Rapidly adopting information technology is the most effective cure for costly and harmful medical errors, say healthcare industry leaders and policy experts, who call for the federal government to lead the way in paying for it.
Swift and widespread use of electronic health records and networks to connect clinics, hospitals, pharmacies and public health agencies outpoll other strategies to boost U.S. healthcare's uneven quality of care in the latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey. Slightly more than two-thirds of the 214 respondents in the online poll of industry executives and healthcare delivery, finance and policy experts agree that information technology could improve quality, compared with 59% who express the same confidence in public reporting of performance measures.
Roughly half say pay-for-performance programs and heightened regulatory oversight are effective strategies to improve health system performance. And just 39% put stock in voluntary efforts as an effective or very effective approach to making healthcare more efficient, suggesting that government needs to play a role in mandating quality improvement.
Notably, only 7% described the Patient Safety and Quality Improvement Act of 2005, which allows providers to voluntarily report medical errors and ensures the confidentiality of doctors and hospitals that do so, as sufficient to reduce medical errors. Three of four Commonwealth Fund survey respondents supported mandatory reporting of medical errors; 60% say reported errors should be publicly disclosed.
Seventy-three percent of respondents backed the notion of fostering the formation of integrated delivery systems or "virtual integration" by IT and/or new payment systems.
The push for IT
The survey results underscore an increasingly urgent push among providers and lawmakers to convert cumbersome paper records and a torrent of emerging clinical information into digital records that can be easily shared and quickly transmitted to aid providers and patients. The American Hospital Association recently endorsed a five-point healthcare reform agenda that would require doctors and hospitals to operate certain healthcare information technology. Richard Umbdenstock, the trade group's president and chief executive officer, lobbied for rapidly expanding use of IT at the associations yearly meeting in San Diego last week.
"Many is not all, and many is not enough," Umbdenstock says of those already operating IT systems.
"If you're not investing in electronic health-record systems, you're going to be falling farther and farther behind on all fronts," Janet Corrigan, president and CEO of the National Quality Foruma Washington-based not-for-profit created to standardize quality measurestold healthcare executives at the San Diego conference.
But healthcare IT is not without critics. A study published in the July Archives of Internal Medicine found ambulatory patients received the same care for 14 of 17 quality indicators regardless of whether providers used EHRs. Researchers found EHRs were used for roughly 15% to 22% of ambulatory-care visits between 2003 and 2004. In California, Oakland-based Kaiser Permanente's problematic and expensive effort to adopt EHRs across the 28-hospital system has generated negative news coverage. And studies have called into question whether electronic prescribing even reduces medical mistakes.
Even its proponents say significant obstacles threaten to undermine IT's expansion in healthcare, in particular: cost and a lack of uniform standards that will allow data to travel among diverse software programs, providers and insurers. "There is no business model that's going to support this," Corrigan said. "It's a public good. We've got to get the federal government to step up to the plate and accept that responsibility."
Seventy percent of survey respondents say the federal government should play a leading role in backing providers' IT investments. Another 58% say health plans and insurers have a responsibility to support expansion.
The survey also finds that 36% of respondents feel the public sector should help pay to establish health information exchanges, or networks that connect hospitals, clinics, public health and other providers. Another 42% call for government funding to establish and operate the exchanges; half say private insurers should shoulder such costs.
And 90% agree Medicare ought to require EHRs within 10 years. Of those, 70% say it should be sooner rather than later, moving the deadline ahead five years.
Commonwealth Fund President Karen Davis is among the survey respondents to describe IT as an effective strategy for improving healthcare. IT alone isn't the answer, she says, but "it's hard to do what needs to be done in healthcare" without it. Davis says technology must do more than just replace the function of "clerks that are trying to find the (paper) records with an electronically integrated record." IT's promise, she says, is its potential to organize and track care and outcomes to improve healthcare delivery. "If all IT does is what paper records do electronically, it will disappoint," she adds.
Corrigan also cautioned executives and doctors in San Diego to be patient as an increasing number of dissimilar measures emerge from various specialty groups and organizations, which she acknowledges makes tracking, reporting and comparing performance tricky. "It's going to be a little chaotic for a while."
In a Commonwealth Fund report released June 26, Davis, an economist, and two of the foundations policy experts called for Congress to establish a national quality coordination board, an initiative backed by the Institute of Medicine but missing from any federal legislative proposals, according to their analysis.
About 56% of respondents agree with the need for the new quality organization.
One respondent, Margaret O'Kane, president of the National Committee on Quality Assurance, stresses that no one strategy, including IT expansion, will suffice to improve healthcare quality, but she describes overhauling payment to providers as essential to making any gains. "The payment system is going to have to change, so that you can't get by practicing 19th century medicine or management," she says.
O'Kane's views mirror nearly all survey respondents. Just 1% say fundamental payment reform is unnecessary. Forty-four percent say that pay-for-performance, touted by the CMS and many in the industry as a means of giving providers real incentives to adopt evidence-based medical practices, should be expanded.
An equal number of respondents say that it should be regarded as an important first step toward a more comprehensive payment overhaul. A quarter of respondents ask for an overhaul of reimbursement, but say that pay-for-performance strategies are an "unnecessary distraction." Almost as many do not see quality incentives as helpful or harmful, but agree with the demand for significant changes to healthcare reimbursement.
As it stands, financial incentives reward healthcare for procedures and treatment, not efficient care, O'Kane argues. The current political interest in expanding coverage has sparked debate over cost, quality and efficient utilization, she says. "There seems to be an understanding that quality and cost are not trade-offs. I just hope we can move forward."
O'Kane says she also considers financial incentives more likely than a Medicare mandate to win EHR adoption among Medicare providers.
Survey respondents favor financial incentives over voluntary industry measures as a strategy to improve healthcare quality. Two-thirds endorse a reward for Medicare beneficiaries who sign on for a so-called medical home, a regular provider who would coordinate patients' interaction with the healthcare system.
Nearly three-fourths say they support "Medicare payment reform" to maintain medical homes, including giving beneficiaries lower Part B premiums for using one.
Davis says the surveys support for medical homes, a national body to oversee and direct quality effortsas well as results that endorse further integration of solo and small physician practicesunderscores healthcare leaders' understanding that national healthcare reform must mean more than merely expanding insurance coverage.
"It's not just access, it's access to what?" Davis says.
This story initially appeared in this week's edition of Modern Healthcare magazine.
What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.