Can electronic health records and other health information technology applications improve our healthcare system and deliver significant improvements in patient care?
According to a recent study, published by PLoS Medicine, the answer is no.
Based on Intermountain Healthcare's experience more than 40 years, however, the answer is clearly yes. And, as Intermountain's chief information officer, I have the evidence to back it up.
In that study, “E-Health Not Ready for Prime Time,” a team of researchers asserted that “many of the clinical claims made about the most commonly deployed digital health technologies cannot be substantiated by the empirical evidence.”
They didn't ask us.
Intermountain Healthcare has pioneered the use of electronic health records since the legendary Dr. Homer Warner opened a small laboratory at LDS Hospital in Salt Lake City in the early 1970s.
At the time, when Steve Jobs and Bill Gates were just in their teens, Warner and his team of doctors and technical experts were developing new and innovative ways to use computers, clinical guidelines, terminologies and communication systems together to deliver better healthcare. Warner's team at LDS Hospital created one of the world's first electronic longitudinal medical record systems, which provided clinicians a new intellectual process and model for analyzing data and making better-informed clinical decisions.
Today, Intermountain is regularly cited as one of the leading healthcare systems in the nation.
Our groundbreaking EHR system is unique in having so many decades of experience and data upon which to draw. That system is core to our record of better care at lower costs, and its value can be demonstrated empirically.
In 1999, for instance, we noticed a striking trend that was part of a national phenomenon: Pregnant women and their doctors were choosing to induce labor before the typical 39-week gestational age.
According to our research, this led to longer and more complicated deliveries, often leading to more Caesarean sections. There also was a disturbing increase in the number of newborns with medical complications.
Because of vital information provided by our technology, we developed guidelines to reverse this trend. Over the course of the next decade, the percentage of women choosing early induction at Intermountain's hospitals dropped from 28% to 2%. This resulted in healthier mothers and babies and a substantial reduction in overall costs.
In fact, a recent study of 300,000 births over the course of the past 10 years shows that, if our nation's Caesarean section rate was similar to that of Intermountain Healthcare, nearly $3.5 billion in annual medical charges could be avoided. A single percentage drop in C-sections alone could save $500 million in one year.
Our EHR system was crucial to this effort. It enabled us to identify the troubling trend and convince the medical staff that changes were required. It allowed us to track the improvement over time and to quantify the healthcare benefits to our patients and the reductions in cost.
Too often, the advantages of EHR systems are seen largely as ones of convenience—the availability and portability of patient information—and immediacy. But arguably the greatest advantage of such systems is their ability to identify and monitor trends over time.
Simply put, you can't improve what you can't measure.
The PLoS Medicine report concluded that “there is as yet relatively little empirical evidence to substantiate many of the claims made about eHealth technologies.”
Not so fast.
The evidence is here in Utah.