Waiting on the ROI: 3 lessons from health IT investments

As the saying goes, time is money — and the healthcare industry has invested a lot of both.

These investments run the gamut of the industry, but special focus and consideration can be given to the IT sector of healthcare. By way of the Health Information Technology for Economic and Clinical Health Act alone, signed into law by President Obama in 2009, the federal government has invested approximately $26 billion in health IT.

But the implementation of IT systems, including EHRs, health information exchanges, electronic prescribing and telemedicine to name a few, hasn't been all smooth sailing. The administrative burden has led some to question the value of IT compared to the time and energy spent on it. It also provides a retrospective look for the healthcare industry to see past mistakes and learn from them.

Is it worth it?
Much of the dialogue surrounding health IT innovation and investments is laced with comments of wastefulness, a big brother type of approach or a hurried implementation leaving many ill-equipped to make good on the investment.

These questions and concerns aren't unfounded — $26 billion is a large chunk of change, and many in the industry are left feeling more frustrated than accomplished.

But many industry experts, technology consultants and CIOs themselves seem to agree that investments made aren't investments wasted.

"I'd never say health IT is not worth the investment," says Fletcher Lance, managing director and national healthcare leader at North Highland, a global consulting group. "I'd see it more as a version one. Version one is always bumpy."

If there is a version one, then there are versions to follow that will improve upon lessons learned by ghosts of IT projects past.

Lesson one: Too much too fast is no good
The end of 2014 meant the beginning of Medicare payment adjustments for eligible hospitals and professionals who failed to meet meaningful use requirements — approximately 200 hospitals and 257,000 professionals in all.

Upon hearing the numbers, the American Medical Association released a statement saying it was "appalled" that more than half of eligible professionals would face penalties for failing to meet meaningful use, a number it says is worse than anticipated.

"The strict set of one-size-fits-all requirements is failing physicians and their patients," the AMA's statement read. "They are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care and imposes an administrative burden."

The AMA's condemnation of meaningful use penalties reflects other complaints about meaningful use policies and guidelines that have been voiced over the years. In sum, hospitals, health systems and clinicians were trying to adhere to a set of guidelines that required significant culture and workflow changes and were only given a minimal amount of time to meet them.

In an April 2011 piece in Becker's Hospital Review, Michael Sinno, former vice president and CIO of Cooper University Hospital in Camden, N.J., and Snehal Gandhi, MD, director of medical informatics at Cooper University Hospital, said the timeframe to implement new information systems is generally much longer than the timeline meaningful use requirements offered hospitals and health systems.

And with meaningful use's constantly changing deadlines, it can be difficult to keep track of what needs to be submitted at what time. Attestation deadline dates have been changed and the time periods to demonstrate meaningful use have changed. In the fall of 2014 alone, CMS changed the deadline for meaningful use attestation three times, first to Oct. 1, then to Nov. 30 and finally to Dec. 31.

"It's unfortunate that a substantial amount of the IT resources are being consumed responding to government regulations," says Wayne Sensor, CEO of Omaha-based care coordination solutions provider Ensocare. "Meaningful use has distracted the industry from focusing on IT solutions that drive substantial value in the form of more efficient, high-quality healthcare."

This isn't to say that meaningful use is a bad incentive. The ideals and goals of improved clinical quality, patient safety and clinical outcomes on the individual level and population health level should be heralded. But the timeline left some hospitals and health systems scrambling to purchase, implement, adopt and integrate brand new systems into their workflow.

Mr. Lance illustrates this issue in the context of the patient portal. "With meaningful use, there's the requirement to implement [the patient portal], but are they really providing the value that the patient wants? What we're doing right now is we're just putting up the portal to meet the requirement, and that's not going to work out really well."

Instead, something more than a financial incentive needs to be driving healthcare organizations to adopt these tools. And they need adequate time to do it.

Lesson two: Be wary of so-called 'silver bullets'
Interoperability is a healthcare buzzword today. Those in IT want systems to "talk" to one another, and clinicians want a way to access information wherever and whenever they need to do so.

Enter health information exchanges; the theoretically perfect solution to the interoperability problem. But as it goes, HIEs also have their flaws.

For one example, take Owensboro (Ky.) Health, a 477-bed hospital in the northwestern corner of the state. Owensboro Health participates in the state of Kentucky's HIE, aptly named Kentucky Health Information Exchange.

Michael Elley, MBA, CIO of Owensboro Health, says his experience with KHIE has demonstrated both positive and negative effects. The hospital's participation in the HIE has helped it meet meaningful use requirements, but given its location on the state border, Owensboro Health is unable to communicate with many surrounding locations.

