In the Wall Street Journal article today entitled “Can Technology Cure Health Care?” by erstwhile WSJ reporter Jacob Goldstein, H. Stephen Lieber, CEO of the health IT trade group HIMSS disputes the idea that “electronic medical records systems focus on billing [and other administrative tasks] at the expense of patient care” and says:
[These systems] are “primarily designed for improving clinical outcomes, and a secondary benefit is that they improve administrative efficiencies.”
Is Mr. Lieber misinformed, or worse, could he simply be lying?
In fact, these systems do neither of these things, as repeated studies are showing such as I aggregated in “2009 a Pivotal Year in Healthcare IT” at http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=2009, and as in this new 2010 study report in Health Affairs:
The team, led by Harvard Medical School professor Catherine M. DesRoches, surveyed more than 3,000 U.S. community hospitals to assess factors such as inpatient costs and mortality and readmission rates. Here are their findings:
Understanding whether electronic health records, as currently adopted, improve quality and efficiency has important implications for how best to employ the estimated $20 billion in health information technology incentives authorized by the American Recovery and Reinvestment Act of 2009. We examined electronic health record adoption in U.S. hospitals and the relationship to quality and efficiency. Across a large number of metrics examined, the relationships were modest at best and generally lacked statistical or clinical significance. However, the presence of clinical decision support was associated with small quality gains. Our findings suggest that to drive substantial gains in quality and efficiency, simply adopting electronic health records is likely to be insufficient. Instead, policies are needed that encourage the use of electronic health records in ways that will lead to improvements in care.… the researchers determined that the technological systems, as currently implemented, do not have a significant impact on improving care and reducing costs, DesRoches said.
A key phrase is “as currently implemented.” To that, I’d add “as currently designed under the leadership of the HIT industry”, which is to say, poorly.
I commented on this report in my prior post “Yet Another Study Shows Health IT Does Not Bat The Ball Out of the Park; And, is HIT an Issue of States’ Rights?” at this link.
These results are also in line with the 2009 National Research Council report, the highest scientific authority in the U.S. that involved Octo Barnett and other health IT pioneers. The NRC report calls current approaches to health IT “insufficient” and calls for major redesign of health IT to support clinicians’ cognitive needs.
From the NRC report:
Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.
And this was from the country’s most advanced centers in terms of healthcare IT.
As to cost savings, there’s the Nov. 2009 “Hospital Computing and the Costs and Quality of Care: A National Study” (Amer J Med 123:1; 40-46) by Himmelstein and Woolhandler at Harvard Medical School, that also concluded “as currently implemented, hospital computing might [very] modestly improve process measures of quality but not administrative or overall costs.”
Typical of the recalcitrant, recidivist IT industry, Lieber goes on to blame doctors:
“… there is a resistance on the part of some to recognize the professional clinical advantage that these systems give them, many default to ‘This is designed for billing, not clinical outcomes.'”
Never does he consider that doctors might have good reasons to avoid the technology – as in, to protect the lives of the patients in their trust. (When they see user-hostile HIT products from major vendors such as these, who can blame them?)
He then waves off “glitches” – the kind that result in untold clinician inconvenience and disruption, and have resulted in an unknown but “tip of the iceberg” rate of patient injury and death per the FDA – by stating that:
“There is a range of systems out there, just as in any kind of product line, ranging from poor to mediocre to excellent.”
His merchant computing, card tabulator/data processing mindset reveals itself in this statement. Unfortunately, health IT, as in other medical devices, IS NOT JUST ANY KIND OF PRODUCT LINE. Malfunctions and poor design do not simply cause a truckload of candy bars to be delivered to the wrong merchant.
As in pharma and other medical devices, when trade group leaders of the HIT medical device companies are unaware of current research, dismiss it, and blame end users, or simply are liars, that industry deserves serious academic and governmental scrutiny.