The stimulus bill also included $1.5 billion for construction, renovation, equipment and acquisition of health information technology systems. It also allocated $20 million for advancing health care information enterprise integration through activities such as technical standards analysis.
But will this investment in health IT cut costs for both employers and patients as some predict?
Supporters argue that health IT can save money by preventing duplication, preventing inappropriate treatments and reducing medical errors caused by illegible handwriting. The Department of Health and Human Services estimates that the federal investment in health IT will reduce health costs for the federal government by $12 billion over 10 years.
Similarly, the pharmacy benefit manager Medco Health Solutions estimates that health IT investments have the potential to cut health care spending by as much as $350 billion. Meanwhile, transparency and accountability could yield an additional $330 billion in savings by reducing the need to practice defensive medicine, resolving a stalemate related to tort reform and addressing the difficult issues around providing appropriate care in the last years of life, Medco states.
David B. Snow Jr., the CEO of Medco, says, "A wired system will create accountability, where every provider and service across the spectrum of health care can be measured based on their contribution in lowering costs and improving clinical quality. Wiring America's health care system is the key foundational step that will enable as much as $680 billion in annual savings."
Automatic warnings are one way that health IT might prevent costly medical errors. Last year, Aetna rolled out a personal health record that alerts doctors when they have a patient coming in with an electronic health record. The system also alerts physicians about potential drug-to-drug or drug-to-disease interactions.
"Physicians have more complete, up-to-date profiles of patients that help them better coordinate care and prevent dangerous drug interactions or even death," says Dr. Troyen Brennan, Aetna's chief medical officer.
The skeptics
Some doctors and researchers are skeptical, warning that government investments in health IT could be a huge mistake. They argue that a myriad of different systems might not connect with each other, which would limit the potential to improve the quality of care.
"Health IT systems are an expensive and still unproven technology for most physicians in the United States. For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won't do much for many Americans," Stephen B. Soumerai, a professor of ambulatory care and prevention at Harvard Medical School, and Sumit R. Majumdar, an associate professor at the University of Alberta's Department of Medicine, wrote in a March essay for The Washington Post.
Another problem is potentially inaccurate information coming directly from billing and claims information, which is linked to diagnostic codes. For example, some electronic records might list a wrong diagnosis picked up from claims data for a test for a disease that the doctor had hoped to rule out. To be fair, paper records sometimes can be incomplete or inaccurate, as well. With some electronic systems, patients can correct any mistakes that they catch. But others do not allow patients to change the record.
The high price of the technology has proven to be a major barrier to adoption so far. As of 2008, only 13% of U.S. physicians had adopted electronic health records, and only 8% of U.S. hospitals had a basic electronic records system in at least one clinical unit, according to a recent study published in the New England Journal of Medicine. Only 9% of American adults have an electronic health record, according to a recent survey from the HR consulting firm Deloitte.
Mayo's experience
The Mayo Clinic has been using electronic medical records since the mid-1990s. "There's improved value to the patients and the employers," says Dr. David Mohr, chair of the information technology committee at the Mayo Clinic in Rochester, Minn.
Health information technology "brings us to a new level. [It] opens up vast frontiers of ways that we can help patients that we couldn't do before. We will see significant savings. We can see improved and more efficient processes, definitely," but this must be weighed with the cost of managing and maintaining the technology systems, he adds.
The country won't see major cost savings if the electronic records are not interoperable, or if federal privacy regulations put up too many barriers to interoperability, according to Dr. Mohr.
Interoperability means that the same health record can be used and updated at many different doctors' offices and hospitals, not just one site. The country needs to spend money to ensure interoperability, which involves standard terminology, standard data models and standard communication processes.
"I hope those barriers can be overcome, but that's still to be seen," Mohr says.
The Mayo Clinic and Microsoft Corp. recently announced the launch of Mayo Clinic Health Manager, an online application where patients can store medical information and receive individualized health guidance and recommendations. It works in connection with Microsoft's electronic medical record, called HealthVault.
"As a physician, I truly appreciate when my patients are actively engaged and informed about their health," says Dr. Sidna Tulledge-Scheitel, a primary care physician and medical director of Mayo Clinic Global Products and Services. "Mayo Clinic Health Manager can help patients share information more easily with their doctors and manage their own health better between office visits."
Kaiser e-records halve errors Health IT has led to notable results for Kaiser Permanente. By using computerized physician order entry, an electronic medication administration record and barcode scanning, Kaiser Permanente reduced medication errors by 57%. Likewise, by using an electronic medical record and patient-tracking software, Kaiser Permanente of Colorado reduced the mortality rate of its patients with coronary artery disease by 76%.
A study published in the journal Health Affairs shows that the number of Kaiser Permanente patients using phone visits and e-mails to their physicians skyrocketed, while the number of physician office visits fell dramatically. For employers, this means employees can be more productive because they're not spending a lot of time driving to a doctor's office and sitting in the waiting room. They can discuss lab results or get a prescription changed without having to take a half a day off work to fit in an office appointment.
At Kaiser Permanente, almost three million patients have access to their information on My Health Manager. They sent about six million e-mails to doctors and other health care providers last year, and they submitted 1.4 million online appointment requests.
"The incentive system is going to have to be changed throughout the health care profession to support the creation and use of electronic medical records," says Phil Fasano, the chief information officer for Kaiser Permanente. "[The cost savings] will be 20% to 30% for the country ... We have such a long way to go in this country [to get ubiquitous access to electronic health records]. It's clear we can get there as a country. There are true benefits for the physicians and the patients."
Podcast
Is $20 billion for EMRs overkill? Maybe.
That's just one of several interesting points MEDecision's David St. Clair makes on the subject during a recent online interview (check it out at tinyurl.com/ca67nh) with Employee Benefit Adviser. Listen in as he also makes a plea for a sober discussion of privacy concerns.
Visit EBA's Raw Bar online at eba.benefitnews.com/podcasts to see who else we've been talking to recently.
