INFORMATION TECHNOLOGY is being touted as a cost-saving solution in healthcare. Three years ago, President Bush put forward the challenge for everyone to have an electronic health record by 2014 to both improve quality and cut costs.
For IT evangelists in healthcare, these were the most exciting words uttered in a long time. Finally, IT had the momentum and credibility it had long sought among healthcare executives.
There’s more interest than ever in implementing healthcare IT and other kinds of advanced technology. Attendance at conference trade shows, such as the annual meeting of the Healthcare Information and Management Systems Society, has skyrocketed. Legislators at various levels are looking for ways to encourage technology adoption.
But even though there’s heightened excitement in technology, that may not mean it’s some kind of magic bullet for reducing healthcare costs or improving care.
Recent studies have illustrated that healthcare organizations will need to implement technology carefully.
For example, a study by researchers at Stanford and Harvard Universities found that electronic health records had little bearing on the quality of patient care. Researchers looked at 17 quality indicators and found that EHRs made no difference in 14 measures, according to the study, published in the Archives of Internal Medicine.
Considering the time, energy and cost involved in implementing EHRs, especially at the ambulatory care level, that’s not a cheery prognosis. An EHR may not provide a quality payback, and that could be bad news if physician reimbursement is more closely tied to improving quality in the future.
Another bit of bad news came from the recently published study from the Center for Information Technology Leadership, which assessed the impact of various kinds of technology on cutting costs and better managing diabetes care.
CITL’s sobering finding was that only the widespread use of electronic registries by providers had the potential to provide a significant return on investment for the nation’s healthcare system. Registries had the potential to save $8 billion over the investment during a 10-year period.
That’s the good news. Other technologies assesssed by CITL, while having the potential to improve clinical outcomes, have far less potential to save money and, in some cases, implementing them would cost billions of dollars more than they’ll save, according to the models used by Boston-based CITL.
As you may know, I’ve closely watched the healthcare IT industry for more than 12 years, and it’s never been a more exciting time for this industry segment. However, these reality-check studies show that it’s not time to just throw gobs of money at IT and expect it to perform miracles.
Before IT ever returns a dime of healthcare providers’ investments, there’s an incredible amount of spadework required. While individual staff members have never possessed as high a level of computer literacy, that doesn’t mean they’ll enthusiastically accept the workflow changes, data recording and additional steps required by digital healthcare.
And the CITL study found that those making the IT investment – the providers – aren’t the ones that are likely to reap the savings from automation. Rather, it’s the payers who will see reductions in spending, while providers are likely to experience revenue reductions because of better care management.
All the technologies in the CITL study provided better clinical care, but that improvement comes at additional cost. That tradeoff – higher cost for higher quality – will need national discussion for diabetes management and other prevalent, costly chronic conditions.
The use of IT in clinical improvement will need close study. Healthcare has sought to identify the “low-hanging fruit” in achieving results with IT. Now’s the time to gather the best quantifiable evidence that’s out there and act decisively.
It’s also time to improve the use of IT in financial and administrative areas to achieve ever more significant savings, and quickly. These savings can be reinvested in clinical applications that may improve outcomes, although perhaps not cutting costs.
Finally, payers need to get more serious about rewarding and incentivizing providers that make technology investments that improve care or patients’ health, but reduce their revenue.
Until this quantum leap in thinking is achieved, the healthcare system will continue to be viewed as dysfunctional, and there will be little confidence that healthcare IT investments are really making much of a difference.