Chuck Lauer: An IT Boondoggle?
A recent Wall Street Journal article left me speechless. Like a lot of other people in healthcare I have been indoctrinated with the belief that unless the industry fully and enthusiastically adopts information technology, hospital and health systems will never run efficiently and be able to deliver quality healthcare to patients. I have attended HIMSS conferences, read articles, and been told by countless IT vendors and consultants and the United States government that every healthcare entity must be totally "wired" to be efficient and effective.
Reading the article Stephen Soumerai, a professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and Ross Koppel, a professor of sociology and medicine at the University of Pennsylvania, has shaken my belief.
In two years, thousands of hospitals and physicians that fail to buy and install costly healthcare information technologies, such as digital records for patient histories and prescriptions, will face penalties through reduced Medicare and Medicaid payments. By that time, the government will have paid out tens of billions of dollars in subsidies and incentives to providers who install these technology programs — the carrot before the stick.
The mandate, part of the 2009 stimulus legislation, was the goal of healthcare information lobbyists and their friends in Congress and the White House. This is no small thing, since the lobbyists claimed and promised that these technologies would make medical administration more efficient and lower medical costs by up to $100 billion annually. However, from the very beginning many physicians and hospital administrators have been skeptical of these claims because of their own first-hand experiences.
Professors Soumerai and Koppel say that the software sold by hundreds of health IT firms is "generally clunky, frustrating, user-unfriendly and inefficient." A good example of this could be a physician looking for a patient's current medications having to click and scroll through many different screens to find essential information. It is time-consuming and cumbersome.
Despite this, since 2009 almost a third of health providers have installed at least some healthcare IT technology. "It wasn't cheap," Mr. Soumerai and Mr. Koppel note. "For a major hospital, a full suite of technology products can cost $150 million to $200 million. Implementation — linking and integrating systems, training, data entry and the like — can raise the total bill to $1 billion."
The authors claim that a new evaluation of the scientific literature has confirmed what many researchers suspected: The cost savings claimed by government agencies and vendors of health IT are little more than hype. Mr. Soumerai and Mr. Koppel cite research done by the faculty of McMaster University in Hamilton, Ontario, and its programs for assessment of technology in health, along with other research centers, including in the U.S. Researchers sifted through almost 36,000 studies of health IT. "The studies included information about highly valued computerized alerts — when drugs are prescribed, for instance — to prevent drug interactions and dosage errors. From among those studies researchers identified 31 that specifically examined the outcomes in light of the technology's cost-savings claims," they write. The findings showed that with a few isolated exceptions the systems had not improved health or saved money.
Another study by Regenstrief, a leading health IT research center associated with the Indiana University School of Medicine, also found that there were no savings from IT. A second Regenstrief study found a significant increase in costs of $2,200 per physician per year from electronic records.
"In short, the most rigorous studies to date contradict the widely broadcast claims that the national investment in health IT — some $1 trillion will be spent, by our estimate — will pay off in reducing medical costs," Mr. Soumerai and Mr. Koppel conclude. "Those studies that do claim savings rarely include the full cost of installation, training and maintenance — a large chunk of that trillion dollars — for the nation's nearly 6,000 hospitals and more than 600,000 physicians."
According to the authors, the sad thing about all of these studies and their findings is the fact that by the time healthcare providers find out that the promised cost savings are an illusion, it will be too late. In other words, after having spent millions upon millions of dollars on the technology they will not be able to throw it out like you would any defective piece of machinery.
Furthermore, according to the authors, it is "common knowledge in the healthcare industry that a central component of the proposed health IT system — the ability to share patients' health records among doctors, hospitals and labs — has largely failed. The industry could not agree on data standards — for instance on how to record blood pressure or list patients' problems. Instead of demanding unified standards, the government has largely left it to the vendors, who declined to cooperate, thereby ensuring years of noncommunication and noncoordination. This likely means billions for unnecessary repeated tests and procedures, double-dosing patients and avoidable suffering."
The authors also state that so strong is the belief in health IT that skeptics and their science are not always welcome. They note that articles that were published years ago in the Journal of the American Medical Association and the Annals of Internal Medicine reported that health IT systems evaluated by their own developers were far more likely to be judged "successful" than those assessed by independent evaluators.
The authors end their article with a cautionary note. "We fully share the hope that health IT will achieve the promised cost and quality benefits. As applied researchers and evaluators, we actively work to realize both goals. But this requires an accurate appraisal of the technology's successes and failures, not a mixture of cheerleading and financial pressure by government agencies based on unsubstantiated promises."
If people in this industry don't wake up and wake up soon we are destined to see an untold amount of money needlessly wasted on technology. Importantly, the federal government needs to take a long, hard look at requiring something that may harm, not help. Remember, this is an industry already awash in wasteful spending on care, at least a third of it with absolutely no benefits to patients. This is why mature leadership is critically necessary to bring reason to an industry already facing incredible financial constraints. We can only hope.
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