Although the change in the House of Representatives has many wondering what might happen to various aspects of health reform, one part that seems secure is the movement to support much greater use of information technology in health care. Certain parts of the industry have fairly advanced systems–most private health insurers and the pharmacy world have automated many processes. Providers have lagged, often because of lack of capital and other resources and because of fear of workflow disruptions. The exchange of information between patients, providers, payers and others is also not easily done in electronic form. So most of the money in the meaningful use program and other parts of the stimulus and reform bill goes toward helping providers get electronic medical records and building health information exchanges.
The government obviously has an interest in demonstrating that all these efforts will have a payback so it is not surprising to see the Agency for Healthcare Quality and Research release a report listing and describing some success stories in the use of HIT to lower costs, improve access and raise health outcomes. (AHRQ Report) The report looked at eight examples of HIT use, two that improved access, such as use of telemedicine in New Mexico to bring specialist treatment to hepatitis patients in rural New Mexico and the state’s prisons and the use of an IT system to track children’s medical care in California and remove access barriers, improving continuity of care.
Other projects improved quality, such as assisting emergency responders in Massachusetts deal with cardiac patients, or reducing the incidence of pressure ulcers in nursing homes, or reducing urinary tract infections. Most had cost savings, including a project to increase e-prescribing and one to use telemedicine to connect schools and schoolchildren to primary care physicians. While the examples all sound good, they are not accompanied by any rigorous exploration of the full costs of implementing the IT solution. In all these cases, AHRQ funding covered most of the design and implementation cost. Good research is needed to ensure that the dollars spent on HIT do produce real net cost savings and that both implementation of the systems and use of the output meets best practices and actually improves patients’ health.