Five ways health IT will reduce the cost of care

IT in other industries has transformed costs associated with common transactions. This may not be the biggest cost benefit in healthcare, but HIT certainly enables consumers/patients to do things themselves that used to require human intervention.

There are so many unsupported, overly optimistic statements in this article that it's hard to know where to start. Maybe the title: "IT will reduce the cost of care..."

The previous commentors raise great objections highlighting the INCREASED costs of implementing and using EHRs, so I'll only address two claims in your point #3.

First, having data in digital format means it is stored, retrieved and transported much more easily than it can be on paper. Given. Totally agree.

However, touting the benefits of all that "information", is a huge leap. EHRs capture data, much of it woefully unstructured, which is not the same as "information". That EHR data we're now capturing somehow provides the best way to manage care is still a prayer awaiting an answer. I too have faith, but I'm not selling all and waiting on the mountaintop just yet. Why?

The data isn't validated. It differs system to system. It's not likely to be reliable except within a single EHR. And we've no standards for interpreting and reporting it yet. So it's far from being "information".

Even so, many doctors routinely voice complaint that systems aren't written for them (see comment)- mostly because EHRs fail to provide reports that are useful even at the clinical level, forget about across platforms. You design your data capture for the kind of reporting you expect to produce. Hence, most EHRs focus on data capture, workflow, and reporting primarily for billing purposes. Strategic BI, covering the vast amounts of data the article addresses, are only as good as the underlying data - which, lacking standards, is highly suspect. Canada's years of experience prove this already.

Lacking adequate data standards, we are far from validating the quality, reliability, and significance of the data collected. Even then the data has yet to be transformed and interpreted (again, according to standards) into actionable information. When the industry (or govt) decides what kinds of clinical reporting we want, and re-writes EHRs to meet those standards, only then will we begin to get some informational ROI.

Second, as mentioned, medicine changes literally every day. So does everything in the technical arena where EHRs have to operate. And security threats morph by the hour.

Yet computer software abhors change. When a new drug hits the market, the doctor writes a paper prescription - no problem. But if its not in your EHR system, it may be a big problem. Even if you type it in, it may need to be coded, categorized, etc. prior to being useable in any "information" output. That's the difference between relying on brain matter versus silicon to interpret medical data. Silicon always requires code.

Change management is why "maintenance" costs of virtually any commercial software (excepting perhaps open source) far outstrip the initial acquisition costs over the whole lifecycle. Cloud computing solves dynamic resource allocation, but not the steady stream of changing software requirements. In simple terms, that means changing, upgrading, enhancing, retrofitting, and making software interoperate with other systems costs more than designing it cost in the first place. ICD-9 to ICD-10 migration is just one such foreseeable change that will cost millions if not billions of dollars. How many unforeseeable platform, security, interoperability, legal and informational changes are coming? Who knows? But one thing we do know - it will cost more money.

We cannot responsibly set expectations that this great endeavor is justified by cost savings, at least not within the next decade. Most healthcare businesses (except insurance companies) are facing a crunch in a much shorter time frame than that. Financial pressures will mean hospitals and clinics across this country will consolidate, merge and close in large numbers in the coming years. Changes in healthcare IT will accelerate this, not save us from it.

EHR migration is still the right thing to do, but not because it will save us any money. It will transform medicine for sure, and we hope, though we cannot yet prove, that it will result in better outcomes.

Above article not written by someone who lives in the clinical end-user's world.

An EHR allows simultaneous chart access by multiple users and is supposed to improve what I can do with the medical record's information. Analyze, flag, alert, search, etc. Nice ...,

SO LONG AS the power is on, the computer is functioning properly, the software is running correctly, and the network is up. Hopefully a hard drive (or something else) hasn't crashed, or malware hasn't made it into the system, the last Windows or EHR (or other) update didn't break something, and backups are occurring properly. The EHR is down? So sad, too bad. There are still patients in the waiting room. What now?

And expense ... several years ago my geek bubble was burst by a former hospital administrator from a large hospital chain who enlightened me re: the prodigious cost of creating and maintaining an EHR.

For my own clinic's medical record, I used H.S. educated people (or, during the summer, their kids who were still in H.S.) to assemble and file my paper records. No can do with an EHR. Need more educated (= more expensive) tech savvy people to keep the beast alive. Or me ... and I'm even more expensive. And computers don't last as long as paper records & file cabinets. Gotta keep replacing them and moving the data. Oh ... and paper records still work when the power goes out.

And then ... there's productivity. Oops. Absent the expense of a scribe, most docs take a tangible hit on the number of patients they can see daily once they transition to an EHR. EHR's simply aren't written by clinicians for clinicians. They are written by back-office coders for sale to administrative personnel. Human data input/interface issues are not considered sufficiently. Yet, that's a critical choking bottleneck for EHR adoption from the clinical end-user's perspective! Like it or not, docs can see more patients by handwriting their notes during patient encounters. If this isn't solved, docs will dump their new EHRs to paper and use the equipment as door stops.

Reducing a doctor's work efficiency does NOT appear to be a useful way to reduce the cost of care.

Re: comments from Mr. Thompson, there is tremendous wishful thinking regarding IT and its effect on healthcare costs. Some of the myths today are the following:
1. We cannot define outcomes currently with any granularity to be helpful. Thus metrics will be process focused only for 10-15years, thus IT will have little or no effect in establishing care standards.
2. Patient involvement does not necessarily reduce costs-in fact may increase costs by their engagement and expectations generating unnecessary testing and diagnostics.
3. So far, consumer transparency has not "bent the curve" . Patients tend to follow their physicians recommendations regardless of other vetted contrary information.

Most cost savings will be at the POS with physicians ordering less duplicative tests and having decision support tools avialable to them in the exam room. Beyond those to mitigating effects, it is hard to see costs impacted favorably by a connected delivery system. Rob MD