Improved interoperability needed to fulfill health IT's promise

Analysis calls for better connections, easier access for patients, providers
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Health IT has failed to live up to its promise so far, largely because it's not interconnected or easy to use, and because providers have not made changes in the way they deliver healthcare services to reap its benefits, according to Arthur Kellerman, M.D., a policy analyst with RAND Corp., who writes in this month's Health Affairs.

The analysis--which is co-authored by Spencer Jones, Ph.D., an information scientist at RAND and an instructor in the Division of General Internal Medicine at Brigham and Women's Hospital and Harvard Medical School--follows up on a widely cited 2005 report that concluded that rapid adoption of health IT could save the U.S. more than $81 billion annually. The results since then are mixed, according to Kellerman and Jones, though, they point out, healthcare spending has grown by $800 billion annually.

For patients and clinicians, modern electronic health record software at times "functions less as ATM cards, allowing a patient or provider to access needed health information anywhere at any time, than as frequent flier cards intended to enforce brand loyalty to a particular health care system," Kellerman and Jones say. They cite poor planning in the rush to claim federal incentives, requiring repeated investment in software tweaks and workflow burdens for doctors and other healthcare workers.

Among the recommendations outlined, according to an announcement touting the analysis:

  • Health information stored in one IT system must be retrievable by others, including doctors and hospitals that are a part of other health systems.
  • Patients should have ready access to and the ability to share their electronic health information, much as consumers now have access to their bank accounts.
  • Health IT systems must be engineered to aid the work of clinicians, not hinder it. Systems should be intuitive, so they can be used by busy health care providers without extensive training.

"We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data," Kellerman and Jones write. "Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume."

Interoperability issues have been a common complaint with health IT systems, with interoperability failures listed among the 10 top health technology hazards in a November report by ECRI Institute.

National Coordinator for Health IT Farzad Mostashari, in a congressional hearing in November, cited the need for a delicate balance between the urgency to modernize the U.S. healthcare system and the pace of change that can be absorbed by both providers and IT vendors. He said that although meeting Meaningful Use was meant to be challenging, substantial progress has been made to improve interoperability.

To learn more:
- read the Health Affairs abstract
- here's the RAND announcement

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