Monday, January 14, 2013
The Rand Study and the impact of EHRs on Healthcare Costs
Last week, Rand published a study in Health Affairs (ANALYSIS & COMMENTARY: What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology), revising its original 2005 healthcare IT cost savings research.
The New York Times wrote about it.
Several publications asked me to comment and here's what I said:
"We're still at an early stage of EHR implementation, healthcare information exchange connectivity, and decision support.
Meaningful Use Stage 2 in 2014 will take us to a new level that will begin to reduce redundancy, over treatment, and waste.
Stage 3 in 2016 will take us even further by enhancing outcomes.
We're on a journey and I have every expectation we'll change the practice of medicine to improve its value (quality/cost). We're moving as fast as we can to accomplish this and I believe by 2016 we'll realize the improvements we're seeking from the meaningful use foundation we've built. Expecting significant cost reductions by 2013 is not realistic at this point in the process."
Many people are working tirelessly to implement EHRs, HIEs, and PHRs. Think of our work like creating the interstate highway system. Soon we'll be able to drive at high speed from coast to coast. In the meantime we need to realize that every day gets us closer to our goal. We need to keep our eyes on the prize and keep building.
Posted by John Halamka at 3:00 AM
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So much room for improvement at the ground level.
Please make sure to take some time to sit down next to one of your doctors or nurses (the cool headed ones, not the complainers) and see what this is doing to the actual delivery of health care.
Would love to see another post about what you learned from each other.
I think it's overly generous to call the RAND paper a "study". It's an Op-ed that introduces no new evidence
Although all the factors identified by the Rand researchers have merit, the biggest lever of all is adoption of interoperable EHR systems that are connected to community health information exchanges. When the industry reaches the 80% - 90% EHR adoption level in the next few years (not if but when), cost savings already being realized in communities with robust HIE (see recent Wisconsin and Tennessee HIE studies showing reduction in service utilization) will happen on a much larger scale, but only if the EHR connectivity is there. An EHR by itself does not provide important functions needed to improve continuity and coordination of care (see the findings from the National PCMH Demonstration). HIE-enabled medication and care reconciliation, patient registries, and sharing of patient care summaries are needed. Meaningful Use Stage 3 is indeed key, but let’s call for higher thresholds on critical care coordination measures. For example, why shouldn’t the majority of care transitions require review/reconciliation of medications AND problems? And a summary of care record be made available electronically for at least 80% of care transitions?
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