Wednesday, January 9, 2013

It Seems Delivery Of Benefits Is A Bit Harder Than People Imagine. More Thought Required.

This very important article appeared overnight.

RAND: Health IT No Bargain Yet

Problems in design and implementation of EHRs, lack of interoperability, and provider resistance hamper productivity gains and cost savings, says RAND report.
Health information technology won't create the kind of cost savings predicted in a 2005 RAND Corp. study until the technology is far more widespread and is used to its full potential, a pair of RAND researchers conclude in a new Health Affairs report.
The earlier RAND report, authored by Richard Hillestad and his colleagues, predicted that the potential efficiency and safety improvements made possible by health IT could save the U.S. healthcare system $81 billion a year. Since 2005, annual health spending has soared from $2 billion to $2.8 trillion, yet quality and efficiency have improved only marginally, despite an increase in health IT adoption, note researchers Arthur L. Kellerman and Spencer S. Jones in the new paper. AdTech Ad
"In our view, health IT's failure to quickly deliver on its promise is not due to its lack of potential but to shortcomings in the design and implementation of health IT systems," they write. "As a result, we believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology, and the failure of many health care systems to implement the process changes required to fully realize health IT's potential."
Like many other observers, the authors spotlight the lack of interoperability among electronic health record systems as a key barrier. One reason for the inability of systems to communicate with one another, they say, is that providers "have little incentive to acquire or develop interoperable health IT systems."
In an interview with InformationWeek Healthcare, Jones pointed out that one way for providers to achieve interoperability is to join health information exchanges. However, many providers don't see a business reason to exchange information or support HIEs, which have not been very successful.
Here is the original abstract.

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

  1. Spencer S. Jones2


A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.
The abstract is found here:
The full article is available if you have appropriate access.
To me what this is showing is that successful delivery of Health IT is a good deal harder than the optimists imagine. Especially relevant is the lack of progress on genuine interoperability and in re-engineering clinical processes to fully exploit Health IT capabilities.
As others have made very clear Health IT is really not a technical program but an issue that needs to be addressed as the clinical and process level. It is not clear that DoHA and NEHTA get the distinction as yet.
Careful review of what we have and what we need for success is certainly a worthwhile project for the New Year!