Articles, PSQH February 18, 2013

We Know What to Do

by Barry P Chaiken, MD

Almost eight years ago Richard Hillestad and his colleagues from the Rand Corporation predicted that electronic medical record systems (EMRs) would generate cumulative efficiency and safety savings of $142 to $371 billion during a 15-year period, an average of $81 billion annually (Hillestad et al., 2005).

Just seven years later, Arthur Kellermann and Spencer Jones from Rand revisited Hillestad’s work and concluded that the increase use of health IT made the quality and efficiency of healthcare only marginally better. At the same time, yet, aggregate expenditures on health care in the United States have grown from approximately $2 trillion in 2005 to roughly $2.8 trillion today.

This Kellerman report evaluates four assumptions made in the original article by Hillestad and attributes the shortfall in observed versus projected results to shortcomings in four areas. Hillestad assumed the following in making his projections: 1) robust interoperability and interconnections of health IT systems, 2) wide adoption of health IT systems by clinicians, 3) effective use of health IT systems to impact care, and 4) changes in incentives and reimbursement systems that emphasized quality rather than revenue.

No surprises here. Anyone who toils in the health IT field knows that these four items represent the key challenges that we all work to overcome as we deploy our health IT applications. Counter to the pessimistic view that the billions of dollars spent on EMRs and other health IT systems are wasted resources, these investments offer a powerful force that, when the conditions are right, will significantly impact quality, safety, and cost.

Excerpts from: We Know What to Do. PSQH, January/February 2013


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