Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Friday, December 04, 2009

The Benefits of Electronic Patient Records – Yet Another Study and Lots of comments.

The following appeared in the NY Times a week or two ago.

November 16, 2009

Little Benefit Seen, So Far, in Electronic Patient Records

By STEVE LOHR

The nation is set to begin an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors’ offices and hospitals, replacing ink and paper. There is wide agreement that the conversion will bring better care and lower costs, saving the American health care system up to $100 billion a year by some estimates.

But a new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.

“The way electronic medical records are used now has not yet had a real impact on the quality or cost of health care,” said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health, who led the research project.

The research is to be presented on Monday at a conference in Boston. It is a follow-on study to a survey of hospitals’ adoption of electronic health records, published this year and financed by the federal government and the Robert Wood Johnson Foundation.

Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. “Very few hospitals today are effectively using the capabilities of electronic health records,” she observed.

“There will be no clear answers on the overall payoff from the wider use of electronic health records until we get further along, five years or more,” said Dr. Bell, senior vice president for health information technology services at Masspro, a nonprofit group. “But that doesn’t mean we shouldn’t go forward.”

The study is an unusual effort to measure the impact of electronic health records nationally. Most of the evidence for gains from the technology, Dr. Jha said, has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others.

But the new study, led by Dr. Jha and Catherine M. DesRoches of Massachusetts General Hospital, suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used.

The research also underlines the challenge facing the Obama administration as it seeks to accelerate the adoption of electronic health records through 2015, even though only about 20 percent of physicians now use them. And the research shows that installing the technology does not necessarily mean that the hoped-for gains in quality and cost containment will follow quickly.

Under the administration’s plan, doctors and hospitals will receive incentive payments for “meaningful use” of “certified” records. The standards will not be complete until the end of the year, but they will include requirements for reporting, data-sharing, alerts and decision-support features that get more stringent year by year.

Lots more here:

http://www.nytimes.com/2009/11/16/business/16records.html?_r=2

There is also coverage:

http://www.kaiserhealthnews.org/Daily-Reports/2009/November/16/electronic-medical-records.aspx

Electronic Health Records Not Yet Making Impact, Patients Turn To Web For Advice

As the United States launches "an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors' offices and hospitals," a new study of 3,000 hospitals "has found little difference in the cost and quality of care," The New York Times reports. "Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. 'Very few hospitals today are effectively using the capabilities of electronic health records,' she observed."

Dr. Ashish K. Jha, "an assistant professor at the Harvard School of Public health, who led the research project," notes that most of the gains found from the technology "has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others. But the new study… suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used" (Lohr, 11/15).

And here:

http://www.healthleadersmedia.com/content/242433/topic/WS_HLM2_TEC/Electronic-Medical-Records-Dont-Save-Money-Says-Study.html

Electronic Medical Records Don't Save Money, Says Study

Cheryl Clark, for HealthLeaders Media, November 20, 2009

Researchers affiliated with Harvard institutions are reporting a variation on the theme "the emperor has no clothes" regarding benefits from health information technology, the second such report to become public this week.

The latest study, published today in The American Journal of Medicine, says that despite Congressional support to the tune of $19 billion, claims of efficiencies from computerizing hospital system records "rest on scant data."

Even "the 100 banner hospitals that are the most wired" are not seeing any cost savings nor do their electronic medical record systems make the administration of healthcare more efficient, says author David U. Himmelstein, MD., associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital.

And here:

http://www.modernhealthcare.com/article/20091120/REG/311209984

Report: IT impacts quality, does not lower costs

By Joseph Conn / HITS staff writer

Posted: November 20, 2009 - 5:59 am EDT

Claims that health information technology will help the hospital industry cut costs are unsupported by facts, at least based on how computers have been used thus far, according to research to be published today.

The report “Hospital Computing and the Costs and Quality of Care: A National Study,” was based on annual surveys of the level of IT implementations at more than 4,000 hospitals, Medicare cost reports and cost/quality databases developed by the Dartmouth Atlas project. The report, led by David Himmelstein, a physician and associate professor at Harvard Medical School, was published in the American Journal of Medicine.

And here:

http://www.healthdatamanagement.com/news/EHR-39397-1.html?ET=healthdatamanagement:e1088:100325a:&st=email

Study Casts Doubt on I.T. Benefits

HDM Breaking News, November 20, 2009

A new study of cost data for 4,000 hospitals contends there is no evidence that computerization has lowered costs or streamlined administration. The study, published Nov. 20 and based on data from 2003 to 2007, also claims there is no strong evidence that increased computerization leads to increased quality.

Further, hospitals that increased their computerization more rapidly had larger increases in administrative costs, according to researchers from Cambridge Hospital/Harvard Medical School and Partners Healthcare System in Boston.

......

The report, "Hospital Computing and the Costs and Quality of Care: A National Study," soon will be available at amjmed.com.

--Joseph Goedert

And here:

http://www.reuters.com/article/domesticNews/idUSTRE5AJ0MQ20091120

No hospital savings with electronic records: study

Fri Nov 20, 2009 1:02am EST

By Susan Heavey

WASHINGTON (Reuters) - New electronic record systems installed in thousands of U.S. hospitals have done little to rein in skyrocketing healthcare costs, Harvard University researchers said in a study released on Friday.

A review of roughly 4,000 hospitals from 2003 to 2007 found that while many had moved away from the paper files that still dominate the U.S. healthcare system, administrative costs actually rose, even among the most high-tech institutions.

The full paper is here:

http://www.amjmed.com/webfiles/images/journals/ajm/AJM10662S200.pdf

This week we also had an article published providing a necessary critique of the paper:

Four Health Leaders Weigh in on Whether EMRs Save Money

Cheryl Clark, for HealthLeaders Media, November 24, 2009

Two groups of Harvard researchers last week reported separate study results showing health information technology systems do not save money. The author of one of the reports said that any claim that it does is "baseless propaganda."

That inspired several health officials, who are trying to improve quality and patient safety, to weigh in with their views. Here is what four health leaders think about whether electronic medical records can actually save money:

Jim Lott
Executive Vice President
Hospital Council of Southern California
Los Angeles

"Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.

"The savings for hospital-centric EMRs will balloon when integration of these confined systems with the rest of healthcare delivery system is realized. The ideal circumstance would be the use of EMR smart cards that would be updated with every patient encounter and that can be read electronically by every medical provider treating the patient, regardless of the providers' medical network or health plan affiliation.

"This virtual integration will facilitate more accurate and speedy patient assessments, diagnoses and treatment plans, and it will reduce duplicate and unnecessary imaging and laboratory tests, as medical providers will have immediate access to the most recent work done on patients both in and outside their own delivery networks."

The three other comments are here:

http://www.healthleadersmedia.com/content/242577/topic/WS_HLM2_TEC/Four-Health-Leaders-Weigh-in-on-Whether-EMRs-Save-Money.html

Essentially they make all make the point the disconnected EMR which does not have links to the rest of the health system and which is not fully used by clinicians so the quality and safety of their work can be enhanced is not where the pay dirt is! Benefits flow when clinicians are helped with their work and can easily access information wherever it is.

Another bit of a beat up. Download and read the paper and see for yourself.

Enough said.

David.

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