Wednesday, February 13, 2013

Why Has Health Information Technology Been Ineffective?

Health information technology is one of the methods often proposed to help rein in rising health care costs. The underlying story is plausible: greater efficiency in dealing with the provision of care and the paperwork burden of medicine, and greater safety for patients as providers can be aware of past medical histories and ongoing treatments. However, at least so far, health information technology hasn’t done much to reduce costs.  Arthur L. Kellermann and Spencer S. Jones ask “What It Will Take to Achieve the As-Yet-Unfulfilled Promises of Health Information Technology” in the first issue of Health Affairs for 2013 (pp. 63-68). (This journal is not freely available on-line, but many academic readers will have access through library subscriptions.)

Back in 2005, a group of RAND researchers forecast that rapid adoption of health information technology could save $81 billion annually. Kellermann and Jones essentially ask: Why hasn’t this vision come to pass?  Here are some of their answers (as usual, footnotes are omitted).

Health providers and patients have been slow to adopt information technology. “The most recent data suggest that approximately 40 percent of physicians and 27 percent of hospitals are using at least a “basic” electronic health record. … Uptake of health IT by patients is even worse.”

Existing health information technology systems don't interconnect. “Are modern health IT systems interconnected and interoperable? The answer to this question, quite clearly, is no. The health IT systems that currently dominate the market are not designed to talk to each other. … As a result, the current generation of electronic health records function less as an “ATM cards,” allowing a patient or provider to access needed health information anywhere at any time, than as “frequent flyer cards” intended to enforce brand loyalty to a particular health care system.”

Health care providers dislike the existing information technology systems.“Considering the theoretical benefits of health IT, it is remarkable how few fans it has among health care professionals. The lack of enthusiasm might be attributed, in part, to the sobering results of studies showing that in many cases health IT has failed to deliver promised gains in productivity and patient safety. An even more plausible cause is that few IT vendors make products that are easy to use. As a result, many doctors and nurses complain that health IT systems slow them down.”

Existing health information technology can raise costs. On this point,, the authors cite a New York Times article from last fall by Reed Abelson, Julie Creswell, and Griff Palmer. (Full disclosure, Reed Abelson was a friend of mine back in college days.) The NYT story reports: "[T]he move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care.Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a New York Times analysis of Medicare data from the American Hospital Directory. Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well."

Kellermann and Jones end with a plea that health information technology systems should be built o principles of interoperability, ease of use, patient-centeredness. I have no disagreement with the principles, but I would note that even within individual companies, it has often proven quite time-consuming and difficult to integrate information technology into operations in a full and productive way. Thus, it's no surprise to me that the health care industry has faced a number of stumbling blocks. I’ve heard anecdotal stories of doctors spending inordinate amounts of time clicking through menus on some IT system, trying to figure out which boxes to check to best represent a diagnosis and a course of care. I’ve heard that some doctors, as they master the system, find that it becomes easier to bill for many separate small services that they wouldn’t have previously bothered to write up.

It seems that it should be possible for the big health care finance operation, both public and private, to get together and hammer out a basic flexible framework for health care information technology. But it doesn't seem to be happening.