HIT Apologia

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By Greg Scandlen,

from NCPA,

Health Affairs recently announced its top 15 articles for 2013, and has made them available to nonsubscribers.

The top article was by a pair of RAND researchers updating what is known about the health information technology (HIT) roll out from the 2009 HITECH law, appropriating $20 billion to upgrade information technology throughout the health care system.

It doesn’t take long ― like just the abstract ― to figure out that people haven’t learned a blessed thing from flushing $20 billion down the toilet. Here’s the complete abstract with my comments:

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually.

This original “study” was horrendously flawed. They deliberately chose (and said so) to ignore any contra information, basing their projections on a best possible scenario that couldn’t possibly come true in real life. In the latest report:

Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion.

They are still minimizing the evidence. There is plenty of evidence that the HIT adoption process has increased errors and slowed productivity. Rather than “mixed” the evidence is overwhelmingly negative. Again, from the latest report:

In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT.

They have it exactly backwards. Rather than reengineering clinical practice to suit the demands of IT, IT must be developed to enhance what is happening clinically. This is fundamental to any acceptance of IT.

Start with making it work in the doctor’s office and THEN build interoperability. DO NOT standardize it from the start, but allow a variety of systems in real-life settings and see what works best and THEN move to standardization.

So, the original estimates on how well HIT will work are based on the assumption that HIT will work well (be widely adopted and used effectively). It’s not their fault that the health care system did not find all this attractive — even though virtually all the evidence in existence at the time predicted exactly that.

Nonetheless, these writers continue to insist it is not the fault of the IT industry or the government, but of those damned providers who fail to “reengineer existing processes of care to take full advantage of the efficiencies offered by health IT.

There was nothing wrong with RAND’s initial analysis, they write. The analysis would have worked out fine if the vendors and providers had fewer “shortcomings” − And we would all live in Paradise if only we had fewer shortcomings.

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