HIT won't cure human nature

Not surprisingly, the study recently published in the New England Journal of Medicine concerning EHRs and diabetes care is continuing to get attention from HIT stakeholders and observers alike.

But while many HIT advocates are pointing to the study as a significant step toward demonstrating the tangible value of EHRs, policymakers may want to resist the urge to jump to too many conclusions.

As this longtime consultant starts off his take on the study, “Simple logic leads us to conclude that a properly installed (including attention to workflow and thorough training) of an enterprise software system such as an EHR will lead to a certain level of standardization in overall process flow, contribute to efficiencies and quality in care delivery and ultimately lead to better outcomes. But to date, there has been a dearth of evidence to support this logic, that is until this week.”

Naturally, he’s encouraged by the study’s findings, but it’s when he turns to the longer term implications that he may be waxing a bit too optimistic.

In particular, he suggests that “what we are seeing happen in the healthcare sector is not dissimilar to what we saw occur in the manufacturing sector. In manufacturing the lag between adoption of enterprise software systems and subsequent increases in productivity has a special term: the ‘Productivity Paradox,’ wherein it was some ten years after wide spread adoption and deployment of these enterprise systems that improvements in productivity metrics could be measured.”

The problem, we’d suggest, is that the efficiency of healthcare “productivity” will probably never come close to matching that found in the manufacturing sector. Why? Because of that productivity input known as the patient.

The fact is, patients come in all shapes and sizes and, more importantly, they bring with them an infinite variety of attitudes when it comes to their own healthcare. Consequently, even factoring in developments such as Personal Health Records, quality-based provider reimbursement, and more consistent patient “coaching”, the use of HIT is not going to make everyone as health conscious as healthcare advocates might want them to be.

And that little detail will always be a “drag” on the efficiencies expected from the use of HIT.

On one level, it seems safe to assume most HIT advocates recognize that patients in the healthcare system are not the same as widgets in a production line. Nonetheless, given the relentless, if understandable, push for improved health outcomes and increased healthcare system efficiency, policymakers would do well to remind themselves occasionally that patients, well, are only human.

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