Health IT and the Stimulus Bill

I’ve written before about the limits and opportunities of health
information technology.  HIT, as it’s more commonly known, is just that
– health information technology.  It can be an important and useful
tool.  But it is the user of that technology – the clinician, the
pharmacist, the administrator, the analyst – who ultimately determines
its value.  If the user invests in it – financially, psychologically
and intellectually – then great things can happen.  Otherwise, it’s
just a tool.  Nothing more.

So when people start talking about spending $25-50 billion on HIT as
part of an economic stimulus bill, I get a little uncomfortable.  $50
billion would be twice the size of the annual NIH budget – a very big
number.  Are we sure the funding – and whatever technology comes of it
– will be incorporated in a way that maximizes its use and value, or

The answer to this question is far from clear, and it would be
impossible to suggest that HIT expenditures come close to meeting
President-Elect Obama’s original “shovel ready” standard for inclusion
in this $1 trillion expenditure.  To wit, there was a really interesting article in the Boston Globe the other day on just this topic.
It’s worth reading, for two reasons.  First, it features commentary by
a couple of guys who know what they’re talking about when it comes to
Health IT, and second, they’re both saying we should be careful about
spending tons of federal money on systems that might not do much to
improve quality or reduce costs.

And they’re not the only ones singing this song.  A new report from
the National Research Council of the National Academies raises similar
concerns about making a gigantic investment in the current way we all
do business.  The report is called “Computational Technology for Effective Health Care:  Immediate Steps and Strategic Directions
and was was released on January 9th in draft form.  The report has a
lot to say on this topic, but one of its most fundamental conclusions
is that pursuit of specific IT applications and installations is the
wrong way to proceed.  Instead, the feds should be developing
cost/quality & outcome goals, and then working to determine how a
national investment in Health IT will support those objectives.  This
is not unlike an article I came across last August in Health Affairs –
a well-respected health policy journal.  It raises numerous questions
about what a big investment in health IT, as it’s currently being
configured, can and cannot do.  At the risk of repeating my own words,
here’s a quote from the first paragraph of the Health Affairs report:
“IT is a tool, not a goal.  Success should not be measured by the
number of hospitals with computerized order entry systems or patients
with electronic personal health records.  Success is when clinical
outcomes improve.  Success is when everyone can learn which methods and
treatments work, and which don’t, in days instead of decades.”

Everyone knows we’re about to have a very big debate in Washington
about health care reform, and most people believe that how we pay for
services, and how services are currently delivered, should be a big
part of the cost/quality conversation.  Does it really make sense to
authorize a huge investment in Health IT BEFORE we have the big debate
about how the health care financing and delivery system should look
going forward?  I would think we’d want the HIT investment to reflect
the conclusions and directions that are drawn from that discussion.

To put this in “shovel ready” terms, if someone decides to put a new
kitchen in their house, or a new bathroom, or a new bedroom, they
usually put together plans that outline their end game before they
begin.  States that build roads, or renovate schools do the same
thing.  Plans, drawings, blueprints – call them what you will – but
they lay out, in advance, how the goals and aspirations of each project
are supposed to be achieved.  Putting billions into Health IT without
putting the plans together first – which is, in fact, what health care
reform is all about – seems exactly backward to me.

And finally, I’ve never understood why we think giving anyone
something for nothing is a good idea.  If the federal government
believes an investment of this kind is a sensible national endeavor, it
should be done on some kind of match basis, so that anyone who receives
funding from this type of program is putting their own money on the
table at the same time.  If the feds simply write checks to
practitioners for purchasing hardware and software, it would seem to
me that the personal and professional commitment that’s required to
turn a tool into a success simply won’t be there to see the project
through to completion.

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2 replies »

  1. Imagine what even a small portion of these funds could do if directed to the NIH and the NCI?
    Would you please do me a favor and provide concrete examples of where new HIT would change the rural hc system as laid out in the “In the Spin III” by Christine Gray on e-patients.net?
    I realize this is primarily a site for hc wonks, but for any suggestion to be translated into political solutions it needs to be translated into terms appropriate for an educated layperson, I.e. the patient. Something a bit more sophisticate than the Misery or hc Breakdown Stories featured in the last campaign. Thcb would be stronger if it could build to more common ground

  2. I share your concerns about spending many billions of dollars to force physicians to adopt electronic medical record systems and build networks that link them. These systems clearly do not meet the needs of either physicians or their patients. (If they did, care providers would already have embraced them.) Yet as you point out the establishment continues to push them.
    However, your suggestion that we not do anything while we discuss the issue further, troubles me greatly as well. This issue has been discussed ad nauseam, while thousands continue to die, millions are sickened, and billions of dollars are wasted each year because physicians don’t have information about their patients. The situation is dire yet we seem to have no sense of urgency! To me, it’s time stop talking and start doing!
    What to do? On the assumption that making a patient’s complete health record available to their care providers will improve care quality and reduce costs, the question is how can we accomplish that simply, cheaply and quickly? The answer is to design a system that will do so.
    Such a system must address three issues: how records are kept, where they are stored and how they are accessed. Our company, Health Record Corporation, has developed one solution. I suspect there are others.
    In our system, we aggregate and store a patient’s lifetime health record on a portable, car key-sized device called a MedKaz™ that the patient owns, controls and carries on a key chain or wears — not on a Web server. It contains copies of the patient’s records in whatever format his/her care providers use: paper, electronic, transcribed or images — we aren’t limited to electronic records. And when the patient sees a care provider, he/she merely gives them their MedKaz™ — thereby fulfilling the function of a network without having to build and maintain one! In turn, the care provider can sort and search these records electronically to find what they are looking for; they upload their notes after each encounter so it always is current. Our unique business model supports this approach.
    It seems to me that this simple system, or something like it, is what we need to get started. It meets the needs of physicians without forcing them to change their record-keeping systems, it doesn’t require government subsidies, and it satisfies consumer security and privacy concerns. Equally important, we can complete it in 12 months!
    Shouldn’t we start doing rather than talking?