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).
What is Health
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.
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
Why is Health
Information Technology Necessary?
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
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
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
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
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.
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.
Patients age 65 or older would account for the majority of
avoided adverse drug events.
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.
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.
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.
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.
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.
HIT systems can help to improve health outcomes and save money
only if they are widely implemented and effectively utilized.
Currently, relatively few providers have access to HIT. As of
2006, less than 10 percent of hospitals had fully integrated EMR
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.
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.
 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
Sharing the Cost
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
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.
Confidentiality and Privacy of HIT Systems
Another significant barrier to HIT implementation relates to
privacy concerns regarding the proper use and access to EHRs.
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.
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.
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).
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.
Adams, Mitchell, David Bates,
Geoffrey Coffman, and Wendy Everett. Saving Lives, Saving
Money: The Imperative for Computerized Physician Order Entry
in Massachusetts Hospitals. Rep.
Smaltz, Detlev and Eta Berner.
The Executive's Guide to Electronic Health Records. (2007,
Health Administration Press) p.03