The HIT Productivity Paradox — It’s Gonna Be OK

The New York Times publishes another article about how spending money on EMRs is a waste since the benefits are not obvious. Like so many media cycles, they build you up (HIT is great) and then tear you down (HIT is a waste of money). 

Fair enough. Are EMR’s worth it? Was MU worth it?

I’ve said before that I don’t think I would have spent the $30-40 billion that way (remember, they use the $19 billion figure because they assume $10-20 billion in savings). I would have focused on mandating standards and trying to push for a uniform data model platform upon which vendors could then build their more external facing products.  

However, I will happily admit that MU has done its job. It has stimulated the adoption of EMRs. It won’t be the 80+ percent they were hoping, but it still got a lot of people off their asses and moving.

Next question: will EMRs provide all the great things we are hoping for?

Certainly we’ve got some issues. EMRs are still not mature, nor is our understanding on how to best use them. But no technology, from cars to computers, started out perfect.  

I’ve been reading "The Signal and the Noise." Very early on, it reminds readers of "the productivity paradox," which helped explain why the early computer age (1970s-1990s) actually saw a lower productivity as everyone was figuring out how build them well and how to use them. Sound familiar?

From Wikipedia:

The productivity paradox was analyzed and popularized in a widely-cited article by Erik Brynjolfsson, which noted the apparent contradiction between the remarkable advances in computer power and the relatively slow growth of productivity at the level of the whole economy, individual firms, and many specific applications. The concept is sometimes referred to as the Solow computer paradox in reference to Robert Solow’s 1987 quip, "You can see the computer age everywhere but in the productivity statistics." The paradox has been defined as the “discrepancy between measures of investment in information technology and measures of output at the national level.” It was widely believed that office automation was boosting labor productivity (or total factor productivity). However, the growth accounts didn’t seem to confirm the idea. From the early 1970s to the early 1990s there was a massive slow-down in growth as the machines were becoming ubiquitous. (Other variables in country’s economies were changing simultaneously; growth accounting separates out the improvement in production output using the same capital and labour resources as input by calculating growth in total factor productivity, AKA the "Solow residual.")

If and how can this best be applied to healthcare IT? It turns out that some smart authors actually addressed this exact issue in a June 2012 NEJM article entitled. “Unraveling the IT Productivity Paradox — Lessons for Health Care.” The authors explain that sure, we are seeing problems with HIT, but it is as expected, just like every other new industry has to evolve. They conclude with the following paragraph:

The resolution of the original IT productivity paradox suggests that current conclusions about the value of health IT investments may be premature. Research suggests three lessons for physicians and health care leaders: invest in creating new measures of productivity that can reveal the quality and cost gains that arise from health IT, avoid impatience or overly optimistic expectations about return on investment and focus on the delivery reengineering needed to create a productivity payoff, and pay greater attention to measuring and improving IT usability. In the meantime, avoiding broad claims about overall value that are based on limited evidence may permit a clearer focus on the best ways of optimizing IT’s use in health care.

Clearly we are not at perfection. HIT can affect efficiency and quality in both good ways and bad.  But rather than try to create some artificial polarization that it is all good or all bad, let’s continue doing our job (for the medical informatics professionals reading this) to keep making HIT better serve our providers and patients, while educating those who get freaked out every time a new stat or story comes out pointing out its imperfection. 

Lyle Berkowitz, MD is associate chief medical officer of innovation, Northwestern Memorial Hospital; chairman of healthfinch ("The Doctor Happiness Company"), author of the Change Doctor blog, and editor of the new book, Innovation with Information Technologies in Healthcare, which has a whole bunch of good stories about organizations who have succeeded with EMRs and healthcare IT by thinking innovatively about the best way to use them in their settings.