Chemotherapy shortage: A symptom of a bigger problem

You may have heard about the chemotherapy shortage over the past few weeks whereby the supply of certain drugs is limited and even causing some infusion centers to reschedule appointments or change treatment plans. While this is not a major disaster and will be fixed shortly, it is emblematic of our country's whole medical system. We really don't have a shortage of drugs as a looming problem – it is more a matter of supply temporarily not meeting demand due to production, transport and inventory. But the bigger problem is coordination. Because our health care is decentralized and insurance coverage is spotty, you will get a wide spectrum of opinions about our nation's health care – from "best in the world" to "bloated, expensive, inefficient and unfair." I see incredible wastage of resources in my everyday practice of medicine – tests that are repeated because earlier results are unavailable or not felt to be reliable. Treatments or diagnostics that are "long shots" and made by both doctors and patients in haste without much reflection. State-of-the-art facilities and equipment that are not used to capacity.There is much talk about electronic medical records (EMRs) as the savior for all of these problems, although the verdict so far is that these systems have not really made much of an impact on quality or efficiency of care. However, we are really only on "version 1.0" of EMRs, and further integration and standardization of these systems do hold the potential to improve many aspect of medical care, particularly the coordination of care and other activities (like chemotherapy availability) that are essential in the very complicated arena of cancer management. I believe that the public needs to be very engaged in the debate regarding EMRs and coordination of care because quality and affordability, especially in oncology, is at stake. An informed and vocal public can steer the health care debate from the rancorous halls of Washington to a discourse with the public and ultimately the enactment and adoption of a coordinated information network, including patient portals and a seamless transfer of information across medical practices and hospitals. These advances have had huge effects in commerce, banking, entertainment and even social networking and dating, so why is medicine being left behind?