Improving Health Care Quality Through Electronic Health Records

In this post, I would like to share a video I watched recently which examines the use of Electronic Health Records (EHRs) to improve quality of healthcare. The video- posted by HRSA- is fairly long but also very informative. Enjoy it.

Can Information Technology Improve Readmission Rates?

Source: Vital Partners

Many factors have been found to be associated with readmissions according to a study done by Allison Nudge and colleagues in Australia.  The authors showed a correlation between readmissions rate and factors like co-morbidities, nutritional status and mood  of the patients. They studied patients with chronic conditions who had two or more admissions in six months. The rate of readmissions is an important issue for hospital administrators and policy makers because of their relationship to increasing costs, especially in health systems that use the DRG (Diagnosis Related Group) payment system like the United States.

It is within this backdrop that I discuss the ability of information technology to help solve or at least, reduce this problem. Carol Everhart, in an article published online in Pharmacy Choice, opined that hospitals should pay attention to the particular reasons why individual patients are returning to the hospital after being discharged home and not focus solely on aggregated hospital data.

How can hospitals do this? It is obvious as shown in Nudge's paper, that one readmission drastically increases the risk for repeat readmissions as well as other factors she described. Granted, there is not much that can be done by physicians without electronic medical records and so, my suggestions are going to be based on situations where there are clinical decision making tools like CDSS (for an understanding of this, see my previous posts).

Is it possible to write a program such that the presence of these risk factors for readmissions are coded in the electronic medical records and a warning system is put in place such that the physician in charge is able to activate an anti-readmissions protocol which can help reduce the likelihood of another readmission? By all indications, this is possible and I am almost sure that this is been put in place somewhere. If you have an idea of where this occurs, please let me know.

We would do well to note that many factors that predispose to readmissions are not known at the time of discharge and consequently, cannot be predicted. However, most of them are known and the patient can benefit from these interventions which can also help the hospital save costs. Will these technological innovations be useful for preventing readmissions that are due to nutritional problems or mood/ psychological imbalances as discussed by Nudge et. al? I guess we just have to keep our fingers crossed.

In my next post, I will report such technological innovations and where they are being put into use.

Readmissions is a very exciting area that I look forward to exploring going forward.

Technology to Improve Patients' Adherence to Medication

I will like to share with you as promised, a technology based initiative that I believe will help improve patient adherence. This program will involve a combination of periodic text messages or e-mails informing patients of the time to take their medication coupled with an alarm fitted on the medication packet that can only be stopped after the patient takes the pill.

Description: the pills will be in an electronic container that will beep like an alarm clock at the time the drug is due to be taken. The alarm only stops when the pill is removed. At the same time, a text message or email will be sent daily to remind the patient. For multiple pills, a computer program can be used.

The initiative has two potential disadvantages: one is that the patient can develop alert fatigue, that is, gets “numbed” to the alerts and might develop an aversion to the system. This can only be solved by a patient education program which must run concurrently. The other is that the system does not actually tell if the patient takes the medication, it only tells if the pill was removed.

Options: The patient will be placed in the program by default but can only opt-out if the physician decides that the patient is not at risk of default, evidenced by writing a letter of undertaking on behalf of the patient.

The mechanism involves active choice by the patient. The patient can only opt out after showing a record of adherence for a period of time, say 3 months after which the doctor can vouch for him/her.

Consequences of default were described by Martin et al. (2005) and include development of worse symptoms, progression of disease to more fatal stages, higher cost of treatment, increased risk of infecting others, time wasting seeking treatment, inefficiency of health systems etc

The program does not preserve the choice of the patient to a large extent. However, with the concurrent patient education program, the patient can be made to understand that the risk of default are too great and that if he complies, he does not have to get an alarm ring and he can be out of the program after 3 months if he complies. The program would be cost effective in that it would save the health system from bearing the cost burden of non-adherence

Reference

Leslie R Martin, Summer L Williams, Kelly B Haskard  and M Robin DiMatteo (2005). The challenge of patient adherence; Journal of Clinical Risk Management, September; 1(3): 189–199.

