For years, Americans have heard about the ways in which information technology would revolutionize the country’s expensive and disorganized health care system. Politicians of every stripe agree that government should promote its widespread adoption, and President Obama’s administration plans to make it a major focus of any health care reform effort. But how much of all this is hype, and how much is real?
Laura Adams is president and CEO of the Rhode Island Quality Institute, a nonprofit that promotes innovation in the state’s health care delivery system. Adams talked with Providence Business News recently about where federal stimulus dollars for health IT should be spent, where they shouldn’t, and how society could benefit from broader adoption of health IT.
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PBN: We’ve been hearing a lot lately about the promise of information technology in health care. What exactly does this encompass, and how do you see its potential?
ADAMS: It’s important to recognize that health IT alone isn’t the answer to our problems in health care. However, it is an essential foundation for almost all other promising reforms. In order for such reforms to succeed – reforms such as the Patient-Centered Medical Home, empowering consumers to better manage their health, evidence-based medicine, chronic care management, payment reforms, and pandemic and bioterrorism preparedness – health IT is critical. This is health IT’s real value – as a key enabler of the improvement of health care quality, safety and value.
PBN: How quickly are health information technologies being adopted?
ADAMS: Health IT adoption in the United States significantly lags other industrialized nations. While there are certainly the issues of cost and the substantial work flow redesign that is required, one of the primary reasons The Economist magazine ranked health care second only to the mining industry in investment in IT is that the majority of the return on investment doesn’t flow to those who buy the systems.
According to a study by the Center for Information Technology Leadership, a physician goes through the expenditure of time and money to evaluate and select a system, redesign their work flow, train their staff, engage IT expertise, weather the productivity decline during implementation, maintain and upgrade the system, etc., only to receive 11 percent of the return on that investment. For every office visit or hospitalization prevented because the patient is healthier, the savings go to those who pay for health care, not to the provider. Payment reforms that reward value, not volume, are key to improving the adoption rate and effective use of health IT systems.
This is not to say that there are no advantages to providers for adopting. Despite the obstacles, Rhode Island physicians are adopting in greater numbers than the national average. This can be attributed to the exceptional physician leadership we have in Rhode Island. One of the Quality Institute’s committees is the Health IT Adoption Committee, comprised of some of Rhode Island’s most respected and competent physician leaders. Together, they’re working to communicate the benefits of health IT to the medical community as pioneers with first-hand knowledge of the benefit that health IT offers to patients and providers.
PBN: The Obama administration is said to be planning to invest $50 billion over five years to encourage broader adoption of health IT. Where do you think that money can best be spent?
ADAMS: There are a number of uses for this money that would meet President Obama’s goals of immediate economic impact and investment in much-needed infrastructure. These uses include advancing the standards that will allow health IT systems to “talk” to each other. It isn’t very helpful for a provider to have a computer in their office that can’t securely exchange information with others involved in the patient’s care. It’s the equivalent of a “dumb terminal” in an office – of very limited value. These standards include standards for data transmission, as well as those for protecting privacy and security of the information.
Another extremely good use of the funds would be to assist physicians, hospitals, long-term care facilities, behavioral health providers, home health agencies, community health centers, hospices and so forth in purchasing, successfully installing and fully utilizing certified electronic medical record systems.
Obviously, I believe that currentcare, Rhode Island’s health information exchange, is a very wise investment in infrastructure for the future. Currentcare is a secure electronic network that, when fully built and with consumer consent, allows medical professionals access to patients’ most up-to-date health information in any provider location. The longer-term vision includes consumers’ ability to access all of their health information electronically in one place, regardless of changes in providers or health insurance status. This system is being built right now in Rhode Island and could immediately put the funds to use to create jobs and allow the state to gain value from the health information exchange much sooner than currently planned.
Work force development is another place where stimulus funds could create value for years to come. Training those who work in health care to leverage health IT to reduce errors, better coordinate care, improve efficiency and gain the maximum benefit from health IT would be money well spent. Having an IT-savvy work force in health care will also stimulate the much-needed market demand for vendor products that are more effective in improving the quality, safety and value of health care.
PBN: How about the opposite case: Where would spending a lot of government money not be a good thing?
ADAMS: Creating large pools of incentives for providers that could be tapped only after they have purchased, installed and begun using systems that improve care is a non-starter. Providers, particularly those that are smaller in size, lack the access to up-front capital to make these investments, and lack the support to succeed in their implementations. The last thing we need is a rash of failed implementations across Rhode Island.
Another less than desirable use of the funds would be to establish loan programs for provider adoption. The barrier to adoption by providers is that the lion’s share of the return on the investment doesn’t accrue to them. Therefore, it would be hard to understand how offering providers a chance to go into debt – even low-cost debt – would be attractive to them if the return would never satisfy the debt.
Making significant sums of money available to providers for purchase of electronic medical records without funding implementation support and assistance in getting the maximum value from the systems could produce waste. We know from experience in Rhode Island that implementation support is key to success, and providers benefit enormously from support that goes beyond what their vendor provides. National data already suggest that 30 percent of electronic medical record implementations fail. This figure will go up if we don’t provide adequate assistance to providers during the transition and in the time period immediately following.
With the proper education and support, [physicians and staff at] small practices can succeed in the transformation from paper to electronic systems and join their colleagues who are already seeing the very tangible benefits for their patients and their practices.
PBN: Widespread adoption of health IT is often held up as something that could help control medical costs. But there would be costs associated with it, as well. How big an impact on health spending do you think IT adoption could have?
ADAMS: Health IT’s impact on health spending will depend entirely upon how it’s leveraged. If it is put to use in conjunction with other key system changes, it could have a significant effect. For example, if health IT were coupled with payment reforms, the impact could be dramatic. If provider payment was directly related to such things as minimizing potentially avoidable complications in the management of chronic care, IT would be indispensable for care coordination and reduction of medical error, and therefore contribute to significant savings.
But even without these system changes, we are beginning to gather empirical evidence of health IT’s impact. In a study published just last week in the Archives of Internal Medicine, a group of Johns Hopkins School of Medicine researchers studied 41 Texas hospitals and found that mortality rates drop by 15 percent when computers replace paper. The study, funded by the New York-based Commonwealth Fund, also found that hospitals with sophisticated computer order entry systems have a 55 percent lower rate of death for patients undergoing coronary artery bypass grafts.
The study also showed that those with high scores for computer order entry were associated with lower average costs per admission and a 16 percent lower risk of developing complications across all reasons for admission. In addition to the pain and suffering caused, complications can add thousands of dollars on to each hospital stay.
A colleague of mine once compared the pressure to show a return on investment in IT with that of trying to prove the return on elevators in a 40-story office building: You know it’s there – it’s just tough to quantify it. •
