The multibillion dollar federal investment in health information technology is producing mixed results, in part because electronic health-record systems remain difficult to use and—as a corollary—their adoption remains incomplete, according to a pair of researchers for RAND Corp.
The RAND duo also charge that today's systems lack interoperability and that providers are failing to re-engineer their care processes to leverage the technology. The six pages of analysis and commentary
by RAND's Arthur Kellermann and Spencer Jones is published in the January issue of Health Affairs.
In 2005, RAND released what became a much-cited study on the estimated national healthcare IT investment needed to achieve EHR adoption by 90% of U.S. hospitals and office-based physicians. The sums and timelines offered were enormous—$98 billion in spending over a 20-year period required for hospitals to achieve 90% EHR use, and $17.2 billion to reach the same EHR adoption rate among physicians.
But the predicted potential benefits were enormous, too. RAND estimated IT-linked healthcare cost savings of $81 billion a year. The study gave ammunition in subsequent years to several failed legislative attempts
to provide federal financial support for health IT.
Kellermann and Jones argue seven years later that critics of the 2005 RAND study now "can claim a measure of vindication" in that the effectiveness of health IT "has yielded mixed results" while overall healthcare spending has climbed from $2 trillion in 2005 to $2.8 trillion today. But that doesn’t mean the 2005 authors were wrong, they said.
"The health IT systems that currently dominate the market are not designed to talk to each other," the two claim. Even with large, integrated healthcare delivery systems that are models of healthcare IT adoption and use—the Veterans Affairs Department and Kaiser Permanente—"information stored in those records is essentially useless if the patient seeks out-of-network care," they said. "The lack of interoperability is so stark that it has led some to speculate that major health IT vendors are opposed to interoperability."
Regarding EHRs' ease of use, the authors said user interfaces on different systems should be similar enough that a clinician could move from one system to another "without extensive retraining," just as a driver can hop between rental cars and "drive any vehicle off a rental lot without instruction."
The RAND researchers cite EHR adoption rates of 40% for U.S. physicians and 27% of U.S. hospitals are using a basic EHR as evidence that adoption of these systems has been "sluggish." But adoption rates are skyrocketing because of the federal EHR incentive payment program under the American Recovery and Reinvestment Act of 2009.
For example, at a meeting in Washington on Tuesday, CMS official Robert Anthony estimated that 83% of eligible hospitals and 33% of physicians and other eligible professionals have received federal incentive payments for adopting and using a certified EHR system. Furthermore, the CMS made a record $1.22 billion in payments in December while 2,000 payment applications came in on Jan. 2 alone, Anthony said.
The federal government has spent nearly $10.3 billion on EHR incentive payments, Anthony estimates.