IT Departments Must Track the EHR Debate

Carl Weinschenk
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Top Health Care IT Trends for 2012

Usually, the job of an IT planner and his or her bosses is to follow wholly technical trends: Is wired better than wireless in the office? Is BYOD a panacea or a Trojan horse? Is security up to snuff?

In a minority of cases, however, they need to look beyond the bits and bytes to big-picture things outside their realm. This is true for a couple of reasons, both of which are evident in the study discussed in this New York Times piece on the use of electronic health records by doctors. For one thing, outside forces have the potential to change how technology evolves and thereby impact IT departments. In this case, health care is one of the more important sectors in telecommunications research and development. What happens in that sector matters elsewhere. A change in how it develops could lead to changes in the broader worlds of IT and telecommunications.

The study, published in Health Affairs, was led by Dr. Danny McCormick, an assistant professor from Harvard. The bottom line of the research is that electronic health records (EHR) increase costs, which is the opposite of the expected and intended effect:

The study showed, however, that doctors with computerized access to a patient's previous image results ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits. That is a 40 percent higher rate of image testing by doctors using electronic technology instead of paper records.
The gap, according to the study, was even greater - a 70 percent higher rate - for more advanced and expensive image tests, including M.R.I. tests and CT, or computerized tomography, scans.

There is pushback from other sources in the story. Perhaps the most telling critique is that the study made use of data from 2008. Of course, technology has shifted significantly in the interim. Serendipitously, a post yesterday at Reuters provided a look at how electronic medical life has changed between then and last December. First, the before snapshot. Wrote Ezekiel Emanuel:


In 2008, 17 percent of office-based physicians and just 9 percent of hospitals had basic electronic health records (EHRs) and fewer than 10 percent used electronic prescriptions. This doesn't mean most physicians were Luddites; rather, there were powerful disincentives to their adoption of health IT.

As of the end of 2011, the story said, 34 percent of office-based physicians used EHR, and e-prescribing was over 40 percent. More than 41,000 physicians, the post said, had collected in excess of $575 million in incentive payments.

 

Clearly, the situation has changed drastically, which could undermine the study results. Dr. Farzad Mostashari, the national coordinator for Health Information Technology in the U.S. Department of Health and Human Services, posted a blog at HealthITBuzz that took the study to task. The details are not directly germane to IT departments' concerns. Suffice to say that they are numerous and appear well grounded.

 

IT departments and planners need to keep this study in the back of their mind. Assuming, for the sake of argument, that the findings are verified. The next step is to study why the number of tests is rising. One possible explanation mentioned in the NYT article is that EHRs make it easier to order tests and doctors therefore are taking advantage at a higher rate. It is interesting that more sophisticated tests are accelerating faster than their basic counterparts. This suggests that EHRs are being effectively used to make the tests that are ordered more effective.

The test, if found to be statistically sound, should be built upon. If its premises are borne out, the use of EHR likely will change - and IT and telecommunications' support roles as well. If it is shown the EHRs are so effective that doctors can better request tests that more often go to the heart (and kidneys and liver) of the patient's condition, the way the system is run will be tweaked accordingly. Likewise, if doctors are ordering more tests simply because it is easy to fill in fields on a drop-down menu, other steps will be taken.

IT will play an important but secondary role in the effort to tailor EHRs to how doctors use them. The most important point is that customizing the use of EHRs is vital in helping them contribute to the main goal: improving health care.



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