Future of IT in Hospital Care

I asked a question in my last post, “What will the future of healthcare look like?” I could also ask that question in another way: “How will information technology impact the way we practice medicine and interact with hospitals? I will attempt to answer the question in different domains:

Source: nyp.org

1.     Disease Diagnosis:  The emphasis on disease management might change in the next 50 years to the development of “diagnostic supercomputers” that can scan the individual, take the vital signs, check important chemical substances like electrolytes, hemoglobin, bicarbonates and other biomedical markers and come up with a diagnosis in a matter of minutes. The role of the doctor might then be to “discuss” with the machine about the rationale for making that diagnosis as well as explore other potential differentials. This goes a step ahead of the currently used clinical decision making systems in that the decisions might be made by the computer and doctors then help to serve as checks and balances.

2.     Patient Treatment: This means that almost no human contact will be needed to prescribe and dispense drugs for patients. The risk of wrong prescription or dispensing will be minimized and pharmacists will only need to monitor the computer programs, much as is being done in hospitals like Bumrungrad today. However, in the hospital of the future, the computer will send the drug prescription directly to the dispensing computer that will ensure that the drugs are given directly to the patient. This system could be expanded to involve medication adherence systems. I will discuss this in a later post.

3.     Streamlined electronic health records: in the health care system of the future, humans will have one unique medical record which they will have access to anytime, anywhere. This can be pulled up at accident scenes, operating theatres, outpatient facilities, etc. This personalized health record will be totally “virtual” and will carry a unique ID much like the social security number. It is personal to the patient and then, patient notes do not need to be carried about they are stored and retrievable but can be accessed remotely anytime

4.     Voice Recognition: There might be no need to write notes by the physician as systems of that day but the system will have automatic voice-recognition software. This will enable the doctor to save money and time because the computer will have the ability to write the notes for the doctor.

5.     Others: There are so many things that will change which cannot be foreseen at the moment but I think that most of it will be beneficial as it has been shown now. However it is important to remember that all innovations in technology might have unintended consequences and it is important to weave-in monitoring and evaluation as an important part of the utilization of new technologies.

Discussion on the Transformational Effect of IT on Health Care

The story of Oleg drives home the importance of quality in health care- which everyone seems to agree about. It also more importantly, stresses the value of information technology in helping to push the frontier of quality in the healthcare industry.

It is important to step away from the patients' point of view and focus instead; in this post on describing the various dimensions that quality in health care might take. It is a futuristic look at the various roles that health information technology might take in the hospital of the future, say 200 years from now.

The advantage of looking into the future is similar to the benefits derived from making sci-fi films which depict scenarios that might happen light years ahead of them. In an uncanny way, these movies seem to come to pass because they open up the imagination to think of the possibilities that might arise from new discoveries and these imaginations drive us to create the realities.

What will the hospital of the future look like? This question could be answered both regressively (looking backwards) and prospectively (looking forward). If that question were answered in the early 1800s, many people might not be able to predict so accurately, the role that information technology has played in our lives thus far. In the early 1800s with the prevalence of so many deadly communicable diseases like the plague or the black death, cholera, small pox and bacterial infections, surgery must have been very limited, however with the advent of the microscope many year later, we could see gems and Alexander Fleming discovered antibiotics. These discoveries changed the way we practice medicine and opened us up to brand new ways of providing healthcare.

I would like to postulate that on an even keel, one of the best discoveries to impact people’s health in this day and age is- you guessed it- the personal computer. With the advent of modern computing and the internet, technology has encroached in our lives in so many ways than we could ever predict. It has changed the way we manufacture, live, run our businesses and even interact with each other. After all, before these inventions, we would not be able to communicate in this way and we might not be able to share information as rapidly about the ever changing world of diseases and their management. So, what does the hospital of the future look like and what will health care look like many, many years from now? I will discuss that shortly.

A Patient's Perspective (2)- The Story of Oleg

Source: EnglishRussia.com

Oleg was born in the city of Omsk on a warm summer day in Russia twenty years ago. His parents were poor peasants who worked hard and saved some money to send their son to school. His dad worked in the lumber company in a nearby town while his mother taught in the local elementary school. He was the second child but his birth was celebrated with much pomp and pageantry in line with local customs, almost as though he were the first child. This is because he was born seven years after his elder brother. His naming ceremony was attended by almost everyone in the town and he was showered with gifts by so many well-wishers.

