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RAND points fingers after health IT predictions fizzle

The think tank says failures in EHR design and usage have prevented the technology from reaching its potential to transform health care.

By Bob Cook — Posted Jan. 22, 2013

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Researchers at the RAND Corp. say their 2005 prediction that health information technology could save the U.S. more than $81 billion annually has not come to pass. But the organization isn’t placing the blame on itself for its inaccurate prognostication.

Instead, in a report in the January Health Affairs, researchers from the policy think tank placed the blame on “shortcomings in the design and implementation of health IT systems” (link).

They blamed vendors for creating systems that are difficult to use and can’t connect with other electronic health records, echoing physician complaints about them. However, the researchers also said doctors and hospitals have not invested the “considerable” time and effort necessary to learn how to use the systems, and adapt their workflow to ensure that technology is smoothing processes, not hindering them.

While various studies show some “marginal” success by health IT in increasing quality and efficiency of patient care, and while health costs have not grown as fast as RAND anticipated in 2005, technology has fallen “short of the rosy future that health IT’s supporters hoped for,” wrote Arthur Kellermann, MD, MPH, and Spencer Jones, PhD, in the Health Affairs report. Neither was involved in RAND’s earlier report, which was published in the September 2005 Health Affairs (link).

The 2005 report, which received funding from health information technology vendors, often was cited as an argument for transforming a largely paper-based health records system into electronic form. It is widely credited with igniting the current push for EHRs, including the federal meaningful use program that pays doctors bonuses for their use of technology or levies penalties if they don’t use the systems sufficiently.

The latest RAND report notes that the 2005 study had many caveats to its $81 billion savings figure — namely, that benefits would be achieved only after a decade or more of effort to create systems that were easy to use, interoperable and embraced by physicians and hospitals. The 2005 report said installation of an EHR by physicians could well create more savings for everyone else in the health system, rather than the practices themselves.

Dr. Kellermann and Jones did not put any figures on how much health IT was saving or costing the health system. Instead, they said existing research is showing little benefit considering the billions of dollars spent on health IT. In particular, they point out, as evidence that health IT is making a minimal difference on health costs, that annual spending on health care in the U.S. jumped in seven years from $2 trillion to $2.7 trillion, according to the Centers for Medicare & Medicaid Services.

Savings still could happen

However, Dr. Kellermann and Jones say the “potential” for health IT to achieve gains in quality and cost of care is still great. But for that to happen, health IT systems need to be interoperable and easy to use, with technical standards that allow doctors using one vendor’s system to easily use another’s without extensive retraining.

“For example, carmakers offer a wide variety of makes and models, but important controls are consistent enough to enable a customer to drive any vehicle off a rental lot without instruction,” Dr. Kellermann and Jones wrote. “Health IT should be no different.”

They also wrote that health IT will be more effective when patients have more control over updating and transferring their records, and when payment based on quality and care coordination overtakes what is largely a fee-for-service system. The researchers acknowledged that federal initiatives, including some elements of meaningful use, are helping move these processes forward.

Dr. Kellermann and Jones went so far as to hint that the original prediction of $81 billion in annual savings in health IT is achievable. When the “preconditions” the 2005 RAND report authors established “are finally realized,” Dr. Kellermann and Jones wrote, “the benefits they predicted will be realized as well.”

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