We have spent a lot of money on health information technology, particularly for providers, over the last few years. The belief is that this will improve quality of care and health outcomes, as well as reduce health spending. The systems themselves are expensive and they tend to add to providers’ cost of doing business, so they would have to save a lot on health care expenses to have a net financial benefit. A highly touted category of HIT has been clinical decision support, which is supposed to help doctors make good care decision and facilitate evidence-based medicine. A meta-review in the British Medical Journal looks at the evidence to date for this proposition in regard to hospital inpatient clinical decision support systems. (BMJ Article) These systems could be particularly beneficial to hospitals because they are increasingly reimbursed in an at-risk manner, for example under the Medicare DRG model.
The most startling conclusion from the review is that there is a significant lack of studies which focus on the key question of cost-effectiveness–does the intervention result in an overall reduction in spending. Only one study fell in this category. Overall, the authors found 78 relevant studies, about half of which focused on medication therapy in the inpatient setting and most were before and after designs. There were few randomized control trials. Ten of the studies looked directly at cost outcomes, the remainder inferred it from a proxy measure, such as length of stay, but none of these studies included the cost of the clinical decision support system. While these limitations are present, 55 or 70% of the studies did suggest a statistically significant reduction in health costs, but again, the cost of the intervention was not included. The studies which focused on pharmacotherapy showed good promise in reducing costs associated with adverse events and other poor therapy management, as did the studies related to venous thromboembolism avoidance. The primary conclusion, however, is that we simply don’t have good evidence yet to conclude that inpatient clinical decision support systems reduce costs.