Quote-of-the-day mailing list
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Subject: qotd: IT savings are little more than hype
Date: Tue, 18 Sep 2012 10:31:31 -0700
From: Don McCanne <email@example.com>
To: Quote-of-the-Day <firstname.lastname@example.org>
The Wall Street Journal
September 17, 2012
A Major Glitch for Digitized Health-Care Records
By Stephen Soumerai and Ross Koppel
In two years, hundreds of thousands of American physicians and thousands
of hospitals that fail to buy and install costly health-care information
technologies—such as digital records for prescriptions and patient
histories—will face penalties through reduced Medicare and Medicaid
payments. At the same time, the government expects to pay out tens of
billions of dollars in subsidies and incentives to providers who install
these technology programs.
The mandate, part of the 2009 stimulus legislation, was a major goal of
health-care information technology lobbyists and their allies in
Congress and the White House. The lobbyists promised that these
technologies would make medical administration more efficient and lower
medical costs by up to $100 billion annually. Many doctors and
health-care administrators are wary of such claims—a wariness based on
their own experience. An extensive new study indicates that the caution
is justified: The savings turn out to be chimerical.
Since 2009, almost a third of health providers, a group that ranges from
small private practices to huge hospitals—have installed at least some
"health IT" technology. It wasn't cheap. For a major hospital, a full
suite of technology products can cost $150 million to $200 million.
Implementation—linking and integrating systems, training, data entry and
the like—can raise the total bill to $1 billion.
But the software—sold by hundreds of health IT firms—is generally
clunky, frustrating, user-unfriendly and inefficient.
Now, a comprehensive evaluation of the scientific literature has
confirmed what many researchers suspected: The savings claimed by
government agencies and vendors of health IT are little more than hype.
To conduct the study, faculty at McMaster University in Hamilton,
Ontario, and its programs for assessment of technology in health—and
other research centers, including in the U.S.—sifted through almost
36,000 studies of health IT. The studies included information about
highly valued computerized alerts—when drugs are prescribed, for
instance—to prevent drug interactions and dosage errors. From among
those studies the researchers identified 31 that specifically examined
the outcomes in light of the technology's cost-savings claims.
With a few isolated exceptions, the preponderance of evidence shows that
the systems had not improved health or saved money.
It is already common knowledge in the health-care industry that a
central component of the proposed health IT system—the ability to share
patients' health records among doctors, hospitals and labs—has largely
failed. The industry could not agree on data standards.
Instead of demanding unified standards, the government has largely left
it to the vendors, who declined to cooperate, thereby ensuring years of
noncommunication and noncoordination. This likely means billions of
dollars for unnecessarily repeated tests and procedures, double-dosing
patients and avoidable suffering.
Comment: This article reinforces two points that we have made
repeatedly about the application of information technology to health
care: 1) The government needs to lead the process, and 2) We need to
look elsewhere for means of controlling spending in health care.
Entrepreneurial approaches to health information technology are designed
to make money - a lot of it. Competitors design their products to be
incompatible with each other in hopes that one can dominate the market
and crowd out the competitors. Public service approaches, such as the
interoperable VistA system of the VA, are designed to help health care
professionals give better and more coordinated care to their patients,
but are not designed for profit. We already own the VistA system, and it
could easily be adapted to become the national standard, at a small
fraction of the costs of the private fragmented systems that are being
forced on providers by the 2009 stimulus legislation.
Particularly annoying is the repeated claim that information technology
and electronic records will save money. Not true. Yet the pursuit of
these savings and the alleged savings from the various experiments in
payment innovations found in the Affordable Care Act - which all
experience to date has suggested have been and will be phantom savings -
have distracted us from proceeding with reform that everyone knows would
recover tremendous waste and ensure health care affordability for
everyone forever - a single payer national health program, aka an
improved Medicare for all.