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A few minutes with Ernie Fletcher

Kentucky Gov. Ernie Fletcher said that despite dramatic advances in medicine in recent years, the process for managing health care has hardly changed since the time of Hippocrates. He wants to change that in his state. Fletcher recently signed a bill into law that will create a statewide infrastructure for electronic health records. Beyond Kentucky, though, he believes federal and state governments can collaborate to improve the quality and reduce the costs of health care nationwide.

How have you convinced people in Kentucky that technology is a good investment?

Fletcher: We use illustrations in advanced manufacturing. Toyota is a large presence in Kentucky, and the quality of the automobile produced today has increased tremendously and yet is still reasonably affordable because of technology. Once you start communicating, people begin to see that the traditional methods of just dealing with the current [health care] process and trying to squeeze down provider reimbursement and do other cost-containment measures are no longer effective. And so, now I think you have folks who are open-minded to doing larger-scale process changes, which include information technology.

What are the appropriate roles for federal and state government in improving health care management?

Fletcher: I think it's an integrated role with the federal government. I don't think you can do it in a stand-alone fashion. But it's a major opportunity for us to have 50 laboratories very much like what happened in welfare reform. Some of the best models and best practices in welfare reform were developed at the state level. And those experiences were taken to the federal level and generalized to the country.... What the federal government could do is to standardize informatics and standardize procedures so we have interoperability, so if you have an e-health record in Kentucky, it's accessible in Florida.

To what extent will the federal government need to fund the development of the health IT infrastructure?

Fletcher: In general, with federal highways, it's an 80/20 match, federal/state. Because Medicaid and Medicare are covering a substantially increasing population, then it probably is the responsibility of the federal government to help us with the infrastructure. The states can step forward and make sure we implement it and advise on ways to implement it, and deliver better quality of health care and save money. ... If there is as great a push as there was on the interstate system under [President] Eisenhower to focus on the medical electronic system, then we would see a major revolution in the delivery of health care, just like we did in economic development and industry development of the country after Eisenhower's administration.

— John Monroe

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