Thursday, January 10, 2013

It Seems Delivery Of Benefits Is A Bit Harder Than People Imagine. More Thought Required.

This very important article appeared overnight.

RAND: Health IT No Bargain Yet

Problems in design and implementation of EHRs, lack of interoperability, and provider resistance hamper productivity gains and cost savings, says RAND report.
Health information technology won't create the kind of cost savings predicted in a 2005 RAND Corp. study until the technology is far more widespread and is used to its full potential, a pair of RAND researchers conclude in a new Health Affairs report.
The earlier RAND report, authored by Richard Hillestad and his colleagues, predicted that the potential efficiency and safety improvements made possible by health IT could save the U.S. healthcare system $81 billion a year. Since 2005, annual health spending has soared from $2 billion to $2.8 trillion, yet quality and efficiency have improved only marginally, despite an increase in health IT adoption, note researchers Arthur L. Kellerman and Spencer S. Jones in the new paper. AdTech Ad
"In our view, health IT's failure to quickly deliver on its promise is not due to its lack of potential but to shortcomings in the design and implementation of health IT systems," they write. "As a result, we believe that the anticipated productivity gains of health IT are being hindered by the sluggish pace of adoption, the reluctance of many clinicians to invest the considerable time and effort required to master difficult-to-use technology, and the failure of many health care systems to implement the process changes required to fully realize health IT's potential."
Like many other observers, the authors spotlight the lack of interoperability among electronic health record systems as a key barrier. One reason for the inability of systems to communicate with one another, they say, is that providers "have little incentive to acquire or develop interoperable health IT systems."
In an interview with InformationWeek Healthcare, Jones pointed out that one way for providers to achieve interoperability is to join health information exchanges. However, many providers don't see a business reason to exchange information or support HIEs, which have not been very successful.
Here is the original abstract.

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

  1. Spencer S. Jones2


A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.
The abstract is found here:
The full article is available if you have appropriate access.
To me what this is showing is that successful delivery of Health IT is a good deal harder than the optimists imagine. Especially relevant is the lack of progress on genuine interoperability and in re-engineering clinical processes to fully exploit Health IT capabilities.
As others have made very clear Health IT is really not a technical program but an issue that needs to be addressed as the clinical and process level. It is not clear that DoHA and NEHTA get the distinction as yet.
Careful review of what we have and what we need for success is certainly a worthwhile project for the New Year!


Anonymous said...

Of course present NEHTA and DOHA leadership do not get it. It is self-evident from their bumbling behaviour, incoherent narrative and blatant waste of taxpayers monies that gives every indication that they never will.

While the incumbents remain and continue as the inmates running the national ehealth asylum, no progress of any measureable, meaningful and beneficial form will be achieved in the required "health reform" and its enabling ehealth support capabilities.

"A Few Years of Magical Thinking?" will continue to be the misguided order of the day to all our detriment.

(Health Affairs, Vol.27 No.5, pp.w383-w390, Aug. 2008)

Anonymous said...

I think one of the other problems with adoption is the ridiculously high cost of entry to healthcare IT. The big vendors and their SI partners charge a fortune and deliver a very poor return on investment. Average projects take twice as long as planned and cost up to 4x the budgeted cost.

Anonymous said...

And what's worse than charging a fortune for poor ROI and very little delivered, is that there is absolutely no accountability at any level in any organisation for it - hence the vendors et al all keep getting away with it time and time again.

Anonymous said...

Lets be clear here, IMHO, the "vendors" aren't the real problem. It is the fact that we can:

1. accept paying 150million dollars of work before we even start to see any reality of benefits to consultants, that are nothing more than labor hire companies with overseas sweat shops delivering open loop projects where the emphasis is on getting huge sums of money for marketing "mission accomplished" type outputs.

2. spend more money on benefits realisation analysis than it would take to build something and understand how and if it is worthwhile.

3. pour money to the usual big four suspects who deliver nothing and walk away blaming everyone but themselves, leaving nothing of value behind, time and time again.

The Emperor has no clothes! Other solutions are available at a much lower cost from local clinical SME companies who work in the domain and are on the ground everyday. But no , lets listen to the big four and pay them disgusting amounts of money to cynically extract money for nothing from the public purse.

Once again, perhaps we should look to the UK where they have now realized how they should have been working with SMEs that build economic value and give value for money all along:

The big boys have failed to deliver, taken the big money and left nothing behind of any value. The powers that be are now talking to the local SMEs with an almost apologetic stance. After the big dollars have gone, they turn to the smaller companies that will deliver efficiently. Imagine the benefits for our industry and exports if that had been done in the first place. Shame on you NEHTA/DOHA and I am sorry but I am not impressed by Nicola/Tanya either!

Hopefully there is someone out there in government land that is up and coming and able to change the thinking of the old crowd and look to ways to embrace the reality of modern project delivery and economic benefit!

Happy New Year to all!

Anonymous said...

Now that many of the vendor systems are PCEHR-complint, I can an hardly wait until the first 'good news' story about the NEHRS! Perhaps a patient going to ED, and the emergency doctors get into the NEHRS to find some vital information about current medications and allergies? Or a patient visits a GP and the GP is able to look up the NEHRS and see the details of recent admissions, and summaries from other GPs?
How long until one of the registered consumers goes to a registered GP/health service and they find that the NEHRS makes a difference to clinical decision making/outcomes? Perhaps there should be an extra e-health PIP incentive payment to report these clinical outcomes? ("you recently visited the NEHRS for this patient - please take the time now to answer a quick survey…")
How will we ever know if the NEHRS makes a difference?

Anonymous said...

"How will we ever know if the NEHRS makes a difference?"

Surely the answer to this question is already available and widely published prior to the $467M+ of taxpayers monies spent on the NEHRS/PCEHR.

If not, anyway of getting the taxpayers' money back?

Suggest both questions are tabled at the next scheduled Senates Estimates Committee hearing.

Bernard Robertson-Dunn said...

Two relevant facts:

Most large IT projects fail
Study: 68 percent of IT projects fail

Most government initiatives re Health IT fail to deliver
e.g. see: Unfulfilled Promises Of Health Information Technology

So what, specifically, did NEHTA/DoHA do, at the start, to avoid these common problems?

It's not as though these statistics are a secret.

Anonymous said...

It's just too sad.
The NEHRS concept was good.
And there was plenty of money to do it.
And now we don't know if it is/will make a difference.
Nor will we ever know if it has failed.

The winners seem to be the bureaucrats that sing their own praises and get promoted, and their friends the big consultants that won the big contracts driving their next model luxury cars.

The targeted cohorts (the aged, parents and babes, chronically ill and rural/remote) will probably just get a brochure. Pity it is not flushable.

Paul Fitzgerald said...

And now Qld Health is being told it will cost at least $440 MILIION to replace HBCIS - this much for a PAS? (yes, I know HBCIS does more than just ADT) Surely it is time for government to look to SME's in the local market (per the earlier comment) and realise that the big guys just aren't cutting it any more. There are solutions in the market today that will give public health PAS and clinical systems all in one, cloud based and easy and inexpensive to implement - i.e months rather than years. At least then, ROI can be ascertained quickly and not after hundreds of millions have been spent.

Dr David More MB PhD FACHI said...

"The NEHRS concept was good." Can I say I disagree profoundly with that assertion. Is was a badly flawed concept.