Monday, December 7, 2009
Health IT: To Good to Be True?
The Obama administration has made Electronic Medical Records and Health Information Technology a centerpiece of its Health Reform proposals, suggesting that millions of dollars can be saved from fraud, abuse and waste. Administration officials also contend that we may also be able to significantly improve the qualtiy of healthcare through eHealth and other technology solutions. While the promise and potential are certainly real, the administration would do well not to oversell the prospects, at least in the short term, and avoid “reinventing the wheel” by learning from those who have gone before. The London Times is reporting that the National Program for IT (NPfIT), which aims to create a single electronic records system for 50 million patients in England, as well as providing electronic prescriptions and other services is not without significant challenges. For one, the global economic slowdown is forcing the British government to look for areas where spending can be cut or reduced. The program is reputed to be the largest non-military IT project in the world and has been criticized over delays to the proposed database of medical records and concerns that the system will not be secure. Fewer than 20 of the country’s large tertiary hospital systems (trusts) have installed electronic medical records under the project, despite an initial deadline for the whole country to have done so by 2010. At the program’s inception in 2000, British officials had defended the system, insisting that it could save the NHS approximately $2.5 billion by 2014. Another problem cited by The National Audit Office is that the Government underestimated the challenges involved in the project, pointing to the “serious delays” in applying new software to individual hospital systems. These concerns do not even take into consideration whether or not those 50 million British patients will even use the system or want their information to be available to others through the system. The truth is it always takes more than good intentions and a good idea to reap good rewards and outcomes. If health IT like health reform is ever to deliver on its potential, it will take a lot of planning, hard work, flexibility and a good dose of patience from all.
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Agreed, Chris.
ReplyDeleteI believe in EMRs and other Health IT initiatives as part of an overall strategy to revamp health care in the US. At the same time, I know there are enormous startup costs and, perhaps even more importantly, significant cultural shifts that will need to take place before they are adopted on a large scale.
The current Senate bill calls for smaller scale initiatives to test new ideas. I think these could be leveraged to look at social media and other IT initiatives to see what sticks with the people who will actually be using them on a routine basis.
Another consideration when looking at the impact of Health IT is to be realistic about savings. Will it cut costs in half? Doubtful. But will it allow for less duplication of tests, more awareness of possible contraindications, and the ability of patients to provide more substantive contributions to the health conversation? I think so.
Chris - You make several important points and the lessons learned from the experience of the NHS is instructive as we move forward with the largest financial and social capital investment in HIT in our history. HIT projects always take longer than anticipated since they require not only consideration of the myriad technical challenges that must be met but also the oftentimes more troublsome cultural and human factors. Are we ready to meet this challenge and will we be successful? I think the answer is it depends. It will depend on wise and stalwart leadership, strong colloboration at the local level among all stakeholders, proper alignment of incentives so that the outcomes we seek are reinforced, and a willingness and flexibility to make course corrections as needed. I remain optimistic that we can reform healthcare and that HIT will play a crucial role in achieving a more equitable, efficient, and effective health care system.
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