See Executive Summary page 2 and page 10 Moving Forward 2006 to today
See Brief Executive Summary page 2 and Brief History page 3 & 4. Department of Health and Human Services, AHRQ
See Brief History pages 3-5. RAND Corp states 2005 “optimistic predictions” did not come true because other conditions/predecessors didn’t occurred i.e HIT systems are not widely adopted, not interconnected and interoperable.
See Moving Forward 2006 to today pages 6-10
See 2,4,5,10, 11 and Conclusions
See page 9, 12 & 14. Internal savings – provider that paid for the HIS reaps the benefits, external – a third party, i.e. insurance company, government, patient reaps the benefits
Consists of:◦ Electronic Medical Records (EMR),◦ Electronic Health Records (EHR) Appointment Reminders◦ Clinical Decision Support Systems (CDSS)◦ Computerized Physician Order Entry (CPOE) prescription medication management system Chronic condition and disease management
In 2004 the Bush administration’s goal wasto have EHR available to the majority ofAmericans by the year 2014 Viewed as a means of◦ increasing health care efficiency;◦ improving efficacy,◦ improving the quality of patient care,◦ saving money and even curbing the escalatingcosts of health care expenditures
Department of Health and Human Services◦ Office of the National Coordinator of Health InformationTechnology (ONC) Created HIT Standards Panel (HITSP) provides guidance and certification for interoperabilitybetween health information systems. National Health Information Network (NHIN) : eHealth Exchange facilitates standards-based health information dataexchanges at state and regional levels HIT for Economic and Clinical Health (HITECH)◦ HIT part of 2009 ARRA stimulus package, meaningfuluse of certified EHR
RAND Health Information Technology Projectteam 2005 Center for Information TechnologyLeadership (CITL) Agency of Health Care Research and QualityStudies (DHHS)◦ systematic review of evidence for the effects of HITon quality, efficiency and cost◦ The first 2 projected $80 billion in savings, thethird was non-conclusive.
2006, Welch et al. Electronic Health Records in FourCommunity Physician Practices, Impact on Quality and Cost of Care 2006 report by Sidorov The Electronic Health Record andthe Unlikely Prospect of Reducing Health Care Costs 2006 Assessment Costs and Benefits of health InformationTechnology (DHHS – AHQR) 2008 Congressional Budget Report Evidence on theCosts and Benefits of Health Information Technology 2011, O-Reilly et al. The Economics of HIT in medicationmanagement: a Systemic review of economic evaluations 2012 Killerman and Jones RAND Corp. Achievingthe As-Yet- Unfulfilled Promises of HIT
While efficacy, practice or administrativeefficiency and quality of care eachdemonstrated positive results and showedpromise, there wasn’t enough evidence inqualitative and quantitative data, acrossvarying provider environments tosubstantiate claims that HIT will save massiveamounts of money and/or slow down therising costs of health care.
Initial investment capital costs◦ fluctuations in cost due to labor, hardware◦ training, support, maintenance,◦ lost revenue during transition, customizations Interoperability Data and connectivity standards Uncertainty about the future
?? Unknown: speculation only Not enough comprehensive cost to value,qualitative/quantitative research, or formalcost-effectiveness analysis. Several external influences and obstacles◦ who pays versus who profits how to generate more internal savings as compared toexternal savings◦ payment models must change to value over volume reducing fee-for-services, incentives for team-careapproach
Many internal influences- many ways to save◦ reducing hospitalizations/re-hospitalizations◦ avoiding adverse drug events◦ improving efficacy◦ eliminating duplication of diagnostic tests◦ improving productivity and efficiency◦ prevention and better management of chronic disease◦ reducing radiologic services◦ efficiencies in billing (providers/payers- a plus for somebut may ultimately cost the government more),◦ cost of quality (reminders for expensive exams),◦ What’s the value for higher volume of patient care
$19 billion in the 2009 stimulus package fordissemination by HITECH Government support and intervention continues -instituted incentives for meaningful EHR use 2011-2014 and penalties beginning in 2015 fornon(meaningful)-EHR use. federal program Direct Project, is providing standardsfor the first of 3 criteria, interoperability betweensystems. By 2014 standardization for message transport, thestructure and format of health data and acceptableterms will be in place with the federal health ITincentive program. More evidence-based studies using cost analysis
References1. A CBO Paper The Congress of the United States, Congressional Budget Office. Evidence on the Costs and benefits of HealthInformation Technology, May 2008 42. Hillestad R, Bigelow J, Bower A, et. al. Can Electronic Medical Record Systems Transform Health Care? Potential HealthBenefits, Savings, and Costs. Health Affairs, 2005;24(5)1103-11173. Hillestad R, Bigelow J, Health Information Technology Can HIT Lower Costs and Improve Quality? RAND Health ResearchHighlights, 2005, RB-9136-HLTH(2005) 104. Kellermann AL, Jones SS. What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information TechnologyHealth Affairs January 2013; 32:163-68 115. Walker J, Pan E, Johnston D et. Al. The Value of Health Care Information Exchange and Interoperability. Health Affairs. 19January 2005:25(6)w5-10 – 5-186. Chaudhry SW, Wang J, Maglione M et.al. Systematic Review: Impact of Health Information Technology on Quality, Efficiency,and Costs of Medical Care. Annals of internal Medicine. 16 May 2006:144(10)742-752 147. GE Healthcare Electronic Medical records (EMR) Centricity EMRhttp://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Electronic_Medical_Records.8. Cerner Ambulatory EHR http://www.cerner.com/About_Cerner/Stimulus_and_HITECH/Certification/ andhttp://www.cerner.com/solutions/Physician_Practices/Ambulatory_EMR_-_EHR/9. Sidorov J. It Aint Necessarily So: the Electronic Health Record and the Unlikely Prospect of Reducing Health Care Costs.2006:25(4)1079-108510. Welch WP, Bazarko D, Ritten K et. Al. Electronic Health Records in Four Community Physician Practices: Impact on Qualityand Cost of Care. Journal of the American Medical Informatics Association. 2007(14)320-32811. Kovner A, Knickman J ed. Jonas and Kovner’s Health Care Delivery in the United States 10th Edition; 2011:334-36312. Sothern California Evidence-based Practice Center. April 2006 Costs and Benefits of Health Information Technology.Evidence Report/Technology Assessment13. O’Reilly D, Tarride J, Goeree R et. Al. The Economics of health information technology in medication management: asystemic review of economic evaluations. Journal of the American Medical Informatics Association. 2012(19)423-428