Doing HIT Right

Matthew Holt has an interesting post up on his latest editorial on electronic medical records (EMR) and a physician's response:

My cursory assessment is that electronic records are vital in improving the healthcare delivered to patients, particularly those with chronic illnesses, over the continuum of care. But it's clear that when they're introduced to ICUs or ED, where speed is the key and care processes are not well defined, things may not be so successful. A real examination of the process absent the technology, and a massive commitment from vendors to improve the human-computer interface, is quickly needed before the movement toward CPOE and EMR is stopped by these kinds of stories. After all, it's easy for a hospitals or physician groups to decide instead to do nothing.

Matthew really sums things up perfectly. As the Children’s Hospital in Pittsburgh demonstrated, installing a CPOE is not even half the battle.

Many of us are familiar with the triumphalism surrounding HIT development and use. But one cause for concern is the apparent lack of standardization going into the implementation of EMRs. This Health Affairs article noted: "effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety." While the move to adopt HIT is progressing at a snail's pace, all that extra time is just adding up to extra problems. Obviously different hospitals need different operating systems, but without standardization in something as basic as the medical record, we can kiss a good chunk of that $81 billion good-bye.

Matthew's commenter replies:

The move toward EMRs is not being led by physicians or hospitals, so our input is amazingly irrelevant. The movement is largely based on a fallacy that improved technology will lead to decreased cost, with a side bar of improved quality of health care. It is led by business interests and followed by the government - ie, the payors. Improved technology will be a huge boon for consulting firms, administrators, and other types of technician and advisors. It will absolutely not decrease costs. Only improved rationing of health care resources will do that.

This physician makes a great point in that the move toward EMRs isn't led by doctors or hospitals, but by communications people, analysts, insurance companies and health policy wonks. That's a problem. As much as physicians are proving supremely difficult to bring along on the ride, there are just too many instances of resistance and error to keep doing it that way. I've called for it before, but we have to ensure medical practitioners (not just doctors, nurses will be doing the bulk of the work) are deeply involved in the development of this software.

The one thing I don't get from this commenter is how she can say with such authority that "It will absolutely not decrease costs." What's her basis for that, given the huge mountain of research suggesting otherwise? Again, we have to ensure our HIT implementation is done right, with some standardization and ample input from practitioners, but even with stumbling along the way money will be saved. Savings are estimated in the tens of billions -- we can't afford to mess this up. And the money isn't nearly as important as the lives that will be spared from medical error and the quality of life improved thanks to better care.

Comments

[fasteddie]

>>It will absolutely not decrease costs. Only improved rationing of health care resources will do that.

I agree that it will not decrease the cost of the actual care - but the cost of the OVERHEAD - billing, claim processing, etc is HUGE. If ATM transactions cost 5 cents - there is NO reason a medical claim processing cannot fall to $1 or less. Having ONE format of everything will make a HUGE difference in costs.

[Kate]

you're totally right. It's the fat around delivering care that can be trimmed. But also having better disease management will prevent unnecessary complications, surgeries, etc.

[Martin]

I would argue that EMR/HIT would decrease total healthcare spending, to the extent that it would allow for the identification of redundant diagnostics and the like. However, this has a very unpleasant flip-side... even without considering the cost of capital charge for the EMR system, procdure costs will have to increase as a result of HIT in order to provide the same number of dollars to cross-subsidize services and provide uncompensated care.