Thursday, March 10, 2011

The Current Literature Shows That Health IT Actually Works in Traditional Types of Use! PHRs are Still an Evidence Free Zone!

The following release has just appeared.

News Release


Tuesday, March 8, 2011

Contact: ONC Press Office

(202) 690-7385

Review of recent studies shows predominantly positive results for health information technology

A study completed by the Office of the National Coordinator for Health Information Technology (ONC) and published in the journal Health Affairs finds growing evidence of the benefits of health information technology (HIT). Using methods that were employed by two previous independent reviews, the new study finds that 92 percent of articles on HIT reached conclusions that showed overall positive effects of HIT on key aspects of care including quality and efficiency of health care.

In addition, the study finds increasing evidence of benefits for all health care providers, not just the larger health IT “leader” organizations (i.e., early adopters of HIT) that have provided much of the data regarding experience with HIT in the past. The previous reviews identified a gap between “leaders” and non-leaders in demonstrating benefits from HIT.

“This article brings us much more up-to-date, both in our confidence regarding the overwhelming evidence of the benefits of adoption and use of HIT, and also in our understanding of problem areas that still need to be addressed, “ said David Blumenthal, M.D., the national coordinator for HIT and one of the authors of the review. “This review is important because it helps us correct for the lag in evidence that occurs naturally in the dynamic HIT field, where changes in technology and accelerating adoption cause the old literature to become quickly outdated.”

The review included articles published from July 2007 up to February 2010, following up on earlier reviews of articles from 1995 to 2004 and from 2004 to 2007. This latest review initially surveyed more than 4,000 peer-reviewed articles, of which 154 were found qualified for the parameters of the study, a number similar to the previous efforts.

The current review found positive results in 96 of the articles (62 percent), and mixed but predominantly positive results in 46 other articles (30 percent). Ten articles were found to have negative or mixed-negative results. In addition to quality and efficiency of care, the authors categorized additional outcomes including access to care, preventive care, care process, patient safety, and provider or patient satisfaction.

The review also reflected a new balance of evidence between HIT “leader” organizations and other entities, especially smaller medical practices. In previous years, much evidence has come from the “leaders.” The current review shows increased evidence of benefits for others as well.

“These new findings are very significant in helping to confirm that our Nation has made the right choice in moving aggressively toward adoption of health information technology,” said Donald Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, as much as $27 billion Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

Positive results highlighted in the article include:

  • One study found that at three New York City dialysis centers, patient mortality decreased by as much as 48 percent while nurse staffing decreased by 25 percent in the three years following implementation of EHRs.
  • In an inpatient study, a clinical decision support tool designed to decrease unnecessary red blood cell transfusions reduced both transfusions and costs, with no increase in patient length-of-stay or mortality.
  • Another study addressing HIT in 41 Texas hospitals found that hospitals with more advanced HIT had fewer complications, lower mortality and lower costs than hospitals with less advanced HIT.

Negative findings in the study were most often associated with provider or staff satisfaction related to difficulties in the process of transitioning from paper-based to electronic-based records and care. According to the article, these findings “highlight the need for studies that document the challenging aspects of implementing HIT more specifically and how these challenges might be addressed,” such as through strong leadership or staff participation when adopting and implementing HIT.

The full release is here:

What the review does not show is that what I would term ‘fringe uses’ of health IT such as PCEHR’s make any difference.

This review is all about the use of Electronic Health Records in the hands of healthcare providers and in this role it is clear Health IT actually works and makes a difference.

What is simply unknown is the impact and value of initiatives like the PCEHR. Until there are reasonable studies to show it actually works and makes a real positive difference our investment on e-Health should be directed at improved provider systems. We have a Government that claims to act in an evidence based way, but for purely political reasons all that goes out the door and the nonsense of the PCEHR gets funded.

The litany of silliness from this Government just seems to roll on. No wonder consumer confidence and retail sales are plunging. People are saving against the inevitable worse times ahead unless sanity will somehow prevail again. I sure hope so.

Go here to read how our markets and economy are so NOT prospering under this Government (despite a mining boom) and do note that the jobs report today actually showed that in February the total hours worked in Australia actually fell (on a trend basis) - so much for a boom.

The public just does not know what crazy policy to expect next and in our small e-Health part of the world we are also victims of the silliness!

I increasingly believe that populist health policy and quality e-Health initiatives (which needs sustained leadership, governance and investment) just don’t mix.

To re-assure us all maybe NEHTA or DoHA would like to release their literature review of peer-reviewed literature that shows that the PCEHR is a great idea. I bet it does not exist! It should if this is PCEHR proposal is anything other than populist evidence free nonsense.

My view is confirmed here by CSC who are actually working with the Federal Government in e-Health.

Personal Health Records: A True "Personal Health Record"? Not Really ... Not Yet.


Jason Fortin and Erica Drazen


A true personal health record (PHR) needs to be comprehensive, interactive, patient-controlled and secure. Despite renewed interest in the potential benefits, the reality is that the PHR market remains fairly fragmented today and outside of a few well-publicized initiatives, current adoption is limited to niche uses of silos of information. Without major changes in behavior and dramatic increases in adoption of clinical systems, a true PHR – and the benefits associated with it – will not be possible.

Download "Personal Health Records: A True 'Personal Health Record'? Not Really ... Not Yet." (PDF 405KB)

I wonder do the US and Australian parts of CSC chat often? Note the point about the need for full clinical systems first!

Pretty sad.


Afternote: The points made about the need to use current studies to asses Health IT value are very important and should not be ignored. Articles from before 2000 seldom have much useful to say!


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