Health IT: Can It Fix Healthcare?

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Technology changes in healthcare promise to deliver all sorts of benefits to the marketplace -- from reduced costs to improved quality, safety and more effective treatments. At the same time, there are fundamental challenges with our delivery system. Healthcare cost is growing faster than the economy. The reason for that is simple: Normal principles of a functioning market are ineffective. We are consumers of healthcare but not buyers - doctors and nurses are.

On the contrary, we tend to demand only the best possible care, especially if the illness is serious. Add to that the advances in medical science with more and more treatment options, innovative pharmaceuticals and medical devices, the growing lifespan, and an increasingly unhealthy lifestyle, and you have a perfect recipe for ever increasing costs. If current trends were to continue uninterrupted, healthcare would take up about a third of all economic activity (see table 1 below) in 2050.

At the end of the century every economic activity in society would be healthcare related.

Table 1. Change in healthcare cost as calculated and projected by the Congressional Budget Office¹

Obviously, this scenario will not happen. But we also should not wait until the system is crashing.

There are high expectations that health IT could help change the dynamics of this development. The healthcare industry is far behind other industries in the adoption of information technology, with all its benefits left to be harvested:

1.       IT could make the delivery of healthcare more effective. The most important prerequisite for that is the widespread adoption of EHR and computerized physician ordering systems. Much has been written about impact on cost and increase in quality: avoiding duplication, miscommunication, drug dosage mistakes and drug-drug interactions, but also about the high investment needs, barriers and pitfalls this technology brings to bear ^{2, 3, 4, 5}

To speed up EHR adoption, the government decided to adopt the stick and carrot method: As part of the Stimulus Bill of 2009, the HITECH Act⁶ set aside $25.8 billion for health IT. It creates financial incentives for EHRs adoption by physicians and hospitals starting in 2011, and penalties that will reduce reimbursement beginning in 2015.

It also establishes the Office of the National Coordinator for Health Information Technology responsible for strategies and impact assessment. This ONCHIT will:

• Define "meaningful use" for an EHR that triggers the above subsidies
• Identify Interoperability Standards to facilitate the exchange of patient data (HITSP)
• Define a process for certifying that Health IT products comply with the standards through the Certification Commission for Healthcare Information Technology (CCHIT)
• Develop a series of prototypes to establish the requirements of a Nationwide Health Information Network (NHIN)

2.       Health IT could lead to a widespread secondary use of healthcare data leading to the improvement of the overall quality and effectiveness of the healthcare system and cost savings. Once available electronically and once other hurdles like the lack of standards, interoperability and privacy mechanisms are addressed, the data can be aggregated and analyzed at scale. Several new scientific disciplines have sprung up that turn these data into new knowledge and insights:

• Evidence Based Medicine - All healthcare decisions should be based on the best evidence derived from systematic scientific techniques, rather than expert opinion.
• Comparative Outcome Research - All alternative diagnostic or treatment choices are compared to determine which works best for which patients or pose what harm.
• Patient Safety Research and medical errors - according to the landmark report⁷ published by the Institute of Medicine, 44-98,000 Americans die each year of medical errors, costing the health care $17-$29 billion annually.

In 2009, $1.1 billion of Stimulus money was set aside for research on "clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions":

• $300 million for the AHRQ
• $400 million for the National Institutes of Health
• $400 million for the Office of the Secretary of the Department of Health and Human Services

 The Agency for Healthcare Research and Quality (AHRQ) was created in 2005 through the Patient Safety and Quality Improvement Act of 2005.⁸ AHRQ created Patient Safety Organizations creating a safe haven for peer review of such data from litigation law suits and to develop electronic standards that would enable the collection, aggregation and analysis of data, root-cause-analyses and organizational improvement programs.

All these initiatives will create the foundation for applications that can transform healthcare. However, the challenge lies in the detail: creating insightful applications and making sense of the information. Consider the challenge of having one EHR system talk to another -- a fundamental requirement for movement of information between systems. Even though standards are being developed for many domains, healthcare is an information-intensive discipline requiring a shake-out of the optimal technical solutions and conventions, which will take time.

But today, the marketplace is still polarized in ways that can make it difficult for practitioners to make decisions about tools and approaches. On the one end of the spectrum are institutions and government programs that create solutions extremely slowly. At the other end are the new up and coming venture backed start-ups that are pushing the next big thing -- like slick and splashy tablet based applications that are good at wowing their potential investors but have yet to prove their usefulness in the market.

Christian Reich is currently senior program manager at the Observational Medical Outcomes Partnership, a public-private research project between PhRMA and academic research institutions managed by the Foundation for the NIH and chaired by the FDA. Seth Earley is CEO, Earley & Associates Inc.

References

1. Congress of the United States, Congressional Budget Office. The Long-Term Outlook for Health Care Spending. November 2007

2. Wang T, Biedermann S. Running the numbers on an EHR. Applying cost-benefit analysis in EHR adoption. J AHIMA. 2010 Aug;81(8):32-6

3. Peterson LT, Ford EW, Eberhardt J, Huerta TR, Menachemi N. Assessing differences between physicians' realized and anticipated gains from electronic health record adoption. J Med Syst. 2011 Apr;35(2):151-61. Epub 2009 Aug 8

4. Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010 Aug 6;10:231

5. Cheriff AD, Kapur AG, Qiu M, Cole CL. Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group. Int J Med Inform. 2010 Jul;79(7):492-500. Epub 2010 May 15

6. Title 42 USC 300jj: Health Information Technology for Economic and Clinical Health Act, Subtitle A - Promotion of Health Information Technology

7. Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human - Building a Safer Health System. National Academy Press, 2000

8. Title 42 USC 299: Chapter 6a - Public Health Service, Subchapter Vii - Agency For Healthcare Research And Quality