Health IT and Medical Economics

"It is very easy to scare people with lies. It is much, much harder to educate them with facts.
But effective persuasion does not depend entirely on facts. It also depends on credibility, honesty, simplicity, repetition, and organization. "


Attached two very interesting articles from "Health Affairs" dedicating an entire issue on Electronic Health Records http://content.healthaffairs.org/current.shtml
I highly recommend those articles to assist you in parsing out the myth and the facts.
Most industrialized nations USE EHRs but docs in the US still debating the issue based on perceived "facts" which resemble secular religious propositions that are not proved or demonstrated but considered to be self-evident.
Cooler heads must prevail. Rational thinking versus emotional knee-jerk-reflex reactions are required.
Its absolutely silly (and dangerous) to call those of us who support a coordinated health care delivery systems as "socialists" and "enemies" of the free-market system.
Any smart business man wants to control costs, ascertain quality and maximize outcome of the services rendered. Most docs don't seem to get this basic economic ABC and roll their eyes when I ask them about PL & cash flow& other financial performance statements.
We must adapt to a rapidly changing market place. If not we do not need a meteor impact to go extinct!

One great article is a must read:

* The Attack On Health IT And Comparative Effectiveness Research: A Warning For What Lies Ahead
* http://healthaffairs.org/blog/2009/03/04/the-attack-on-health-it-and-comparative-effectiveness-research-a-warning-for-what-lies-ahead

Attached the abstracts of some other articles in the same issue:

Health Information Technology: On The Fast Track At Last?

A MAJOR ANOMALY OF THE Information Age is that a huge sector of the U.S. economy has been so lacking—and for so long—in its use of information technology (IT). As dozens of major industries retooled themselves in the 1980s around new means of conveying, processing, and analyzing information, health care largely sat on the sidelines. We all suffered. How many deaths or injuries have occurred because clinicians lacked the right information about the right patient at the right time—when much or all of it could have been acted upon through the use of health IT?
Just why health care lagged so badly in adopting IT is a complex story, deeply interwoven with much of the sector’s lingering cottage-industry nature. More than half of doctors still practice in groups of four or fewer physicians; not surprisingly, a survey published in the New England Journal of Medicine (3 July 2008) suggests that only about one in eight physicians have even a basic electronic record system. Despite the substantial growth of e-prescribing, as Maria Friedman and colleagues note in this volume, the vast majority of doctors still write out their prescriptions by hand.

In the classic terms of a vicious cycle, the fact that health IT hasn’t been broadly adopted has almost certainly reinforced these cottage-industry tendencies—not to mention the many other failings of our health care enterprise. If you can’t or won’t share information across health care settings, the system inevitably remains much as the Institute of Medicine’s Crossing the Quality Chasm report summed up in 2001: insufficiently centered on patients, error-prone, needlessly inefficient, uncoordinated, and delivering vastly inadequate value for the dollars expended.

Now the overall health IT environment is changing, if not fast enough, as this issue of Health Affairs makes clear. One measure of progress is that plans are afoot in Washington to incorporate substantial health IT investments into an economic stimulus package, in hopes of boosting the economy while building the backbone of a twenty-first-century health care system. There’s already ample evidence that these technologies can and will be enablers of massive restructuring of health care delivery. In this issue’s Report from the Field, our journalism partnership with Kaiser Health News, Carleen Hawn reports on how a small but growing corps of clinicians are tapping into social-media tools such as Facebook to communicate with patients and reorganize their practices. And as Caroline Chen and colleagues record, when Kaiser Permanente introduced comprehensive electronic health records, complete with secure e-mail messaging between clinicians and patients, primary care office visits dropped by 25 percent. Can we seriously contemplate redressing the supposed primary care shortage by adding thousands more physicians before we get similar IT systems in place nationwide?