"We're on the border of Kentucky and Indiana, and there's at least two health systems that are 45 minutes away from us, and they're not on the state HIE," he says. "A lot of these exchanges, if they're a state HIE, they are not crossing the state borders. And then if not every facility and provider is a part of that, you're still [left] with an incomplete picture, and the value you're going to get is lessened."

But HIEs don't have to be the only path to interoperability. Mr. Sensor suggests the industry shift its attention elsewhere.

"I am a complete supporter of interoperability, and I think we owe it to our patients to find mechanisms to assure that their clinical information can follow them. However, I'm not personally convinced HIEs are the solution," he says.

While many HIEs have succeeded, many have also failed, Mr. Sensor says. There's another caveat: The industry doesn't necessarily agree on what success for an HIE really looks like, which makes measuring results and outcomes difficult.

Additionally, maintaining HIEs are costly, and stakeholders aren't jumping to volunteer the dollars to fund these systems that have not fully demonstrated their benefits.

"You could make an easy case that this is valuable to the patient, but no one expects the patient to pay for their data to move from Hospital A to Hospital B," Mr. Sensor says. "Likewise, many would suggest that independent physicians would generate some value out of the existence of information flowing between providers, and again, I think it would be unrealistic for independent physicians to finance or pay for a portion of HIEs."

Mr. Lance with North Highland, however, thinks it's too soon to jump ship.

"If we stay with the concept of version one, this is version one of many things," he says. "Has it been hard to implement and more costly than we expected? Yes. Will it morph into something else? Probably so. But the idea of shared data that crosses a network of facilities that can be used by patients, clinicians and other physicians — my belief is that it will evolve over time."

He adds, "I don't think you can…[throw] the baby out with the bathwater in version one."

Lesson three: It isn't what you have, it's what you make of it
If there is one overarching, all-consuming investment in healthcare IT, it is the EHR. Again, the federal government itself has invested upwards of $26 billion in EHR meaningful use incentives, and hospitals — be it due to these regulatory demands or otherwise — are largely and quickly implementing such technologies, especially smaller and mid-sized hospitals and health systems.

Mr. Sensor anticipates seeing even more expenditures surrounding EHRs in the upcoming year, but he also notes that the EHR alone isn't the key puzzle piece.

"Many, like myself, have come to realization that the EMR is really simply an electronic medical record," he says. "It's simply a repository of data around the patient. And most of the industry has found, in and of itself, there is very little return on investment from simply having that EMR. The real return is going to be generated by mining that information and leveraging it in a way that we can provide more efficient care."

Essentially, the EHR isn't going to revolutionize healthcare. What the industry does with it will.

Industry professionals are already looking to enhance the EHR and utilize it for strategic purposes beyond just meeting federal requirements.

"A lot of people made the investment in Epic, Cerner, McKesson," Mr. Lance says, calling these health IT vendors "heavy iron." He continues, "People are now looking at IT to see if they can put some type of cloud-based layer above those systems. There's a lot of exploration around, 'How do I put this layer on top of my heavy investment where it's lighter and more flexible and easier to implement?'"

Mr. Sensor adds another example, such as tools to automate discharge processes using information collected in the EHR or predictive analytics.

"We all agree in the industry that EMRs are a necessary technology, but it's those sorts of additional efficacies that ultimately will begin to generate the ROI that we all hope for relative to EMRs," Mr. Sensor says.

Continuous investments
Undoubtedly, this country has invested a significant amount of time and energy — and likely blood, sweat and tears — into health IT initiatives. And while $26 billion sounds like an astronomical number, it really isn't all that much when compared to the IT spend of other industries, Mr. Sensor says.

"Our per capita spending in healthcare is actually more modest than virtually all of those other prescribed industries," Mr. Sensor says, mentioning industries such as banking and retail. According to Gartner Consulting's 2014 IT Enterprise Summary Report, healthcare providers' average IT spend is 4.2 percent of their revenue. Education spends 4.7 percent of their revenue, media and entertainment spend 5 percent and banking and financial services spend 6.3 percent.

Mr. Sensor continues, "But it is increasing, and frankly, I think given the quantity of data that we're now attempting to leverage and utilize effectively, it will have to continue to increase."

Eventually, though, Mr. Elley with Owensboro Health says the investment will make itself clear, and the healthcare industry will start seeing costs go down — the way it wants them to go.

"If we improve care delivery, if we can make it easier to access care, if we can make it safer to receive care and if we can provide you better outcomes because of all this data we have, in the end, the patient is going to improve," says Mr. Elley. "IT is going to be the primary driver of driving down those costs."

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