Friday, April 11, 2014

This Is A Useful Discussion Of The Value That Can Be Found In Deployment Of Health IT, Especially The More Advanced Forms.

The following appeared a little while ago.

How to measure the value of health IT

Posted on Mar 07, 2014
By Mike Miliard, Managing Editor
There's been a whole lot of capital invested in health information technology these past few years. And some people – especially those who are in charge of spending more of it – want to know whether it's money well spent.
It may seem obvious to some in this industry, but it's still a question that bears asking: Is the value of health IT self-evident at this point, five years after HITECH? Or is the jury still out?
"I think in the United States we've passed a tipping point," says John Hoyt, executive vice president of HIMSS Analytics. "People understand that IT can create value."
The catch? "It's not automatic."
Instead, recognizing and reaping the value of IT systems comes only with careful planning – and commitment to seeing project through, says Hoyt.
"It has to be designed for, as part of implementation and post-implementation optimization," he says.
And after install, even when it's there, that value can sometimes be hard to quantify, says HIMSS Analytics Senior Director of Research Jennifer Horowitz: "I would argue that people aren't doing a very good job of measuring the value they get."
In July 2013, HIMSS unveiled its new Health IT Value Suite, a trove of quantitative and anecdotal data meant to help healthcare stakeholders assess technology's value. Its 1,000 case studies are meant to offer evidence that health IT works – even if the notion of value could have 80 different meanings.
That fact is illustrated by the Value Suite's STEPS taxonomy – the acronym stands for satisfaction, treatment/clinical, electronic information/data, prevention/patient education and savings – which lays out dozens of documented real-world examples of the myriad ways health IT has led to improved care and financial gains.
"Pinpointing the clinical and financial impact of health IT investments is complex," said Carla Smith, executive vice president of HIMSS, at a press conference this past summer announcing the suite's launch.
"The value of health IT is demonstrated in many ways; some may be unique to an organization, while others may be highly adoptable and scalable," she said. "HIMSS created the Health IT Value Suite to organize and create a common vocabulary to identify, classify and discuss the many known examples of health IT value, to create a comprehensive library of case studies from which we can research impact, and to educate all on the findings."
One of the challenges, of course, is that different types – and different sizes – of providers arrive at value in different ways. A fully tricked-out academic medical center is in a different position, after all, than a tiny rural physician practice.
"The leading-edge institutions are investing the effort to measure before they implement and after they implement, and they've got demonstrable evidence," says Hoyt.
Indeed, when HIMSS is bestowing Davies and Stage 7 Awards to top-notch facilities, part of the requirement to qualify is that the provider "present to us evidentiary data that quality has improved, efficiency has improved, something," says Hoyt.
That's not necessarily a return on investment, however.
"Quality has a measure of value, financially, but it's harder to derive," says Hoyt. "It's not mathematical." It's not necessarily as easy, in other words, as installing a PACS system and immediately reaping the efficiency benefits of getting rid of film, for instance. "That's why we use the term 'value,' and not ROI."
At the same time, just because an organization is implementing an EHR or other system, "that doesn't mean they're getting value," he says. "That just means they're going along with a wave."
For instance, there are big differences between the ambulatory and inpatient spaces in terms of how immediately they recognize value. "It might be a little harder for the docs," says Hoyt with a laugh. "Because they're not as big and screwed up as a lot of hospitals."
More to the point, it's critical that organizations be fully committed to health IT transformation to see tangible improvements in their care delivery. It's not beneficial to merely dip a toe in the water with a rudimentary EHR; you have to be in it to win it.
Hoyt points to evidence from HIMSS Analytics showing that value-based purchasing scores correspond closely to where an organization sits on the HIMSS EMR Adoption Model.
"Fundamentally it shows that there's not a big payoff in quality until Stage 6," says Hoyt. "Because you're still building the pieces. You don't get the payoff."
"You can see that Stages 2, 3, 4, 5 the scores are sort of not changing much," say Hoyt (see chart below). "Then at 6 there's a bump. And at 7 there's a big bump up."
It's just another indication, he says, that there is value in health IT.
"You do get quality improvements, you do get efficiency improvements. But it doesn't really happen until probably Stage 6. Because you're still building the bridges. And your traffic volume doesn't improve until the thing is damn near finished. So that's really the message."
There is a lot more:
Little more needs to be said with this article. It provides pointers to a useful set of resources and concepts that need to be considered as Health IT is planned and delivered.
A good read and some good links!

1 comment:

Bernard Robertson-Dunn said...

IMHO, you can't identify the value of a solution by looking at the solution. You have to look at what the solution does for you - i.e.what problem it solves.

Evaluating the value of Health IT means looking at any health outcomes the use of IT may achieve. The article alludes to that, but doesn't explicitly state it.

That's why I keep banging on about the PCEHR being an IT system and that any measure of it is useless unless it involves health outcomes.

And from what I read today about PWC being engaged to "conduct a clinical safety audit looking at the accuracy and quality of data included in electronic discharge summaries uploaded to the PCEHR." it seems that an IT solution has been implemented and now they are looking to see if it does what is needed to be done.

Seems a bit backward to me. They should have stated what the system should do and then acquired or built a system to do those things. They seem to have implemented a system without knowing what it would do and are now looking to see if it does what's needed.

Rather like throwing mud at a wall and seeing what sticks. It might work but it's an awfully expensive and slow way to cover a wall.