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interoperability framework
We should shift our collective attention to rebooting the interoperability framework to begin realizing cost restraint as quickly as possible.

Rethinking health IT standards

Expected savings will follow with the right framework for interoperability


By Joel White
Posted: February 15, 2013 - 12:01 am ET
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Consumers have come to expect the conveniences that come with digital transactions. From checking clothing prices at multiple stores to keeping your bank account in your hand, the Internet in tandem with mobile devices has revolutionized the speed and ease of vast swaths of economic activity.

But when it comes to healthcare, patients and providers continue to struggle with new technologies designed to bring these same conveniences to the examining room.

The Healthcare Information and Management Systems Society has defined interoperability as “the ability of different information technology systems and software applications to communicate, exchange data accurately, effectively and consistently, and use the data that has been exchanged.”

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Put simply, an interoperable electronic health-record system would allow healthcare providers—whether it is your primary-care physician in your hometown or emergency room doctors in a different state—to easily access your medical records to effectively and efficiently treat you. This means any doctor in the country could know when you had your last flu shot, what medicine allergies you might have, your blood type, and other important information used in treatment.

But we're not quite there yet.

In 2005, the RAND Corp., a not-for-profit institution that provides research on various public policy topics, published an analysis estimating that EHR adoption has the potential to save $81 billion a year provided the technology is interoperable. And in recent years, government agencies have been working with medical providers to begin implementing health information technologies—even offering incentives for the program through federal stimulus funds.

When RAND recently released a follow-up study, analysts found their original cost-savings estimates have not come to fruition, and many in the IT, provider and political communities have declared IT's potential a failure. While it may be true that we have not yet seen the cost savings we expected, that does not mean the efforts have been in vain. With minor changes in the course of federal policy, health IT holds vast potential to wring tens of billions in inefficiencies out of our bloated healthcare system.

The U.S. spends almost $3 trillion a year on healthcare—a rate that is steadily increasing by about 3% each year. In 2013, healthcare will consume 24% of the federal budget—the highest percentage of any budgetary item. Even if EHRs had resulted in all the potential savings RAND had first projected, rising costs on other fronts would have simply mitigated the increase in health costs.

Dr. Art Kellermann, the RAND study's senior author, stated, “The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place.”

For every study finding that health technologies are not reducing costs, there are dozens more accounting for lower costs and better outcomes. I would take Dr. Kellermann's statement a step further and argue that the design of the IT systems are not the problem; it is the standards in the federal incentive program that have failed to meet RAND's caveat: We are not close to a truly interoperable IT infrastructure.

So while some are citing the RAND study to adopt a “the sky is falling” mentality to health IT, the dialogue should instead shift to better aligning standards with cost savings.

Joel White, executive director of the Health IT Now Coalition.
White
What we know from the recent RAND analysis is what we knew from the original research: Without an interconnected, interoperable infrastructure, realized savings will not materialize. Put another way, we know that the lack of interoperability is a key factor in limiting the effectiveness of EHRs.

So rather than focus on arguments that computers and information management systems won't work in healthcare, we should shift our collective attention to rebooting the interoperability framework to begin realizing cost restraint as quickly as possible.

When it comes to adopting and implementing health information technology systems, we have made great progress in recent years. Now that we have laid the adoption groundwork, we must rethink our strategy related to standards.

Bottom line: Fix the standards, realize the savings.

Joel White is executive director of the Health IT Now Coalition.



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