March 9, 2011
A government study published on Wednesday indicates that the daunting task of implementing electronic health information systems across the country may not be a lost cause.
The review of 154 other studies about health information technology, or health IT, found that 92 percent were positive overall, researchers with the Office of the National Coordinator for Health Information Technology found.
"These new findings are very significant in helping to confirm that our nation has made the right choice in moving aggressively toward adoption of health information technology," Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said in a statement.
Most of the paperwork underlying U.S. health care is just that-paperwork. Prescriptions are scrawled on paper pads, medical records are kept in paper folders, and patients must often pay fees and transport written records if they want one physician to see another's notes, test results, or scans. The system discourages the sharing of information, which can lead to poorer care, and can foster deadly errors.
In 2009, President Obama signed the Health Information Technology for Economic and Clinical Health, or HITECH, Act, offering $14 billion to $27 billion in incentives to hospitals and doctors' offices if they would start using electronic health records. The Health and Human Services Department wanted to see how well the fledgling attempts at using health IT were working.
The study, published in the journal Health Affairs, looked at its effects on access to care, patient satisfaction, efficiency, and effectiveness of care, among other factors.
"This review of the recent literature on the effects of health information technology is reassuring," the study concludes. "It indicates that the expansion of health IT in the health care system is worthwhile."
Most strikingly, the team, led by Melinda Beeuwkes Buntin, noted, "The benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters."
National Coordinator for Health Information Technology David Blumenthal, who helped write the study, called the results "very encouraging." He has overseen federal efforts to increase the use of electronic health records.
About two-thirds of office-based doctors still rely on paper records to keep track of patient care, according to the National Center for Health Statistics. Computer-based records are promoted as a way for doctors, pharmacists, and insurers to seamlessly share patient information, reduce errors in prescribing, and, eventually, reduce costs.
While many doctors and hospitals have been skittish about switching to electronic records, government officials hope this latest research, with its predominately positive results, will encourage health care providers to adopt electronic systems.
"Electronic information, especially standards-based information, can become dynamic; interacting with other information to generate useful safety alerts, call attention to treatment alternatives, enable instantaneous assessments of quality of care or outcomes for patients, or contribute to public health surveillance," Blumenthal said in an interview. "We have never, in the history of medicine, had such tools at our disposal. Meaningful use will help usher them into routine, widespread, and effective use."
But widespread adoption of new technology has been complicated by a range of challenges, including the problem of interoperability and information sharing among institutions. Blumenthal said his agency is working with the health care industry to develop policies and standards for information transfer, but some have called for an increased government role.
In a letter published Saturday in The New York Times, Boston University health policy professor Alan Cohen called for more federal incentives and regulations to get health care providers to collaborate more.
"Federal government investment in health information technology, while a good first step, is insufficient to change hospital and physician behavior," he wrote. "Payment reforms and restructured health care delivery organizations are also needed.… The key ingredient, though, is government leadership."
Another challenge is cost. Another study in the same issue of Health Affairs found that for an average five-physician practice in Texas, health IT "implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year." And implementing a new system took more than 700 hours of work, the study determined.
But Blumenthal says the federal grants, which can offer a private physician up to $63,750, are expected to be widely used. A survey released in January found that 41 percent of office-based doctors and 65 percent of hospitals intend to take advantage of the grants, which require recipients to effectively develop an IT system in order to keep the money.
March 9, 2011