A Letter to the Editor

By John Halamka
10:29 AM

As I've mentioned in several blog postings, we're now living through one of the most exciting times in the history of healthcare information technology. With change comes controversy.

Over the past week, several articles have appeared in the press about the value of electronic health records and their impact on quality/safety/cost. David Bates, Blackford Middleton, and I have been asked to respond to them. Here's one of our upcoming responses.

Dear Editor:

As Harvard Medical School faculty and experts in healthcare information technology, we wish to respond to the March 11, 2009 article "Obama's $80 Billion Exaggeration" by Jerome Groopman and Pamela Hartzband. Our response is below:

"We already have clear evidence demonstrating that electronic records improve care and reduce costs when implemented well in specific settings. Three of many examples include:

1. We (Middleton) have published a detailed case study of the cost and quality benefits of EHR at Family Care of Concord, NH demonstrating net benefits per clinician per year of $30,324. This is comparable to the cost savings we've estimated in our academic health centers.

2. We (Middleton, Bates) have published a cost-benefit analysis of hospital-based provider order entry documenting at net savings of $1.7 million per year from drug dosing guidance, nursing time utilization, and error prevention.

3. We (Halamka, Bates) have documented cost savings from automating radiology and medication ordering processes to significantly reduce utilization, pharmacy costs, and staffing.

Much of this evidence comes from a few sites which developed their own records such as the Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. Similar benefits should be possible throughout the country, but will require successful implementation and meaningful use of the new technology. Models by the Center for Information Technology Leadership and others suggest that the total financial benefits may be very large.

The United States is behind many other countries in implementing electronic health records. Most other industrialized nations are already using them and getting their benefits. They did this without cost-effectiveness analyses, simply because it was so obvious that there would be important benefits with respect to quality, safety and efficiency. Furthermore, nearly all the major integrated delivery systems have followed suit, such as Kaiser and Geisinger Healthcare System. The Veteran’s Administration system is nearly completely electronic, and that has played a large role in the high quality performance achieved by the VA.

Groopman cites a study which we (Bates, Middleton) did which found that implementation of electronic records was not associated with improved quality across the U.S. However, he did not cite the portions of that article documenting that performance does improve substantially when the right things are included in the record.

The electronic health record represents a transformational change in healthcare, and will enable an array of improvements—although it will not necessarily result if implemented badly. The electronic record is to the paper record as the automobile was to the horse and buggy. No one will want to go back.

President Obama’s incentives should result in a major increase in electronic record adoption in the U.S., and hopefully will bring us past a “tipping point” which will result in nearly complete adoption. This will result in higher quality, safer care, and lower costs. These are goals that all Americans want and can embrace.

David Bates MD, MSc, Medical Director of Clinical Quality & Analysis at Partners HealthCare.

John D. Halamka MD, MSc, Chief Information Officer at Harvard Medical School and Beth Israel Deaconess Medical Center

Blackford Middleton MD, MPH, MSc, Director of Clinical Informatics Research & Development at Partners HealthCare"


This blog was first posted at Life As a Healthcare CIO.

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