Health IT in 2013: A Renewed Focus on Efficiency and Effectiveness

Originally posted on the Electronic Health Reporter.

Although we are only a month into it, 2013 is already shaping up to be an important year for health information technology (IT).

Two recent developments have increased pressure on the health care community to deliver results from government investments in health IT systems.  First, concerns about the federal budget are causing policymakers to take a close look at programs with a large budget. As of July 2012, the U.S. Centers for Medicare and Medicaid Services (CMS) reports that the government has spent almost $6.6 billion in incentive payments for electronic health record (EHR) systems, and the amount of money spent on health IT will only continue to grow.

Second, policymakers are taking an extra critical look at any program that appears to be underperforming. Whether fair or not, health IT will likely fit this profile as well because of recent concerns that have been raised about the effectiveness of some of these investments. In particular, earlier this month, the RAND Corporation released a report backtracking on its earlier assertion that health IT could save the United States more than $81 billion annually. This claim in the original RAND study played an important role in helping to quantify the potential impact of health IT for policymakers.

The authors of the latest RAND report have raised doubts about the accuracy of that prediction. More importantly, however, they have pointed to a number of factors that have contributed to the lower-than-expected performance of health IT in the United States. In particular, they argue that current performance is the result of slow adoption of health IT systems, the selection by health care providers of EHR systems that are not interoperable or easy to use, and the failure of health IT providers to adapt their processes to the technology.

Many of these problems were somewhat expected. For example, it is not too surprising that health care providers adopted systems that are not user friendly since those purchasing the systems are a relatively unsophisticated customer-base. We’ve seen the same type of problems in other areas of government. In the early-2000s, the Help America Vote Act gave out millions of dollars to state and local election officials to purchase new voting systems. Although there was (and is) a strong need to procure more sophisticated voting systems, many of these officials made poor decisions on what types of systems to purchase. We’ve seen the same type of problem in health care.

It is also not too surprising that health care providers are experiencing interoperability concerns since the federated, bottom-up approach to building health information exchanges does not properly incentivize data sharing or consumer access to data. The Department of Health and Human Services (HHS) has included some top-down mandates on meaningful use around these issues, but that is no replacement for consumer-driven competition. Still, while the United States may be taking the long route to data portability, at least projects like the VA’s “Blue Button” initiative to give consumers access to data are generally moving us in the right direction.

That is why, even with these minor setbacks, we should still have a positive outlook on the potential of health IT. True the RAND report is a bit discouraging, but it’s also come at an ideal time when health care practitioners and policymakers still have time to refine their efforts to implement the HITECH Act. After all, implementation is far from over and there is still time to have a course correction.

For example, HHS was tasked with defining three stages of meaningful use for EHR systems where each stage reflects an increase in complexity and utility. We have passed stage 1, where the criteria focused on capturing important data and reporting clinical quality measures, and we have moved into stage two, which focuses on exchanging and transferring health information in different settings. The third stage which focuses on improved outcomes is not set to occur until 2016, so there is still time to get this right.

And the key to maximizing benefits is to encourage health care organizations to meet high performance metrics through the adoption of advanced technologies. A few years ago I co-authored a report on maximizing the benefits of IT. I wrote “Policymakers should recognize that IT is a means and not an end—it’s unreasonable to expect that simply using IT to perpetuate existing analog processes will lead to better solutions. Existing problems shouldn’t just be digitized; IT should be used to find new solutions to old problems.” These same words hold true today in health care where providers do not always understand that innovation takes a combination of people, process and technology.

This is why we need to be thinking long-term about how to maximize the benefits of health IT, not only in delivering more effective and efficient care, but also in rethinking how we use IT to innovate in health care. There are countless possibilities where IT can lead to radically new solutions in health care, from using IT to monitor health in the home to using health data for new types of medical research. But the reality is that we won’t get there unless we constantly evaluate where we are falling short and implement policies to address these problems so we can successfully move forward.