Four years ago the Obama administration offered up $19 billion in stimulus funds to help get health care IT (including electronic health records, or EHRs) in the pink--or at least in the black.
Better information technology throughout the health care system would save money, improve care and bring the health care industry into the 21st century, proponents argued.
But, as is obvious by the continuance of paper records, isolated institutional networks and clunky interfaces, health care IT is still in critical condition.
A new report, assembled by the RAND Corporation, a non-profit, non-partisan research group, suggests that health care IT is not a hopeless case, however. In fact, the researchers argue that if institutions adopt smart practices in putting these systems in place, society could still reap the promised benefits. The findings were published online January 7 in Health Affairs.
A 2005 study conducted by a different group of RAND researchers, estimated that use of health information technology in the U.S. could save more than $81 billion a year. This and other similar projections have come under criticism because the effectiveness of care has not budged much and spending on health care continues to rise, having added some $800 billion to annual spending since 2005.
But EHRs and other health care IT solutions should not be left for dead, the authors of the new report argue. "The failure of health information technology to quickly deliver on its promise is not caused by lack of potential, but rather the shortcomings in the design of the IT systems that are currently in place," Arthur Kellermann, a policy analyst at RAND said in a prepared statement. He and his co-author, Spencer Jones, noted in the report: "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."
How to cure these ills? Kellermann and Jones have a prescription at the ready.
First, health systems need to adopt platforms that can communicate among themselves. For example, a doctor in an emergency room should be able to quickly and easily pull up a digital record of a patient's file even if that patient's home health system is in an entirely different hospital network across the country. As the researchers point out in their paper, "the current generation of electronic health records functions less as 'ATM cards,' allowing a patient or provider to access needed health information anywhere at any time, than as 'frequent flier cards,' intended to enforce brand loyalty to a particular health care system."
Second, health care IT systems must be user-friendly. "Few health IT vendors make products easy to use," the researchers noted. "As a result, many doctors and nurses complain that health IT systems slow them down." Federal incentives for hospitals and networks to adopt IT systems might have rushed the selection process. And because many of these systems are new, there is little comparative data on effectiveness and usability.
Third, this sort of information technology needs to be much more widely adopted for it to start really paying off. According to recent estimates, only about 40 percent of doctors are using any kind of EHR in their practices, and only about 27 percent of hospitals are using them. Perhaps even more challenging, patients are not always helping to create a demand for EHRs--often not using them even when they have access. "Uptake of health IT in the U.S. has a long way to go to achieve the critical mass required to fully realize its potential," Kellerman and Jones wrote.
Some essential elements of the health care system need to change as well, the researchers noted. So long as we still have a pay-for-service (rather than a pay-for-result) financial structure for health care, doctors and hospitals will continue to be incentivized to do more billable things (such as screenings and procedures) rather than to put effort into the most effective options that will have the best results. And until a change in these incentives occurs, the researchers wrote, "health care providers will have little incentive to use health IT in ways that reduce costs instead of increasing them."
Health care technology alone, of course, cannot stop the precipitously rising health care costs. Increasingly expensive prescription drugs and medical technology along with rising rates of chronic diseases (such as metabolic syndrome, diabetes and heart disease) conspire to keep costs climbing. And although the 2010 Affordable Care and Patient Protection Act aims in part to help keep health care costs down, many of the provisions to do this are still yet to take full effect.
But more and better health care IT might just connect more people to better--and more affordable--health.