A few weeks ago I wrote about the challenges of adopting electronic medical records to provide value for different stakeholders and the entire health care system. Well, this week the Congressional Budget Office released a paper on “Evidence on the Costs and Benefits of Health Information Technology.” This paper is a reasonable review and synthesis of the literature, but it’s important to recognize that the CBO’s mission is to focus on how federal legislation can change government spending.
While the paper concludes that savings from adopting HIT are generally uncertain, it does make some supportive comments about its value. For example the paper states that “the net effect of more use of health IT would probably still be lower overall costs than would otherwise be the case.” Another perspective about the value of HIT systems in the CBO paper is that HIT systems have a fundamental role as an enabling tool for improving the performance of the health system by making it “easier to reduce health spending if other steps in the broader health care system are also taken to alter incentives to promote savings.” One specific way HIT systems do this is by promoting greater financial integration among payers and providers as they collaborative fund HIT systems because each will share in the benefit of the systems. (The paper also notes that by making more clinical information available in electronic form, HIT systems can help facilitate cost effectiveness research which can also lead to cost savings.)
In terms of Federal funding to support HIT use, the paper notes that, “Given that the returns of health IT to the providers who invest in such systems are less than the returns to society as a whole, an argument could be made that the federal government’s intervention is necessary to raise the rate of the technology’s adoption to be more in line with its total returns.” And, “Relying on private markets to act, however, would probably lead to a slower rate of adoption than if the federal government intervened.”
How then should the federal government promote greater use of HIT systems? Aside from the leading role the government has already taken is setting standards for many technical specifications of HIT systems, the CBO paper states that the three primary avenues are:
- Mandating use of HIT system
- Financial incentives to use HIT system
- Grants to subsidize purchase of HIT systems
So while the CBO study is a good synopsis, it doesn’t really add much that is new: In looking for ways to control healthcare costs, health information systems are only one piece of the puzzle, but they are a crucial for improving the efficiency of healthcare delivery, avoiding preventable mistakes – like adverse reactions from known drug allergies– and helping people get better faster by not making them wait to be treated while tests are repeated.
What I conclude from all this is that investing in HIT systems is like encouraging preventive care and testing. Both have up front costs that produce future benefits, and both are only valuable when used appropriately. Perhaps if we relabeled HIT systems as a type of preventive health intervention, there would be more widespread public support, since everyone likes prevention – right?
What do you think?
Completely agree that a fundamental issue for HIT regulation is interoperability so different systems can communicate with each other.
One of the other issues that your comments bring up is the goal of HIT systems, i.e. are they intended to save money, improve the quality of care, or some of each? Deciding the answer to that question is important for helping develop policies to promote their development and adoption. Thus far, policy makers seem to want to posit that HIT systems will do both – and of course the reality is that only time will tell what outcomes we will really see.
The govt just does not understand the practice and economics of medicine.
Mandating physician use of EMR’s and IT will not lower costs. It will most likely raise costs as all other mandates do!
To lower costs we need some individual responsibility from the patient. When the patient is primarily responsible for the cost of care, they will make certain that they keep the costs down, and that tests are not repeated 2 or 3 times because someone else is paying for it.
Govt may help to make rules for a level free market playing field. Start by freezing Medicare rates at present levels, but allow balance billing. That will start price competition and keep costs down.
The one EMR -IT regulation that should work is to make certain that all EMR’s have the ability to communicate with each other. Information is crucial and the more we have in front of us will allow for better and morecost effective care.