A VISIT TO THE HOSPITAL
Primary care physician Matt Handley believes that information technology enables him to provide better patient care.
So much so that he recently spent an afternoon hooking up a computer and DSL line at the home of a patient so she can contact him more frequently.
Handley is the associate medical director for quality and informatics at Group Health Cooperative in Seattle, a nonprofit health system armed with technology systems that have replaced paper records and enable patients to take part in their healthcare online.Indeed, health information technology is the new rage for politicians and many healthcare providers who think it will help transform the industry.
Proponents say it will lower healthcare costs and improve quality of care.
Others aren’t so sure.
But computerized record-keeping and communication has the potential to change hospital care and procedures dramatically.
“It gets right to the heart of what we do every day . . . and hospitals have to take pause and think about what this will mean for them,” says Gary Kalkut, senior vice president and chief medical officer of Montefiore Medical Center in the Bronx.
The issues, Page E7.
How is this technology being used?
The systems do a variety of tasks, including replacing paper records with computerized versions and offering capabilities such as bar codes on medications, record management and suggestions for best practices for patient care. With some systems, patients can use the Web to access their medical records and lab results, communicate with physicians, schedule appointments and refill prescriptions.
How does this help patients and doctors?
Private-practice physicians who use comprehensive technology systems reported seeing positive effects on delivery of care and communication with other providers and patients, according to a New England Journal of Medicine survey published last summer. Eighty percent of the physicians polled reported their systems helped them avoid giving drugs to patients with known allergic reactions. More than 65% were alerted to order a critical lab test and recommend preventive care measures.
At Group Health, the integration of electronic records was shown to improve cholesterol and blood pressure in patients with chronic diseases. Montefiore Medical Center’s electronic prescription and dispensing system offers assistance such as a maximum dose alert. The system has helped cut medication errors by about 80%, Kalkut says.
What about costs?
Health technology may reduce healthcare costs. It has been shown to decrease duplicative testing and laboratory use, and can be set up to seek out generics rather than brand-name prescriptions.
“We have been able to improve cost effectiveness of prescribing in a dramatic way,” Handley says. Generics are typically prescribed about 30% of the time elsewhere, but Handley says Group Health physicians recommend the more cost-effective medications about 90% of the time because of the reminder in their system.
How common are these systems?
Although a number of major healthcare providers in Southern California -- such as Kaiser Permanente, UCLA Medical and USC University Hospital -- are using various forms of information technology, the medical community overall has been slow to embrace electronic records, according to recent studies.
A study published this month in the NEJM looked at almost 3,000 hospitals across the country, finding that only 1.5% had adopted comprehensive electronic systems throughout their facilities and only 7.6% had basic systems in at least one clinical unit.
What are the primary barriers?
Technical problems, expense and culture change are among the biggest issues.
Cedars-Sinai Medical Center in Los Angeles spent $34 million creating and implementing a physician order system for medication, labs and procedures in 2002. But physicians said the system took too long to use, limited their ability to make medical judgments and didn’t recognize complex orders or misspelled words. The system was eliminated after three months.
Other technology has had similar problems. Some is too slow or reduces productivity, some is difficult to implement, others require costly training and some physicians are resistant to change. As Cedars-Sinai experienced, health industry IT systems don’t work out about 30% of the time, according to a February article in the Journal of Usability Studies.
The major barrier for health IT systems may be cost. Seventy-three percent of hospital respondents in the NEJM article said they did not have enough capital for the systems, and 44% were concerned about the maintenance costs.
The Obama administration plans to help physicians through reimbursements of up to $60,000 per medical practice and $11 million per hospital. But hospital technology systems can range from $20 million to $200 million. Group Health spent $40 million, and Montefiore has spent about $150 million over 10 years.
What is the outlook for future use of these systems?
Some providers and many in government believe that technology will play a large role in healthcare reform. Through the American Recovery and Reinvestment Act, the Obama administration plans to provide almost $22 billion to help healthcare providers who embrace technology, mostly through Medicare and Medicaid reimbursements.
Nick Papas, spokesman for Health and Human Services, calls health IT “the future of health care.”
Still, the administration’s goal to have a nationwide health IT system by 2014 has been met with skepticism from some because of issues including privacy and funding.
The current healthcare pricing model is based on an in-person visit to a doctor or hospital. This would need to be changed to take into account online interactions, such as e-mail consultations.
Many IT systems already in place are proprietary. And even if the systems were accessible to other physicians, many don’t speak the same language, Kalkut says.
The policies for regulation and safety are also an issue. Some personal health records now available online -- such as Microsoft’s HealthVault or Google Health, where patients create their own records -- don’t fall under HIPAA, the federal law that guards patient confidentiality.
Linda Dimitropoulos, director of health services research for RTI International, an independent, nonprofit research and development organization, says consumers need to be able to “understand where data will be used and shared, with whom, and for what purposes and I don’t think that is very clear right now.”