Health IT benefits called into question

Report underscores limitations of previous studies
By Erin McCann
01:00 AM

Healthcare organizations nationwide have spent billions of dollars to implement health information technology, most with the expectation it will improve quality and safety, and lower costs. According to a recent report, however, not all outcomes have been positive, particularly with regard to efficiency.

The January study, conducted by RAND Corporation for the Office of the National Coordinator for Health IT, examined 236 health IT studies from 2010 to 2013, and found that 77 percent of them reported either positive or mixed-positive outcomes – meaning there existed at least one negative correlation between health IT and the care metric, but the original authors concluded the benefits outweighed negative or neutral effects.

However, nearly 20 percent of the studies on health IT’s efficiency outcomes yielded negative results, and only 45 percent saw overwhelmingly positive outcomes, with researchers describing efficiency as including costs, utilization and timelines.

Drilling down further into efficiency, CDS alerts and reminders were proven to be most ineffective, with some 43 percent of studies reporting negative results.

“Cost effects ranged from a 75 percent decrease to a 69 percent increase in the targeted costs; however, many of the studies clustered in the range of six percent to 12 percent increases in the targeted costs,” RAND officials wrote in the report. “These findings suggest that layering technology on the existing payment system may not result in lower costs.”

As for patient safety, researchers also found mixed results. For instance, 17 percent of the studies assessing health IT’s impact on safety had produced negative outcomes, and 67 percent had reported all positive results.

“While the great majority of studies reported positive outcomes for process quality measures, not all studies did so, and most studies lacked sufficient detail to determine which factors may have led to the lack of benefit found,” officials wrote.

The report underscored quality as the metric most improved by implementing health information technology, as the lion’s share of studies, 58 percent, saw positive outcomes, and another 24 percent saw mixed-positive results.

When officials drilled down further into the data, they also found clinical decision support, computerized provider order entry and meaningful use all produced the most beneficial outcomes, at 66 percent, 64 percent and 63 percent positive respectively.

Contrastingly, electronic prescribing was the least able to prove its worth, as more than one-fourth of all studies reported negative outcomes.

Overall, the numbers talk, but they don’t tell the whole story, as there remains a “pervasive limitation” on how these health IT studies are conducted and reported, officials say, citing methodological and reporting problems “that limit our ability to draw firm conclusions about why the intervention and/or its implementation succeeded or failed to meet expectations,” the researchers concluded, citing authors who drew cause-and-effect conclusions from cross-sectional design studies.

“An even more pervasive limitation is the lack of reporting about key elements of context and implementation of health IT,” they added.

For instance, contextual elements are often absent from the studies themselves, such as a hospital’s financial position, and staff education and training performed. Without such improvement of the reporting process, “We will tend to base conclusions about the effects of health IT primarily on studies examining narrow targets and will miss the potential effects on broader outcomes,” officials wrote.

However, despite the findings by RAND officials, anecdotally, the evidence for health IT is glaring for many.

For the folks at Worcester, Mass.-based Reliant Medical Group, the $24 million EHR investment was also worth every penny, according to Larry Garber, MD, medical director for informatics.

When talking finances, Garber, speaking at an industry conference last May, cited the $2 million annual revenue increase the medical group saw just from increasing compliance rates for Medicare Advantage patients.

Their Epic EHR generates patient problem lists and has the ability to extract data from lab results. “We have alerts that remind us to put (lab results) in the problem list, and we have alerts that say, ‘OK, so now that it's in the problem list, for billing, this is the right way to bill for those problems?’” Garber said.

This, he noted, is particularly important for Medicare Advantage patients, as physicians are paid for the diagnoses for those patients and the documentation they provide. So they have a tool automatically reminding staff which items haven't been diagnosed each year on the patient that are on the problem list, and the tool will automatically complete the documentation and billing.

As a result, the medical group has seen their compliance rate for chronic kidney disease Medicare Advantage patients surge from 20 percent to 84 percent within a three-year period.

Just last year Andrew Watson, MD, vice president of Pittsburg-based UPMC, noted a savings of $7,000 overall after implementing a telemedicine platform at an acute care community hospital. And that’s after all the capital expense.

“It’s small numbers,” he said speaking at the American Telemedicine Association tradeshow last year, but for a critical access hospital, “this adds up.”