Tinker Ready hosts a St. Patrick’s Day Edition of the Health Wonk Review this week – be sure the check it out. One of the most interesting posts come from Health Affairs Blog, written by Danny McCormick, David Bor, Stephanie Woolhandler and David Himmelstein. To sum it up, the authors recently published an article detailing their study results that found a significant increase in medical imaging orders correlated with the ordering physician having access to electronic imaging results (the study focused on correlation, not causation, and the authors acknowledge that causation cannot be drawn from such a study – as is the case with pretty much any observational study). They were taken to task by Dr. Farzad Mostashari, the National Coordinator for Health IT, and their article in this edition of the HWR is their response to Dr. Mostashari.
Healthcare information technology is a Big Thing these days. It’s one of the cornerstones of the ACA. Medical practices are getting incentives for implementing electronic health record (EHR) systems, as long as they can demonstrate “meaningful use” of those systems (although in some cases, the requirements might actually be making things more complicated).
The “common sense” view is that of course HIT will save money and make life more convenient for patients, providers, and health insurance carriers. My own family’s experience with my father’s rare autoimmune disease leads us to believe that more HIT would be a good thing. His illness left him with kidney failure a decade ago, and he’s been on dialysis ever since. He has several specialists who see him for various aspects of his care, and yet a lot of the data sharing between the doctors is done by my parents carrying copies of files from one office to another. It would definitely be easier – and probably more accurate – if all of his treatment history was on one centralized database that all of his doctors could access.
I also tend to assume that more HIT will also result in lower overall healthcare costs by eliminating duplicate testing and allowing doctors to be more efficient with resources. But the McCormick/Bor/Woodhandler/Himmelstein study seems to indicate otherwise. We probably shouldn’t just dismiss it. They were careful to note that their study doesn’t indicate causation, but they do point out that it calls into question the blanket statements that have been tossed around over the past few years about how HIT will definitely lead to lower healthcare costs. One has to wonder if some of those assertions were based more on wishful thinking or “common sense” rather than solid empirical data.
Dr. Mostashari’s article (in response to the original article by McCormick et al) is compelling as well, although the study authors do seem to provide solid rebuttals to most of his points in their most recent article. One point that stands out is the fact that there are many subtopics within the realm of healthcare IT. Dr. Mostashari seems to be focusing more specifically on EHRs, whereas the study was more focused on technology in medical offices that allows doctors to see test results in an electronic format. Perhaps more widespread use of EHRs will indeed result in “… improvements in the coordination and quality of care, and the prevention of unnecessary and costly complications and hospitalizations.” as Dr. Mostashari predicts. But that doesn’t mean that all aspects of HIT will lead to reductions in healthcare spending.
My guess is that increased HIT will eventually (after the hiccups and bugs are worked out) result in more efficient care, better coordination of care between multiple doctors, fewer medical errors, and more streamlined health insurance claim processing. After reading the articles by McCormick et al and Mostashari, I think it’s clear that there’s some controversy in terms of whether HIT will lead to lower costs. I do think that HIT is coming one way or the other. It’s 2012. Most Americans are walking around with a touch screen mini computer in their pockets. We expect lightening fast internet connections and instant access to virtually any data we can think of. HIT will have to keep up, simply because technology keeps improving and it has to follow suit. But we’d be wise to carefully consider empirical data as much as possible in order to implement systems that have the best chance of success in terms of improving care and also lowering costs.