've been a doctor for 34 years, 26 of them at L&M," he said. "That's why this is imperative to me. I would like to make a bigger contribution."

j.benson@theday.com