This year's federal stimulus law includes a $19.5 billion investment in health information technology. It extends incentive payments to doctors and hospitals that buy and use electronic medical records, with penalties starting in 2015 for those who don't go digital.

The law also sets aside $1.5 billion for construction, renovation, equipment and acquisition of health information technology systems, and allocates $20 million for advancing health care information enterprise integration through activities such as technical standards analysis.

But will this investment in health IT bring the expected cost-savings for employers and patients?

Supporters argue that health IT can save money by preventing duplication, preventing inappropriate treatments and reducing medical errors caused by illegible handwriting. The Department of Health and Human Services estimates that the federal investment in health IT will reduce health costs for the federal government by $12 billion over 10 years.

Similarly, pharmacy benefit manager Medco Health Solutions estimates that health IT investments have the potential to cut health care spending by as much as $350 billion. Meanwhile, transparency with accountability could yield an additional $330 billion in savings by reducing the need to practice defensive medicine, resolving a stalemate related to tort reform and addressing the difficult issues around providing appropriate care in the last years of life, Medco states.

"A wired system will create accountability, where every provider and service across the spectrum of health care can be measured based on their contribution in lowering costs and improving clinical quality," says David B. Snow Jr., the CEO of Medco. "Wiring America's health care system is the key foundational step that will enable as much as $680 billion in annual savings."

He adds: "Wiring health care empowers the fundamental capability to measure, examine, evaluate and improve each element and every process in real-time. This, in turn, provides a level of insight and accountability that will improve the quality of service and ensure payers and patients alike are confident they are receiving the greatest value for each health care dollar invested. We must overcome the barriers of technology, cost and inertia — which preserve the status quo of inefficiency — in order to relieve the health care cost-burden on individuals, employers and government."

Automatic warnings are one way that health IT might prevent costly medical errors. Last year, Aetna rolled out a personal health record that provides alerts to doctors when they have a patient coming in with an electronic health record, as well as alerts warning physicians about potential drug-to-drug or drug-to-disease interactions.

"Physicians have more complete, up-to-date profiles of patients that help them better coordinate care and prevent dangerous drug interactions or even death," says Dr. Troyen Brennan, Aetna's chief medical officer.

The skeptics

Some doctors and researchers have been skeptical, warning that government investments in health IT could be a huge mistake. They argue that a myriad of different systems might end up not being able to connect with each other, which would limit the potential to improve the quality of care.

"Health IT systems are an expensive and still unproven technology for most physicians in the United States. For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won't do much for many Americans," Stephen B. Soumerai, a professor of ambulatory care and prevention at Harvard Medical School, and Sumit R. Majumdar, an associate professor at the University of Alberta's Department of Medicine, wrote in a Washington Post op-ed piece.

Another problem is potentially inaccurate information coming directly from billing and claims information, which is linked to diagnostic codes. For example, some electronic records might list a wrong diagnosis picked up from claims data for a test for a disease that the doctor had hoped to rule out.

To be fair, paper records sometimes can be incomplete or inaccurate, as well. With some electronic systems, patients can correct any mistakes that they catch. But others do not allow patients to change the record.

The high price of the technology has proven to be a major barrier to adoption so far. As of 2008, only 13% of U.S. physicians had adopted electronic health records, and only 8% of U.S. hospitals had a basic electronic records system in at least one clinical unit, according to a recent study published in the New England Journal of Medicine. Only 9% of American adults have an electronic health record, according to a recent survey from the HR consulting firm Deloitte.

Mayo Clinic

The Mayo Clinic has been using electronic medical records since the mid-1990s. "There's improved value to the patients and the employers," says Dr. David Mohr, chair of the information technology committee at Mayo Clinic Rochester in Minnesota.

Health information technology "brings us to a new level. [It] opens up vast frontiers of ways that we can help patients that we couldn't do before. We will see significant savings. We can see improved and more efficient processes, definitely," but this must be weighed with the cost of managing and maintaining the technology systems, he adds.

The country won't see major cost-savings if the electronic records are not interoperable, or if federal privacy regulations put up too many barriers to interoperability, Dr. Mohr asserts.

Interoperability means that the same health record can be used and updated at many different doctors' offices and hospitals, not just one site. The country needs to spend money to ensure interoperability, which involves standard terminology, standard data models and standard communication processes, Mohr comments. "I hope those barriers can be overcome, but that's still to be seen."

Mayo Clinic and Microsoft Corp. recently announced the launch of Mayo Clinic Health Manager, an online application where patients can store medical information and receive individualized health guidance and recommendations. It works in connection with Microsoft's electronic medical record, called HealthVault.

"As a physician, I truly appreciate when my patients are actively engaged and informed about their health," says Dr. Sidna Tulledge-Scheitel, a primary care physician and medical director of Mayo Clinic Global Products and Services. "Mayo Clinic Health Manager can help patients share information more easily with their doctors and manage their own health better between office visits."

Kaiser Permanente

Health IT has led to notable results for Kaiser Permanente. By using computerized physician-order entry, an electronic medication-administration record and barcode scanning, Kaiser Permanente reduced medication errors by 57%. Likewise, by using an electronic medical record and patient-tracking software, Kaiser Permanente of Colorado reduced the mortality rate of its patients with coronary artery disease by 76%.

A study published in the journal Health Affairs shows that the number of Kaiser Permanente patients using phone visits and e-mails to their physicians skyrocketed, while the number of physician office visits fell dramatically.

For employers, this means employees can be more productive because they're not spending a lot of time driving to a doctor's office and sitting in the waiting room. They can discuss lab results or get a prescription changed without having to take a half a day off work to fit in an office appointment.

At Kaiser Permanente, almost 3 million patients have access to their information on My Health Manager. They sent about 6 million e-mails to doctors and other health care providers last year, and they submitted 1.4 million online appointment requests.

"The incentive system is going to have to be changed throughout the health care profession to support the creation and use of electronic medical records," says Phil Fasano, the chief information officer for Kaiser Permanente.

"[The cost-savings] will be 20% to 30% for the country ... We have such a long way to go in this country [to get ubiquitous access to electronic health records]. It's clear we can get there as a country. There are true benefits for the physicians and the patients."

NHIN aims to connect health IT dots

With Health and Human Services Department officials laying the groundwork beginning in 2006, the Nationwide Health Information Network (NHIN) currently is being developed to link all government efforts to provide a secure, nationwide, interoperable health information infrastructure — connecting providers, consumers and others involved in supporting health and health care.

This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision-making and support appropriate use of health care information beyond direct patient care to improve health.

To promote a more effective marketplace, greater competition and increased choice through accessibility to accurate information on health care costs, quality and outcomes, the Office of the National Coordinator is advancing the NHIN as a "network of networks" to connect the diverse entities that need to exchange health information, such as state and regional health information exchanges, integrated delivery systems, health plans that provide care, personally controlled health records, federal agencies, and other networks.

The NHIN is built upon a core set of capabilities to enable nationwide information exchange encompassing a diverse set of organizations, technologies and approaches. Core capabilities include:

• Ability to find and retrieve health care information within and between health information exchanges and other organizations.
• Ability to deliver a summarized patient record to support patient care and patient health.
• Ability to support consumer preferences regarding the exchange of his or her information, including the ability to choose not to participate in the NHIN.
• Ability to match patients to their data without a national patient identifier.

The core capabilities of the NHIN establish an interoperable infrastructure among networks and systems that allows for different approaches and implementations, while ensuring secure information exchange for patient care and population health.

Source: http://www.healthit.hhs.gov