Discussion
The United States spends more per capita on health care than any other industrialized nation, yet often ranks much lower on indicators of health care quality.
According to a
study by the Institute of Medicine, medical errors kill between 44,000 and 98,000 Americans each year. Indeed, medical error represents the fifth leading cause of death in the United States.
One way to reduce error, improve the quality of health care and decrease the costs of providing care is to implement a health information technology system. A health information technology system would allow medical information exchange between consumers, insurers, health care providers, researchers and government agencies. This system would ensure that accurate, updated medical information is available wherever and whenever a patient is treated so providers can more accurately and quickly diagnose and treat patients. Health information technology should help to prevent medical errors, reduce administrative costs, and expand access to affordable care.
Health information technology is often defined in terms of the initiatives that fall under its scope, such as electronic health records, telehealth, electronic ordering systems, decision support tools, networks, and infrastructure.
Researchers point to health information technology’s use in realizing efficiency savings, increased safety, and quality improvements.
Efficiency Savings
One
report in the journal Health Affairs projects that the United States could save up to $513 billion over the next 15 years if the country adopts a national health information technology system.
Increased Safety
Studies by the
Institute of Medicine have estimated that between 44,000 and 98,000 deaths occur each year due to medical errors. Undoubtedly, some of these deaths would be prevented with better information technology, and various reports argue that adverse drug effects could be drastically reduced.
Quality Improvements
Health information technology can be used to develop clinical-effectiveness research, process improvements, and more potent prevention programs.
Costs
Researchers at the
University of California-San Francisco provide one cost estimate for implementing electronic health records for a single health care provider is about $44,000 to set up and at least $8,500 per year to maintain.
One
Health Affairs report put the cost of developing a national health information technology network at $103 billion in capital costs and an additional $53 billion to ensure interoperability between providers. While this investment in modernizing the health care system is significant, a
study by the RAND Corporation estimates a potential cumulative efficiency savings for the entire health sector of more than $620 billion over 15 years.
Public Perception
Although the U.S. has been slow to adopt health information technology, strong bipartisan support has been shown on the federal and state level. According to recent surveys, most health care consumers would like to check and refill prescriptions online, get test results electronically, and email their doctors.
Exit polls from the 2008 presidential election showed that health care is the third most important issue to voters, and the second most important domestic issue.
A Kaiser Health Care tracking poll shows that the top health care issues voters wanted the presidential candidates to discuss were: (1) reducing costs, (2) expanding coverage, and (3) improving quality. Health information technology can be used to both reduce costs and improve quality, and these savings may make health care more affordable, effectively expanding coverage.
Furthermore, 72% of respondents said that “requiring hospitals to develop systems to avoid medical errors” would be “very effective” in reducing preventable medical errors. Another 51% of respondents said that “more use of computerized medical records and computers instead of paper records for ordering of drugs and medical tests” would be “very effective” in reducing preventable medical errors.
Chart: Perceptions on Health Information Technology
Source: National Survey on Consumers’ Experiences with Patient Safety and Quality Information
Public opinion can also be seen by public action. After two years of development, Internet giant Google launched a health information technology application, Google Health in May of 2008. The thousands of users who signed up immediately created a profile into which they can enter health information or import information from the records of dozens of partner providers.
Talking Points
Don’t hospitals and doctor’s offices already have health information technology?
In a 2005 report, the
RAND Corporation found that only about 20 to 25 percent of hospitals and 15 to 20 percent of physicians’ offices had health information technology systems.
Won’t this make health care even more expensive?
While it is true that hospitals and doctors’ offices may be required to invest in new technology solutions, the long-term picture shows overall cost savings due to improvements in efficiency, safety, and health quality.
Won’t different state health IT systems result in less connectivity?
Interoperability is a major issue in health information technology, and that is why efforts have been made to start developing national standards. In August 2006, the
Department of Health and Human Services (HHS) approved three sets of “interoperability specifications.” These specifications are the first step toward national standards. In January of 2007,
HHS approved four prototypes of a national health information network, and steps are being taken to connect these prototypes to state networks.
What about privacy concerns?
Health and treatment records will remain confidential, with many security measures in place to allow consumers the same protections and confidence they have long held in the technology they use in banking, making airline reservations, paying bills, and filing tax returns.
Who Else Is Doing It?
The Department of Health and Human Services (HHS) has moved forward on some health IT initiatives and created the position of
National Coordinator for Health Information in 2004. Interoperability is an issue that the federal government could play a lead role coordinating, but states are critical to successful implementation, and many have begun studying its potential.
As of 2008, at least twenty-two states (
Idaho,
Illinois,
Indiana,
Florida,
Kentucky,
Louisiana,
Maine,
Maryland,
Michigan,
Minnesota,
Mississippi,
Montana,
New Hampshire,
North Dakota,
New Mexico ,
New York,
Oklahoma,
Texas,
Vermont,
Virginia,
Washington,
West Virginia) had created task forces to study the potential implementation of health information technologies.
Spotlight on Innovation
Pennsylvania On March 27, 2008, Governor Edward G. Rendell signed
2008 Executive Order 2008-03 creating the Pennsylvania Health Information Exchange. This network, known as PHIX, will be an interoperable electronic medical record and electronic prescribing system.
ArizonaThe Council of State Governments granted the 2007 Innovation Award to Governor Janet Napolitano for the
Arizona Health-e Connection, a national model for state governments looking to develop public-private partnerships that encourage electronic record systems.
What Can You Do?
There are a number of ways that state executives can promote health information technology in their states. The
Center for State Innovation has model legislation to create a task force to examine your state’s needs and develop a strategy for the adoption of electronic health records. State executives can also help to implement solutions in their state by convening a summit to bring experts and policy makers together. In certain cases, these exploratory initiatives have resulted in permanent private organizations that work to facilitate collaboration between health care consumers and providers for better service.
Resources
Policy Reports
Robert H. Miller, Christopher West, Tiffany Martin Brown, Ida Sim, and Chris Ganchoff
Opinion Polls
State Programs
State Legislation and Executive Orders
P.L.111-2007
http://www.in.gov/legislative/pdf/acts_2007.pdf
Executive Order 979
http://www.governorbarbour.com/proclamations/Executive%20Order%20Home%20Page/EO-HealthInfrastructure.htm
House Bill 0428
http://www.nmlegis.gov/Sessions/07%20Regular/final/HB0428.pdf