The Decade of Health IT
“By computerizing health records,” then President George W. Bush said in his 2004 State of the Union Address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.”
To the barricades? Not quite, but it’s fair to say that those fifteen words kicked off a revolution in the healthcare industry – what would later be coined “The Decade of Health IT.” Chances are, if you are reading these words you have been engaged on the frontlines of this battle for change.
Unlike most policy debates in Washington, health IT transformation has enjoyed broad bipartisan support. Five years after the Bush address, newly-elected President Barack Obama reaffirmed Bush’s call for ubiquitous EHRs in a January 2009 speech at George Mason University.
"We will make the immediate investments necessary to ensure that, within five years, all of America's medical records are computerized," Obama said. "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests."
And how goes the campaign? When President Bush brought healthcare IT into the public’s consciousness, only about 12 percent of all healthcare providers reported using an electronic health record. Today, 93 percent of physician practices report using an EHR, while 85 percent of all U.S. hospitals use a certified EHR.
According to the HIMSS Analytics Electronic Medical Record Adoption Model, at the end of 2006, only 22 percent of U.S. hospitals had achieved Stage 3 or higher on the EMRAM. By the end of 2012, more than 77 percent of U.S. hospitals had reached a minimum of EMRAM Stage 3 – the minimum level at which organizations begin to use key nursing applications such as clinical documentation and clinical decision support with error checking.
In 2004, about 23,000 people attended the HIMSS Annual Conference and Exhibition. Last year in New Orleans, attendees numbered nearly 35,000 – growth of more than 50 percent. This year, I would not be surprised if total attendance at the February show in Orlando comes within a whisker of 40,000 (preliminary numbers are incredibly strong).
But these numbers measure the means, not the ends, of healthcare transformation. The real markers of success were clearly laid out by our past and current presidents. Are we avoiding medical errors? Have we reduced healthcare costs? Has care for patients improved? Let’s review.
It’s hard to find firm numbers for medical errors, since the system is incented to under-report. However, there are many studies and scientific estimates of medical error fatalities.
Then: In 2004, we were still talking about the 1999 Institute of Medicine report, “To Err is Human,” that estimated 98,000 annual deaths caused by medical errors. But a study by HealthGrades reported that the number of deaths caused by medical errors had grown to 195,000 annually.
Now: In 2013, annual medical error fatalities had reached 210,000, according to toxicologist John T. James, who runs an advocacy organization called Patient Safety America. (James speculates, however, that the number of fatalities from unreported adverse events could bring the total to in excess of 400,000 annually.)
Contrary to what you might read in the popular press, overall healthcare spending has indeed slowed over the Decade of Health IT. That doesn’t mean we’ve reduced cost – but we have reduced the rate of cost growth.
Then: In the decade before Bush’s address, overall healthcare costs doubled. The rate of growth in 2004 alone was approximately 8 percent.
Now: In contrast, over the last three years, the health care spending growth rate was 1.3 percent – the lowest three-year growth since 1965.
Patient care and patient satisfaction are not synonymous, of course, but poor care should, in theory, lead to low satisfaction.
Then: A 2005 Commonwealth Fund study that found 74 percent of all Americans were confident that they would receive “quality and safe medical care” when they need it.
Now: Patient satisfaction in the United States continues to rank among the highest in the world, with a recent study showing that 77 percent of Americans are very satisfied with their healthcare – especially with their doctors, nurses and hospitals.
I long to see a second “Decade of Health IT” in which providers, vendors, insurers and the government make a commitment not just to slow costs and fatalities, but to reduce them outright.