Health Care IT: Will The Potential Be Realized?
BY NICK ADAM, JULY 26, 2006
Investments in health information technology (HIT) are slowly growing as hospitals, spurred on by the possibility of cost and quality of care benefits, increasingly incorporate HIT into daily use. HIT may very well come to play a large role in all health care sectors, including the orthopedics industry.
In 2004, President Bush established the Office of the National Coordinator for Health Information Technology (ONC). The mission of ONC is to provide leadership for the improvement and efficiency of health care through implementation of an infrastructure of health information technology. Since then, government support for HIT seems to have cooled. Of the $1.8 trillion that the government spent on health care in 2005, only $85 million was directed towards HIT.
Health Information Technology is a vague blanket term meant to refer to a number of electronic systems that some physicians and hospitals are using to increase efficiency and quality of health care. HIT often refers to:
1) Electronic Health Records (EHR): An EHR provides clinicians with easy access to patient information. An EHR allows physicians to make decisions based upon a large pool of information.
2) Electronic Medical Records (EMR): Often times, the term 'EMR' is used interchangeably with 'EHR'. In actuality, an EMR is a subset of an EHR. It is the electronic equivalent of a legal health record and documents any services that a healthcare organization has provided to an individual.1
3) Computer Provider Order Entries (CPOE): A CPOE refers to a computer-based system that automates the process of ordering medication. Many believe that CPOEs will help reduce the large number of medication errors and adverse drug events that occur each year.
Many predict that HIT will be able to help curb the excessive cost of America's health care. In September of 2005, Rand Corporation released a report that notes that other industries saw annual productivity growth of 1.5%-4% attributed directly to IT. Should health care see the same increase in productivity, Rand believes that HIT could lead to an annual decrease in spending of anywhere from $346 billion to $813 billion. However, they admit that many factors necessary for such a substantial increase in productivity (significant investments in EHR systems, strong competition on quality and cost, etc.) are missing. Instead, they believe the health care industry can realistically expect the adoption of HIT to lead to annual savings of $81 Billion. Much of the major savings comes from the capability of HIT to reduce hospital lengths-of-stay, nurses' administrative time, and drug usage in hospitals.2
Along with the financial benefits, many see HIT as a way to improve quality of care for patients. The New York Times reported that medication errors harm 1.5 million and kill several thousand people each year. They report that HIT, (more specifically, CPOEs) will help ensure a substantial decrease in the number of harmful and costly medical errors.3 Rand Corporation includes $3.5 billion saved through a reduction in medical errors in their $81 billion total.
Although many studies predict savings, in terms of both money and lives, there are a number of conditions and problems that plague HIT. The Rand study assumes that 90% of hospitals and physicians adopt HIT and use it correctly. However, the Rand study also notes that only 15-20% of U.S. physicians and 20-25% of hospitals have adopted HIT systems. Indeed, Jaan Sidorov, the author of "It Ain't Necessarily So: The Electronic Health Record And The Unlikely Prospect of Reducing Health Care Costs" reports the percentage of physicians using HIT systems has remained at 17% since 2001. He also reports that 75% of physicians do not act on information provided by HIT systems. He supposes that physicians may resent the loss of 'professional autonomy' which comes with HIT. Jaan Sidorov also notes that HIT can lead to decreased efficiency and an increase in medical errors due to the inability of hospital and physician staffs to use the systems correctly.4 Another hurdle facing HIT, as William Holstein notes in "Can Technology Heal The Health Care Industry", is the lack of any inter-industry standards to guide the development of health IT. He notes that, as a result, systems used by hospitals, physicians and insurers are often not interoperable.5
Ultimately, however, there seems to be a consensus that there is not enough data on HIT to determine whether HIT will lead to colossal savings or prove to be an expensive waste of time. Indeed, even the Rand study proves to be inconclusive. They recognize that the implementation of HIT faces serious barriers due to substantial costs and uncertain payoffs. Rand Corporation hopes the government and important players will bear the cost of implementing HIT but recognize that those costs may result in nothing more than yet another addition to the enormous burden of the U.S.'s health care expense.
References:
1Thomas, Randy L. "Learning the Alphabet of Healthcare IT" Healthcare Financial Management. Westchester: Mar 2006.Vol.60, Iss. 3; pg. 100, 2 pgs
2Hillestad, Richard. "Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs," Health Affairs 24, no. 5 (2005): 1103–1117
3Harris, Gardiner. "Report Finds a Heavy Toll From Medication Errors". The New York Times, The New York Times Company. July 21, 2006
4Sidorov, Jaan "It Ain't Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs" Health Affairs, 25, no. 4 (2006): 1079-1085
5Holstein, William. “Can Technology Heal The Health Care Industry?” Chief Executive. New York: Mar 2006., Iss. 216; pg. 52, 4 pgs
