Archives December 17, 2009

Hospital Computerization Not a Budget Saver, Concludes Study

by Barry P Chaiken, MD

By Joshua Feblowitz

The recent survey of over four thousand hospitals found no connection between computerization and reduced costs. In addition, increased computerization led to only small improvements in the quality of care.

Researchers found that more “wired” hospitals had higher total costs and more rapid cost increases. They also examined a list of the “100 Most Wired” hospitals and determined that these institutions had performed no better in terms of administrative expenses or quality of care.

These findings contradict previous anecdotal evidence indicating the benefits of healthcare information technology (IT), a category that includes systems such as electronic medical records and computerized order entry. The study has sparked significant controversy, in part because President Obama and others have widely promoted healthcare IT as a tool for saving money and improving healthcare. The 2009 stimulus bill included over $19 billion to encourage the adoption of healthcare technologies.

Using twenty-four different measures of hospital technology, researchers created a composite “computerization score” and compared this with changes in administrative costs and quality of care during the years 2003 to 2007. The only area in which they found significant improvement was in the quality of care for heart attacks.

“There’s no evidence that what we are doing is actually working,” says lead author Dr. David Himmelstein, a professor at Harvard Medical School, who calls promises of improved quality and reduced costs “propaganda of the healthcare IT industry.”

“It’s easier than saying what needs to be said,” Himmelstein argues. “We need to abolish the private health insurance industry. It’s much easier to say that there’s a silver bullet here, and all we need to do is install these fancy machines.”

However, these results, experts say, are far from definitive. Certain hospital computer systems have proven to yield substantial benefits. Computerized physician order entry, for example, a technology used to enter prescriptions and order tests, has been shown to greatly improve the quality of care. Even things as simple as adding barcodes to medications can dramatically reduce medical errors, says Dr. Barry Chaiken, chair of the Health Information Management Systems Society.

These types of improvements in quality are well documented. A study at Brigham & Women’s Hospital in Boston, Massachusetts, showed that computerized order entry systems could reduce serious errors by up to 55 percent and the overall error rate by over 80 percent.

Computerization accomplishes these improvements, experts argue, by giving hospitals the ability to manage information more efficiently. “When a facility installs software, they are looking for something that gives them better control over the chaos in their department,” says Keith Herron, representative for Patient Care Technology Systems, a healthcare IT company. “They also want to be able to document the patient encounter and document more fully.”

“If your physician has more information about your health, they are likely to make better decisions,” says Dr. Ashish Jha, professor at Harvard Medical School. “In a paper-based world, important pieces of information are often missing. Mistakes aren’t caught as easily. There are many ways in which technology if designed and implemented effectively can improve quality.”

Experts also criticize the study’s methods of examining hospital computerization. “This study is very problematic because both their measures of cost and their measures of technology have serious limitations,” says Jha.

“If you look at something and don’t find it, it could be that there’s no effect,” Jha continues, “Or, it could be that the way you looked at it didn’t make sense.” Specifically, Jha notes that the study’s “computerization score” included factors unrelated to patient care, such as accounting and staff scheduling.

Jha also says that the study’s measures of costs and quality are very broad and may not accurately reflect the benefits of healthcare information technology. Data on computerization was reported by hospitals and collected by the Health Information Management Systems Society. Researchers compiled this data into their own composite scores of quality, costs and computerization before performing statistical analysis.

Others suggest the reason for these findings is that current hospital systems simply aren’t very advanced. Although many hospitals spend a great deal on information technology, says Dr. Robert Kolodner, former National Coordinator for Healthcare IT, the number of hospitals with sophisticated electronic health records is “vanishingly small,” less than two percent.

“They are using the best data they have,” agrees Chaiken. “But I don’t think we’ve reached a tipping point as to what healthcare IT can do.”

In addition, experts say, healthcare IT is only beneficial if applied in the correct way. “It all comes down to how you implement these systems,” says Dr. Adam Wright, co-author of the study, “It’s not the technical quality of the system that you purchase but the way you use it.”

In order to benefit from these technologies, says Dr. Michael Siegel, head of the Digital Health group at MIT, we must accept new approaches to healthcare. “We’re managing the process, moving at incredible speeds, as if things were still the same. There has been lots research done that when you introduce IT and don’t change what you’re doing, it doesn’t help.”

“I would call for some patience,” says Wright, who likens the process of development to the construction of the Transcontinental Railroad. “Imagine you’re building a railroad. Laying tracks across the country. It’s very boring and very expensive. And until you hammer in the Golden Spike, you can’t actually drive a train across the country.”

Reprinted from: Scope, December, 2009


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