COM­MEN­TARY: Re­think health IT stan­dards for cost sav­ings

Ex­pected sav­ings will fol­low with the right frame­work for in­ter­op­er­abil­ity

Modern Healthcare - - NEWS - Joel White

Con­sumers have come to ex­pect the con­ve­niences that come with dig­i­tal trans­ac­tions. From check­ing cloth­ing prices at mul­ti­ple stores to keep­ing your bank ac­count in your hand, the In­ter­net in tan­dem with mo­bile de­vices has rev­o­lu­tion­ized the speed and ease of vast swaths of eco­nomic ac­tiv­ity.

But when it comes to health­care, pa­tients and providers con­tinue to strug­gle with new tech­nolo­gies de­signed to bring th­ese same con­ve­niences to the ex­am­in­ing room.

The Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety has de­fined in­ter­op­er­abil­ity as “the abil­ity of dif­fer­ent in­for­ma­tion tech­nol­ogy sys­tems and soft­ware ap­pli­ca­tions to com­mu­ni­cate, ex­change data ac­cu­rately, ef­fec­tively and con­sis­tently, and use the data that has been ex­changed.”

Put sim­ply, an in­ter­op­er­a­ble elec­tronic health-record sys­tem would al­low health­care providers—whether it is your pri­mary-care physi­cian in your home­town or emer­gency room doc­tors in a dif­fer­ent state—to eas­ily ac­cess your med­i­cal records to ef­fec­tively and ef­fi­ciently treat you. This means any doc­tor in the coun­try could know when you had your last flu shot, what medicine al­ler­gies you might have, your blood type, and other im­por­tant in­for­ma­tion used in treat­ment. But we’re not quite there yet. In 2005, the RAND Corp., a not-for-profit in­sti­tu­tion that pro­vides re­search on var­i­ous pub­lic pol­icy topics, pub­lished an anal­y­sis es­ti­mat­ing that EHR adop­tion has the po­ten­tial to save $81 bil­lion a year pro­vided the tech­nol­ogy is in­ter­op­er­a­ble. And in re­cent years, government agen­cies have been work­ing with med­i­cal providers to be­gin im­ple­ment­ing health in­for­ma­tion tech­nolo­gies—

We should shift our col­lec­tive

at­ten­tion to re­boot­ing the in­ter­op­er­abil­ity frame­work to be­gin re­al­iz­ing cost re­straint as

quickly as pos­si­ble.

even of­fer­ing in­cen­tives for the pro­gram through fed­eral stim­u­lus funds.

When RAND re­cently re­leased a fol­lowup study, an­a­lysts found their orig­i­nal cost­sav­ings es­ti­mates have not come to fruition, and many in the IT, provider and po­lit­i­cal com­mu­ni­ties have de­clared IT’s po­ten­tial a fail­ure. While it may be true that we have not yet seen the cost sav­ings we ex­pected, that does not mean the ef­forts have been in vain. With mi­nor changes in the course of fed­eral pol­icy, health IT holds vast po­ten­tial to wring tens of bil­lions in in­ef­fi­cien­cies out of our bloated health­care sys­tem.

The U.S. spends al­most $3 tril­lion a year on health­care— a rate that is steadily in­creas­ing by about 3% each year. In 2013, health­care will con­sume 24% of the fed­eral bud­get— the high­est per­cent­age of any bud­getary item. Even if EHRs had re­sulted in all the po­ten­tial sav­ings RAND had first pro­jected, ris­ing costs on other fronts would have sim­ply mit­i­gated the in­crease in health costs.

Dr. Art Keller­mann, the RAND study’s se­nior au­thor, stated, “The fail­ure of health in­for­ma­tion tech­nol­ogy to quickly de­liver on its prom­ise is not caused by its lack of po­ten­tial, but rather be­cause of the short­com­ings in the de­sign of the IT sys­tems that are cur­rently in place.”

For ev­ery study find­ing that health tech­nolo­gies are not re­duc­ing costs, there are dozens more ac­count­ing for lower costs and bet­ter out­comes. I would take Dr. Keller­mann’s state­ment a step fur­ther and ar­gue that the de­sign of the IT sys­tems are not the prob­lem; it is the stan­dards in the fed­eral in­cen­tive pro­gram that have failed to meet RAND’s caveat: We are not close to a truly in­ter­op­er­a­ble IT in­fra­struc­ture.

So while some are cit­ing the RAND study to adopt a “the sky is fall­ing” men­tal­ity to health IT, the di­a­logue should in­stead shift to bet­ter align­ing stan­dards with cost sav­ings.

What we know from the re­cent RAND anal­y­sis is what we knew from the orig­i­nal re­search: With­out an in­ter­con­nected, in­ter­op­er­a­ble in­fra­struc­ture, re­al­ized sav­ings will not ma­te­ri­al­ize. Put an­other way, we know that the lack of in­ter­op­er­abil­ity is a key fac­tor in lim­it­ing the ef­fec­tive­ness of EHRs.

So rather than fo­cus on ar­gu­ments that com­put­ers and in­for­ma­tion man­age­ment sys­tems won’t work in health­care, we should shift our col­lec­tive at­ten­tion to re­boot­ing the in­ter­op­er­abil­ity frame­work to be­gin re­al­iz­ing cost re­straint as quickly as pos­si­ble.

When it comes to adopt­ing and im­ple­ment­ing health in­for­ma­tion tech­nol­ogy sys­tems, we have made great progress in re­cent years. Now that we have laid the adop­tion ground­work, we must re­think our strat­egy re­lated to stan­dards.

Bot­tom line: Fix the stan­dards, re­al­ize the sav­ings.

Joel White is ex­ec­u­tive di­rec­tor of the Health IT Now

Coali­tion.

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