How to measure the value of health IT
There's been a whole lot of capital invested in health information technology these past few years. And some people – especially those who are in charge of spending more of it – want to know whether it's money well spent.
It may seem obvious to some in this industry, but it's still a question that bears asking: Is the value of health IT self-evident at this point, five years after HITECH? Or is the jury still out?
"I think in the United States we've passed a tipping point," says John Hoyt, executive vice president of HIMSS Analytics. "People understand that IT can create value."
The catch? "It's not automatic."
Instead, recognizing and reaping the value of IT systems comes only with careful planning – and commitment to seeing project through, says Hoyt.
"It has to be designed for, as part of implementation and post-implementation optimization," he says.
And after install, even when it's there, that value can sometimes be hard to quantify, says HIMSS Analytics Senior Director of Research Jennifer Horowitz: "I would argue that people aren't doing a very good job of measuring the value they get."
In July 2013, HIMSS unveiled its new Health IT Value Suite, a trove of quantitative and anecdotal data meant to help healthcare stakeholders assess technology's value. Its 1,000 case studies are meant to offer evidence that health IT works – even if the notion of value could have 80 different meanings.
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That fact is illustrated by the Value Suite's STEPS taxonomy – the acronym stands for satisfaction, treatment/clinical, electronic information/data, prevention/patient education and savings – which lays out dozens of documented real-world examples of the myriad ways health IT has led to improved care and financial gains.
"Pinpointing the clinical and financial impact of health IT investments is complex," said Carla Smith, executive vice president of HIMSS, at a press conference this past summer announcing the suite's launch.
"The value of health IT is demonstrated in many ways; some may be unique to an organization, while others may be highly adoptable and scalable," she said. "HIMSS created the Health IT Value Suite to organize and create a common vocabulary to identify, classify and discuss the many known examples of health IT value, to create a comprehensive library of case studies from which we can research impact, and to educate all on the findings."
MORE THAN JUST ROI
One of the challenges, of course, is that different types – and different sizes – of providers arrive at value in different ways. A fully tricked-out academic medical center is in a different position, after all, than a tiny rural physician practice.
"The leading-edge institutions are investing the effort to measure before they implement and after they implement, and they've got demonstrable evidence," says Hoyt.
Indeed, when HIMSS is bestowing Davies and Stage 7 Awards to top-notch facilities, part of the requirement to qualify is that the provider "present to us evidentiary data that quality has improved, efficiency has improved, something," says Hoyt.
That's not necessarily a return on investment, however.
"Quality has a measure of value, financially, but it's harder to derive," says Hoyt. "It's not mathematical." It's not necessarily as easy, in other words, as installing a PACS system and immediately reaping the efficiency benefits of getting rid of film, for instance. "That's why we use the term 'value,' and not ROI."
At the same time, just because an organization is implementing an EHR or other system, "that doesn't mean they're getting value," he says. "That just means they're going along with a wave."
For instance, there are big differences between the ambulatory and inpatient spaces in terms of how immediately they recognize value. "It might be a little harder for the docs," says Hoyt with a laugh. "Because they're not as big and screwed up as a lot of hospitals."
More to the point, it's critical that organizations be fully committed to health IT transformation to see tangible improvements in their care delivery. It's not beneficial to merely dip a toe in the water with a rudimentary EHR; you have to be in it to win it.