EHR’s and Cost Savings – Not A Sure Bet

While there is increasingly less doubt that a system-wide revaluing and rebuilding of our primary care infrastructure will both reduce health care costs and improve health outcomes, there is less certainty with regard to the contributions of the high-tech elements of health reform. A recently released study by researchers out of Harvard Medical School scheduled for publication in the American Journal of Medicine suggests that despite Congressional support of more than $19 Billion, claims of increased efficiencies attributable to hospital computerization (EMR) “rest on scant data.” The study was based on a review of over 4,000 hospitals over a 5-year study period. The hospitals examined were at various stages of EMR implementation and capability, and ultimately even the “100 most wired hospitals” (as defined by an independent ranking of hospital computerization) are seeing neither cost savings nor significant increased administrative efficiencies. Additionally, the study found no appreciable difference between these “leaders” and the full study sample. In addition, researchers from Massachusetts General Hospital have also just released a study with a similar design and a conclusion that there was “little difference in the cost and quality of care” between those hospitals who had adopted EMR and those that had not.

While each of these studies can be challenged to some degree given the personal agendas of the authors, they leave me more convinced than ever of my previously held opinion that the jury is simply still out on EMR. There are clear advantages that should be obtained from the adoption of health information technology (HIT), but the entire enterprise is compromised by poor design. EMR’s are designed with the goals of the individual user, physicians and hospitals, as the focus. I think of this focus on management of individual patient records, coding technology, billing and the like as design based on micro level goals. Instead, the objective should be to meet the goals of the health system at the macro level. This is the functional equivalent of asking each airline to invest in separate, non-interoperable systems to control air traffic, and then expecting airline safety to improve. In fact, it is my opinion that the only way to control, and potentially reduce health care costs and improve outcomes at the system level through application of HIT is through the creation of a standardized, universal, completely interoperable system, or at the very least, the development of technology that allows the currently disparate systems to communicate as an interoperable information system.

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1 Comment »

  1. […] Article Ray Saputelli’s Blog, 8 December 2009 Article (Himmelstein 2009) […]

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