The Office of the National Coordinator for Health IT (ONC)
has done an outstanding job of promoting EHR technology through Meaningful Use
financial incentives, and it has fostered a spirit of cooperation among IT
stakeholders. But ONC sometimes sounds more like a cheerleader than an
objective observer on the extent to which modern informatics can transform
healthcare.
The jury's still out. A RAND Corporation report in 2005
predicted that the efficiency and safety improvements made possible with health
IT could save the U.S. healthcare system $81 billion a year. Since 2005,
however, annual health spending has soared from $2 trillion to $2.8 trillion,
and quality and efficiency have improved only marginally, despite an increase
in health IT adoption, according to researchers Arthur L. Kellerman and Spencer
S. Jones in a newly released RAND study published in Health Affairs.
Kellerman, chair of policy analysis at RAND, and Jones, a
RAND information scientist and instructor at Harvard Medical School, lay it on
the line: "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. ... 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 healthcare systems to implement the process changes required to fully
realize health IT's potential."
ONC recently boasted about paying out $10.3 billion as of
December 2012 to more than 180,000 physicians and hospitals to encourage
installation of EHR technology and to bolster its meaningful use in patient
care. The new RAND report suggests the program isn't exactly generating
meaningful savings.
Like many other observers, the RAND scientists spotlight the
lack of interoperability among electronic health record systems as a key
barrier. One reason: Providers "have little incentive to acquire or
develop interoperable health IT systems," the authors say.
In talking with thought leaders and clinicians, I also get
the impression that many healthcare providers would rather forego the incentive
checks and even cough up the eventual penalty fees than deal with the
aggravation of implementing an EHR system.
Although Kellerman and Jones are right to point to poor
design and lack of interoperability as obstacles, the other key to turning EHRs
(as well as CPOE and clinical decision support systems) into cost-effective
tools is to change the healthcare payment model.
Before healthcare providers small and large will see the
need for this technology, they'll have to be forced into a pay-for-performance
model that requires a lean, mean operational approach to patient care. Once
that financial model is fully in place, clinicians will see the value of a
computer-assisted system that picks up needlessly duplicative lab tests,
life-threatening drug allergies buried in paper medical records, and the like.
Because without such a system, all the excessive tests and adverse patient
outcomes will come out of their pay checks.
Cathy Schoen of the Commonwealth Fund, a private foundation
attempting to improve the U.S. healthcare system's performance, said it best:
"When you pay [providers] differently -- especially emphasizing team care
-- information systems become critical as they get used in an efficient and
effective way, because people want to avoid duplication. ... They want
real-time information on where the patient is and what's going wrong."
Health IT doesn't have to be a sinkhole in which we pour
billions of dollars. And in fact many individual provider organizations have
proved that it can improve quality of care and lower costs. But as a nation, we
still fall woefully short of that goal.
Source: informationweek
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