Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Time Capsule: Is Healthcare IT Really "The Right Thing to Do?" Prove it.
I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in April 2007.
Is Healthcare IT Really "The Right Thing to Do?" Prove it.
By Mr. HIStalk
I like to shock people by telling them that a hospital is basically a clean hotel with lots more staff, lots worse service, and a nightly rate that no one in their right minds would voluntarily pay for an uncomfortable bed, incessant noise, and bad food.
Going with the hotel analogy, if you owned a mid-priced hotel in a highly competitive market, what would motivate you to make an IT investment?
- It would perform some function that increases customer loyalty or occupancy rates, thereby increasing profits
- It would reduce costs and allow more aggressive pricing, thereby increasing profits
- It would improve quality in a perceptible way that would support higher room charges, thereby increasing profits
See the common theme?
None of these motivations work for hospitals. We’re already full, even those hospitals with poor performance and low satisfaction scores. Patients don’t really care if we automate or not, even though we keep trying to convince them how wonderful it is. IT rarely reduces costs for a given organization and hasn’t put the brakes on healthcare spending.
Worst of all, despite stacks of arguments trying to prove that technology investments improve patient outcomes, evidence is skimpy at best.
That leaves two reasons to invest the many millions today’s IT solutions often cost. Either (a) it’s a cost of being in business, or (b) it’s the right thing to do.
"Cost of being in business" is the lazy answer that IT vendors love. Walmart eats companies for lunch that hide behind what they think are fixed costs that Walmart can eliminate. A few good Rollback Specials and Mr. "Cost of Being in Business" isn’t for much longer. Luckily (for everyone but patients and payors, anyway), hospitals collectively have few original ideas, so the competitive threat is minimal.
Walmart invests legendarily in IT, but they’re not throwing money at the same off-the-rack systems that every other department store uses (like hospitals do.) Without the motivation of competitive advantage and eventual increased profits, why bother? Spend the money on nicer bathrooms or friendlier cashiers instead. The payback is more certain.
"It’s the right thing to do" is noble-sounding, but easily riddled with holes. You can’t prove it’s the right thing to do, can you? If even one hospital that didn’t spend $40 million on a clinical system has better outcomes than yours that did, then obviously it isn’t just about IT.
Most hospitals wouldn’t touch an expensive new drug without reams of studies proving its safety, efficacy, and cost-benefit ratio. Those same hospitals, however, continue to buy IT on faith alone, using either the "cost of being in business" or "right thing to do" rationale. If IT were a drug, we’d ban the chippy blonde sales rep from our hospital.
All of this would be irrelevant if patients found IT valuable. My doctor doesn’t use an EMR, but I’m not about to switch to a different one. My dentist doesn’t use computers except for scheduling and billing, but I’m sticking with him. When I need a new provider, I have zero interest in whether they use computers or not.
In other words, I’ll give lip service to laypeople about the wonderfulness of healthcare IT, but my feet vote differently. I’m the Chrysler sales guy who parks his Toyota around back and hopes the prospect doesn’t notice.
Maybe today’s IT systems really do improve outcomes or cost. If so, then I challenge vendors to prove it and customers to demand that proof before buying their wares. Otherwise, spend the money on staff, training, and equipment instead because we know those improve quality and efficiency.
It is five years later and the studies do not show improvement in outcomes or reduction in costs. When the costs of the EHRs, training, support, and maintenance are included as costs of treating diseases, there is an increase in costs.
Very few, if any, heeded your sage advice.
Yes, it is five years later. However, migrating an entire industry from paper to electronic records of structured data easily requires 10 to 20 years to mature. Until the industry as a whole becomes proficient and fully integrated (read efficiently communicating with each other) the true ROI of the investment in Healthcare IT will not be fully realized.
I came from a 26 year prior career in Manufacturing and Distribution. That industry went through this same process in the 1980’s. Looking back after 15 to 20 years, they would never go back to paper card files or ledgers to operate. The same will likely prove true for this Healthcare IT initiative.
And finally, with regard to increasing profits. All of my current organization’s Physician’s note at least one level of increase in their E&M billing after adopting an EHR system that provides support for their coding.
It is important to look at the long run rather than focus on the short term labor pains. It is time for Healthcare to catch up.