Problems in design and implementation of EHRs, lack of interoperability, and provider resistance hamper productivity gains and cost savings, says RAND report.
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Health information technology won't create the kind of cost savings predicted in a 2005 RAND Corp. study until the technology is far more widespread and is used to its full potential, a pair of RAND researchers conclude in a new Health Affairs report.
The earlier RAND report, authored by Richard Hillestad and his colleagues, predicted that the potential efficiency and safety improvements made possible by health IT could save the U.S. healthcare system $81 billion a year. Since 2005, annual health spending has soared from $2 trillion to $2.8 trillion, yet quality and efficiency have improved only marginally, despite an increase in health IT adoption, note researchers Arthur L. Kellerman and Spencer S. Jones in the new paper.
"In our view, health IT's failure to quickly deliver on its promise is not due to its lack of potential but to shortcomings in the design and implementation of health IT systems," they write. "As a result, we believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology, and the failure of many health care systems to implement the process changes required to fully realize health IT's potential."
Like many other observers, the authors spotlight the lack of interoperability among electronic health record systems as a key barrier. One reason for the inability of systems to communicate with one another, they say, is that providers "have little incentive to acquire or develop interoperable health IT systems."
In an interview with InformationWeek Healthcare, Jones pointed out that one way for providers to achieve interoperability is to join health information exchanges. However, many providers don't see a business reason to exchange information or support HIEs, which have not been very successful.
An HIE is not the only way to create interoperability, he added. "You could eliminate the need for an HIE if it were possible for providers on different EHR platforms to exchange information through standards-based exchange," he noted.
Jones and Kellerman find reason for optimism in the spread of the Direct secure messaging protocol, which allows providers to send clinical information to other providers. Also, they point out that Meaningful Use stage 2 requires EHR vendors to add capabilities for exchanging standardized documents with standardized content, which should make it easier for providers to exchange information.
But Jones told InformationWeek Healthcare that most providers still lack the ability to query databases outside of their organizations. And even if they participate in an HIE that allows them to access data from outside sources, physicians are unlikely to use that data unless it's integrated into their workflow, he said.
Usability is another big problem, the report points out. The researchers cite physician input into the development of the VA and Intermountain EHRs as a reason for the superior usability of those systems. While such engagement with doctors might be difficult for commercial vendors to duplicate, Jones said, "There is a lot of unhappiness with the functionality and usability of the EHRs out there today. If a commercial entity decided to focus on that and have that be a differentiating factor in the product, they'd be rewarded by the marketplace."
Jones admitted that physicians and nurses don't like to do data entry in EHRs. "That's a tough nut to crack." But vendors are not putting much effort into improving usability today, he said, partly because of the rush to market their systems. One way they could make the EHRs more user-friendly, he suggested, is to automate more of the documentation work, lessening the burden on providers.
The basic challenge that must be overcome, he said, is persuading doctors to change how they work so they can use their EHRs to improve productivity. For example, he noted, the use of EHRs might enable doctors to bring patients back less frequently for follow-up visits. But this won't happen until physicians are ready to change and until financial incentives evolve so that it becomes feasible for them to practice differently.
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