June 4, 2009

Health Information Technology As a Health Care Reform Tool

Two major goals of health care reform, much discussed in the current debate, are slowing the growth of health care spending and ensuring and evaluating the quality of care paid for by federal and state payer sources.  One of the tools thought to be a key factor in achieving these goals is Health Information Technology (HIT).[1]   

What is Health Information Technology?

HIT is a system of Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) to be used and updated by health care providers in the provision of health care.  EMRs are stored in an organizational, institutional, or provider setting and could contain, for example, lists of drugs to which an individual is allergic, medications being taken, patient diagnosis, and laboratory results.   EHRs are all of the Electronic Medical Records from a patient's separate health care providers, which can be shared among various institutions and providers, and which provide a comprehensive view of a patient's overall health.[2]  EHRs, in their comprehensive capacity, can be used as a tool to enhance care coordination, reduce adverse drug effects, and ensure proper care is received for patients with multiple chronic conditions.[3]

Why is Health Information Technology Necessary?

Health Information Technology can be used to improve both individuals' health care and the overall health care system.  Some of the benefits of HIT for individuals are increased care coordination, increased patient safety, and better management of chronic conditions.  For the overall health care system, HIT has the potential to slow the rapid growth of health care expenditures, decrease the occurrence of duplicate lab tests and imaging, and identify and track disease outbreaks[4].

• Slowing Growth in Health Care Expenditures
  
  HIT is commonly seen as a necessary component of a national strategy of slowing the growth of health care costs, primarily through: reduced hospital stays as a result of increased patient safety; more efficient drug utilization; reduced nurses' administrative time; and better scheduling and coordination of services. These combined initiatives will save more than $77 billion annually, according to a Rand Corporation report from 2007.[5]
   

• Facilitating Care Coordination
  
  Studies indicate that better information systems such as those that could be provided through the use of HIT would significantly improve care coordination and compliance monitoring.[6] Currently, most providers lack the information systems necessary to coordinate a patient's care with other health care providers, monitor patient compliance with preventive health care measures and disease management guidelines, or measure and improve performance.[7]
   

• Increasing Patient Safety
  
  Increased safety would result largely from the alerts and reminders generated by the EHR systems for medications.  These systems would be able to provide immediate information to physicians, such as a warning about the potential for an adverse reaction with a patient's other drugs.[8]    The Rand report estimated that if all hospitals used an HIT system with electronic prescribing, around 200,000 adverse drug reactions could be eliminated each year, with an annual savings of about $1 billion.[9]   Patients age 65 or older would account for the majority of avoided adverse drug events. [10]
   

• Managing Chronic Conditions
  
  HIT can also facilitate chronic-disease management.  When a patient's information is entered into the EMR, risk factors for chronic diseases will trigger the EMR to prompt the doctor to order additional tests or begin preventive measures.  The EHR will then record and track the results of the tests over time.  Effective disease management can reduce the need for hospitalization, thereby improving health and reducing costs. [11]
   

• Reducing the Overutilization of Laboratory Testing and Imaging Services
  
  Medical imaging and laboratory testing are also seen as a source of increased health care spending.  Medicare Part B spending on imaging alone rose from $6.80 billion in 2000 to $14.11 billion in 2006.[12]  An additional significant cost comes from laboratory tests repeated by different providers.  One in five tests was repeated because the results were not available at the point of care.[13]  Having all of a patient's previous laboratory tests and medical images in a centralized location would significantly reduce the number of tests that are repeated unnecessarily and would allow any new provider to have immediate access to a chronology and discussion of changes in a patient's health care over time.
   

• Monitoring and Detecting Disease Outbreaks
  
  While a comprehensive HIT system will be beneficial to the health of individual patients, it will also be beneficial in the public health setting.  HIT has the potential to provide health officials with early detection of infectious disease outbreaks around the country.  Some EHR systems have automatic triggers, based on symptoms reported and the chief complaints identified by patients, which will alert the CDC and recommend to the physician which tests to order.  The system will also send reminders for the physician to report the test results back to the CDC.  The physician will also get information on nearby cases with similar attributes.[14]

Obstacles to HIT

Though there are many potential benefits to widespread health information technology implementation, there are also obstacles to be dealt with by providers, government agencies, and the companies that manufacture HIT products.  The high start up costs, concerns about beneficiary privacy, and lack of current interoperability among competing systems are all significant obstacles to effective implementation and use of HIT.

• Absorbing High Start-Up Costs
  
  HIT systems can help to improve health outcomes and save money only if they are widely implemented and effectively utilized.[15]  Currently, relatively few providers have access to HIT. As of 2006, less than 10 percent of hospitals had fully integrated EMR systems[16] and only 15-20 percent of doctors' offices had an HIT system.  Smaller hospitals and those with a high proportion of Medicare patients are least likely to have HIT systems. [17]
   

• Creating Standard Formats for Data Sharing
  
  Though HIT implementation has been growing in recent years, there has been little market pressure to develop interoperable systems and there has been little sharing of health information between existing systems.  This inefficient method of piecemeal implementation may cause additional barriers in the future. [18]   EMRs and EHRs are said to be interoperable if they can be recognized across systems using a standard format and coding for procedures, diagnoses, and medication[19]
   

• Sharing the Cost of Implementation
  
  Providers may lack sufficient incentives to implement and maintain the costly HIT systems.  Providers who move to HIT systems incur costs of transferring older, paper records to a digital format for use in an EMR or EHR. It is important to incorporate the older, paper records to achieve the potential of HIT toward patient safety, cost savings, and efficiency.  The digital scanning or manual input and comparison of paper data to the EMR or EHR is a time-consuming and expensive process and must be done in a way that ensures the exact information has been captured.[20]  Patients get the benefit of better health, health care systems benefit from lower costs, but providers pay to implement HIT and experience lower revenues due to maintenance costs.   
   

• Assuring Confidentiality and Privacy of HIT Systems
  
  Another significant barrier to HIT implementation relates to privacy concerns regarding the proper use and access to EHRs.[21]  Currently, nearly 150 people have access to a patient's medical records during a hospitalization, including doctors, nurses, technicians, and billing clerks.  In addition there are approximately 600,000 payers, providers, and other entities that have access to the records when handling claims, which involve converting raw physician data to billing data.[22]  If these records are kept in a centralized database and accessible over the internet it is estimated that up to 12 million people could have access to the EHRs.[23]  In order to ensure that proper privacy safeguards are developed, the Health Information Technology Policy Committee was established by the American Recovery and Reinvestment Act (ARRA).[24]

Conclusion

To ensure maximum benefit to individual patients, HIT should be adopted in a secure, managed, and logical way so that its potential for increased efficiency, cost savings, and increased patient safety can be met.  An incomplete or inefficient implementation of HIT across our health care system will leave information gaps, rendering the system ineffective.  In addition, a national beneficiary education campaign about HIT would be useful to improve beneficiary understanding of HIT.  This in turn should aid patient-provider interactions toward improved health care delivery and improved health care outcomes.

Copyright © 2010 Center for Medicare Advocacy, Inc.