As the papers in this volume make clear, we shouldn’t embrace the likely benefits of health IT without ignoring the risks or the considerable implementation challenges ahead. Jos Aarts and Ross Koppel remind us that adoption of computerized physician order entry (CPOE) systems has been associated in some instances with unintended consequences—including, counterintuitively, more adverse drug events, not fewer. Deven McGraw and Linda Dimitropoulos and their colleagues argue that it will be critical to build public trust in health IT by addressing privacy concerns. That will be no small matter, since the combination of an unwieldy federal regulation and myriad contradictory state laws makes overall national policy on the privacy of health information a complete mess.

As of this writing, even assembling a health IT piece of a stimulus package is having its problems. Years of talk about standard-setting still hasn’t produced a sure-fire path to interoperability among competing proprietary health IT systems. If the goal is to share information broadly for the public’s benefit, why should taxpayers be asked to invest more in systems that won’t talk to each other? Talk about Bridges to Nowhere, IT-style! Surely a nation that once agreed on a common standard for the width of railroad tracks ought to be able to agree on interoperability of electronic health information. But we’re not there yet.

As momentum for health reform builds in Washington, addressing such concerns should be deemed every bit as important as broadening health insurance coverage or focusing on prevention. We thank the funders who made this well-timed thematic issue possible: the Markle Foundation, the California HealthCare Foundation, and the federal Agency for Healthcare Research and Quality.

Susan Dentzer, Editor-In-Chief


The Promises And Pitfalls Of Health Information Technology

Successful innovators leave no doubt that health information technology (IT) can have a dramatic impact on care, despite the challenges of implementation and adoption. The papers in the sections that follow describe efforts all along the continuum from large health care organizations to small independent physician practices.
Catherine Chen and colleagues document how adoption in Hawaii of Kaiser Permanente’s new comprehensive electronic health record (EHR) system—complete with secure e-mail messaging and "e-visits" between physicians and patients—has reduced enrollees’ old-fashioned office visits for primary care by more than 25 percent in four years. Next, Anna-Lisa Silvestre and colleagues report survey results describing how Kaiser’s patients value the convenience of online appointment scheduling, e-mail contact with their doctors, and instant access to lab test results. Stephen Parente and colleagues report on EHRs’ impact on patient safety and find some evidence of positive effects. Farzad Mostashari and associates then describe state-backed efforts to implement health IT among independent physician practices in Massachusetts and New York City.

Carleen Hawn’s Report from the Field on social media in health care focuses on how various organizations, physician practices, and patients are making growing use of these tools. Personal health records (PHRs)—either stand-alone or as patient-oriented complements to EHRs—have important potential in such areas as promoting better self-management for patients with chronic conditions. However, as James Kahn and colleagues report, PHRs are unlikely to fulfill their promise without improved health literacy and computer competency for many patients. Joy Grossman and colleagues describe how health insurers are developing and promoting PHRs but are also encountering lack of trust and privacy concerns among patients, providers, and payers.

Medicare’s apparently sure-fire strategy of promoting electronic prescribing with payment incentives has hit snags as well, Maria Friedman and colleagues report. A comparison by Jos Aarts and Ross Koppel of efforts under way in the United States and six other industrialized countries to implement computerized physician order entry (CPOE) systems shows advantages—even though adoption is slow, systems are often poorly integrated, they’re producing new and different types of errors, and users are frequently frustrated.

The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care

Catherine Chen, Terhilda Garrido, Don Chock, Grant Okawa and Louise Liang

Abstract

We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.



Health Information Technology And Patient Safety: Evidence From Panel Data

Stephen T. Parente and Jeffrey S. McCullough
The potential of health information technology (IT) to transform health care delivery has spurred health IT adoption and will likely contribute to increased investments in coming years. Although an extensive literature shows the value of health IT at leading academic institutions, its broader value remains unknown. We sought to estimate IT’s effect on key patient safety measures in a national sample. Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety. Although these results are encouraging, we suggest that investment in health IT should be accompanied by investment in the evidence base needed to evaluate it.