Measuring the Value of Health Information Technology; Different "Perspectives" Claimed

(Note: The paper that I will be quoting in this note uses the term "health information technology (HIT)" to largely refer to EHRs which makes little sense to me because HIT obviously includes systems such as LISs and RISs that have demonstrated their value for decades. Therefore, I have automatically substituted the term EHR for HIT in the note.) ...

(Note: The paper that I will be quoting in this note uses the term "health information technology (HIT)" to  largely refer to EHRs which makes little sense to me because HIT obviously includes systems such as LISs and RISs that have demonstrated their value for decades. Therefore, I have automatically substituted the term EHR for HIT in the note.)

Supporters of EHRs have a major problem. The problem is that a number of published studies have seriously questioned their value. This poses a problem for the supporters of these systems who are now trying to discredit the studies. Below is an excerpt from one such article that discusses how we can avoid untoward conclusions about EHRs (see: The Value of Health Information Technology: Filling the Knowledge Gap)

...[S]ystematic reviews of HIT have found that the evidence for value is inconclusive and that existing studies suffer from major limitations.This finding is true even of the most recent literature reviews, despite a greatly increasing number of studies evaluating HIT. In this paper, we suggest a way to overcome these deficiencies and make HIT evaluations more relevant to the current needs of the healthcare system, by presenting a conceptual framework for measuring the value of HIT, examining how a sample of published HIT articles report the information needed to make meaningful assessments of value, and proposing a set of criteria for future evaluations that would make them more useful for policy makers....To make more general assessments, evaluations of HIT should take into account 3 principles: 1) value includes both costs and benefits; 2) value accrues over time; and 3) value depends on which stakeholder’s perspective is used....

Principle 3: There are many possible perspectives from which to view the value of HIT. For example, consider 2 physician group practices, located across the street from each other, both of which have implemented the same HIT system. Through the use of physician-reminder prompts, the delivery of screening colonoscopies increased 2-fold among eligible patients for both practices. If one physician group practice were reimbursed under fee-for-service, the increase in services would be a source of revenue, and therefore an increase in value to the practice. If instead of fee-for-service the other physician group practice were paid by capitation, this increase in services would be a cost to the group ...and therefore a decrease in value....As another example, from the perspective of a small provider operating under fee-for-service, an EHR may necessitate that the physicians see fewer patients because of the increased documentation burden. But from a patient’s perspective, the improved documentation may result in better clinical decision making and improved health outcomes. From another patient’s perspective, however, the decrease in visit volume may have a negative effect in that it may make it more difficult for him or her to book a visit. 

OK. If you did not get this from the quote above, EHRs are designed to serve hospitals and ambulatory centers by supporting all of the following activities: (1) generating a bill; (2) supporting physicians and nurses by documenting healthcare delivery; (3) supporting the professional activities of myriad other hospital "ancillary services" such as pathology/lab, radiology, and pharmacy; and (4) serving patients with patient portals,  An assumption is also made that a single system can support both inpatient and outpatient care using one database. There are going to be winners and losers across these functions so stop bitching!

Here's a hypothetical question. If physicians were to go to an app store to buy an EHR and all of the physician comments about an app said that it reduced their work efficiency by 20%, would they purchase the app? The answer is no. What if the comments said that the app increased the efficiency of hospital billing but also decreased physician efficiency, would they still buy it. In other words, would physicians take take a hit in their productivity for the benefit of the hospital? The answer is still no.

EHRs are inadequate because healthcare is laboring under the false assumption that a single monolithic system can simultaneously effectively support all healthcare work functions. In a previous note on this idea, I explained why the current EHR model has been adopted (see: What's Really Wrong with EHRs: Beginning a Deep Dive):

  • ...[H]ospital executives have been saddled with the burden of a premise that is not accepted in any other U.S. industry. It's the idea that it's possible to manage most of the important hospital computing tasks with a single, massive information system. This idea was promoted by IBM in the 70's and 80's with their so-called Hospital Information Systems (HISs) and continues to hold sway today with the electronic health record (EHR)....
  • This assumption of deploying "one big hospital information system" has resulted in EHRs designed primarily to capture patient charges and support billing but also to support healthcare delivery by physicians and nurses....EHRs simply makes their jobs more difficult.

In my mind, the argument that there are winners and losers in an EHR deployment makes no sense. There is no other U.S. industry that would go down such a path.

Source: labsoftnews.typepad.com