The delayed promise of healthcare IT

If the US is any indicator, the sky is the limit when it comes to potential gains from healthcare IT — the Institute of Medicine says the US wastes more than US$750 billion a year on unnecessary or inefficient services

By Art Kellermann and Spencer Jones  / 

Sat, Mar 02, 2013 - Page 9

Because information technology (IT) has so quickly transformed people’s daily lives, we tend to forget how much things have changed from the not-so-distant past. Today, millions of people around the world regularly shop online; download entire movies, books and other media onto wireless devices; bank at ATMs wherever they choose; and self-book entire trips and check themselves in at airports electronically.

However, there is one sector of our lives where adoption of information technology has lagged conspicuously — healthcare.

Some parts of the world are doing better than others in this respect. Researchers from the Commonwealth Fund recently reported that some high-income countries, including the UK, Australia and New Zealand, have made great strides in encouraging the use of electronic medical records (EMR) among primary-care physicians. Indeed, in those countries, the practice is now nearly universal.

Yet some other high-income countries, such as the US and Canada, are not keeping up. EMR usage in the US, the home of Apple and Google, stands at only 69 percent.

The situation in the US is particularly glaring, given that healthcare accounts for a bigger share of GDP than manufacturing, retail, finance or insurance. Moreover, most health IT systems in use in the US today are designed primarily to facilitate efficient billing, rather than efficient healthcare, putting the business interests of hospitals and clinics ahead of the needs of doctors and patients.

That is why many Americans can easily go online and check the health of their bank account, but cannot check the results of their most recent laboratory work.

Another difference between IT in US healthcare and in other industries is the former’s lack of interoperability. In other words, a hospital’s IT system often cannot “talk” to others. Even hospitals that are part of the same system sometimes struggle to share patient information.

As a result, today’s health IT systems act more like a frequent flyer card designed to enforce customer loyalty to a particular hospital, rather than an ATM card that enables you and your doctor to access your health information whenever and wherever needed. Ordinarily, lack of interoperability is an irritating inconvenience. In a medical emergency, it can impose life-threatening delays in care.

A third way that health IT in the US differs from consumer IT is usability. The design of most consumer Web sites is so obvious that one needs no instructions to use them. Within minutes, a seven-year-old girl can teach herself to play a complex game on an iPad.

However, a newly hired neurosurgeon with 27 years of education may have to read a thick user manual, attend tedious classes and accept periodic tutoring from a “change champion” to master the various steps required to use his hospital’s IT system. Not surprisingly, despite its theoretical benefits, health IT has few fans among healthcare providers. In fact, many complain that it slows them down.

Does this mean that healthcare IT is a waste of time and money?

Absolutely not.

In 2005, colleagues of ours at the RAND Corporation projected that the US could save more than US$80 billion a year if healthcare could replicate the IT-driven productivity gains observed in other industries. The fact that the US has not gotten there yet is not a problem of vision, but of less-than-ideal implementation.

Other industries, including banking and retail trade, struggled with IT until they got it right. The gap between what IT promised and what it delivered in the early days was so stark that experts called it the “IT productivity paradox.”

Once these industries figured out how to make their IT systems more efficient, interoperable and user-friendly, and then realigned their processes to leverage technology’s capabilities, productivity soared.

In the US, as in much of the world, healthcare is late to the IT game and is experiencing these growing pains only now, but healthcare providers can shorten the process of transformation by learning from other industries.

The US government is trying to help. In 2009, the US Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act.

HITECH has undeniably accelerated IT adoption among healthcare providers, yet the problems of usability and interoperability persist.

Globally, the healthcare IT industry should not wait to be forced by government regulators into doing a better job. Developers can boost the pace of adoption by creating more standardized systems that are easier to use, truly interoperable and which afford patients greater access to and control over their personal health data.

Healthcare providers and hospital systems can dramatically boost the impact of health IT by re-engineering traditional practices to take full advantage of its capabilities.

If the US is any indicator, the sky is the limit when it comes to potential gains from healthcare IT. According to the US Institute of Medicine, the US currently wastes more than US$750 billion per year on unnecessary or inefficient healthcare services, excessive administrative costs, high prices, medical fraud and missed opportunities for prevention.

Properly applied, healthcare IT can improve healthcare in all of these dimensions. The payoff will be worth it. Indeed, as with the adoption of IT elsewhere, we may soon wonder how healthcare could have been delivered any other way.

Art Kellermann is chair in policy analysis at the RAND Corporation. Spencer Jones is an information scientist at the RAND Corporation.

Copyright: Project Syndicate