Oleg grew up with his mother and father doting over him, but at about the age of five years, he was sickly and was not allowed to play with the kids for fear of “catching a fever”. Everyone thought he was just spoiled silly, but his parents suspected something was wrong. They had gone to the local doctor so many times but he assured them that Oleg was fine and that he was only passing through this phase.

The Road from Omsk.
Source:omskcityblogspot

Then one cold December morning, Oleg complained of weakness of his limbs and for the entire day, could not move his legs or arms and was crying due to the excessive pain. Panic-stricken, the parents rushed him to the local doctor who was at a loss about what to do. The primary care doctor could only guess what this strange condition was- he had no way to test the child in order to make a diagnosis, he did not even have painkillers strong enough to stop the pain. He tried calling the hospital at the next town but there was nothing they could do- they had to try to bring the child to the hospital the next morning. At dawn, the parents and the family doctor set forth to go to the hospital, four hours away by road - the child cried all the way to the hospital.

At the local district hospital, the doctors succeeded in giving the child some very strong painkillers and he slept fitfully- for the first time in 2 days. Alas, the hospital did not have the necessary equipment to diagnose the condition and they had to refer to the specialist hospital in far away Moscow. Could they call the doctors over there so they could have a discussion about the case? Yes but the phone call was limited because the specialist could not see the patient- he could only rely on what the other doctors said.  Finally, they agreed to send the child to Moscow but the parents refused. They had no money. How could they fly their son to Moscow? How could they even afford his medical bills? There was simply no way. Sophia, Oleg’s mother wept bitterly.

Russian Specialist Hospital
Source:Indiabizclub

The people from the town took a collection for the family and they were finally able to send Oleg to Moscow for specialist care. The tests were done and the doctors argued bitterly over the possible diagnosis. Lou Gehrig’s disease? Amyotrophic lateral sclerosis? Guillain Barre’s syndrome? They finally had to make use of the hospital’s newly installed Clinical Decision Support System to make a final diagnosis in line with current evidence based research: Multiple Sclerosis.

The clinicians were glad that their multi-million ruble electronic medical record fitted with a state-of-the-art clinical decision support system was finally yielding dividends. However, the battle for Oleg’s life had just begun…

Patients' Perspective of IT and Quality of Care

A few of my readers have asked me to be slightly less “technical” in my writing as some of the material seemed too arcane for some readers who are non-medical or non-information technology savvy. In the light of this, I have decided to make this post a little less technical and address it to a broader audience.

What I will like to discuss this time, is essentially quality control and information technology from the perspective of a patient and not from the angle of the technicians or service providers. I want to make a case for the importance of the uptake of information technology in every sphere of the health care value chain. By this term, I mean the entire gamut of patient care from the time the patient gets sick to the time he/ she comes in contact with the service provider until the time he/she is discharged.  All the transactions that take place during this interaction are important and as we know, it affects the final outcome: basically whether the patient gets well completely, his/her condition is managed properly such that they can live comfortably with the complications or the patient gets worse (hopefully not) or dies (heaven forbid!).

Source: iStockPhoto

Every contact with care providers is thus important for the patient and also for the provider in many ways. Every patient is an opportunity for the medical personnel- nurses, doctors, pharmacists, physiotherapists, etc to learn about the case and get better- this is the idea behind teaching hospitals. In addition, every patient is a unique source of data. Even though this might sound strange to some readers, it is very true. From preventive health interventions to the first time the patient comes in, the patient supplies data- about time of entry, presenting complaint, diagnosis, drug interactions, drug efficacy, efficacy of medical interventions, infection control… the list is virtually endless. The data collected can then be utilized to improve medical processes and care for patients.

Despite these however, the average patient does not care for the various terminologies, but basically about this: “help me get well, with effective but inexpensive medical care that will help me have a better quality of life”. To the trained eye, the statement is very complicated as there is an entire range of arguable definitions like, how do you define “humane treatment”, “inexpensive”, “quality of life” etc. To the patient however, it is simple.

We will explore this through the hypothetical experiences of two patients in two different contexts: Oleg in Omsk, Russia and Sama in Bombay, India.

I will tell you their story in the next few posts.

Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 4)

Before going back to the story of Oleg and Sama, I want to quickly discuss the effect of clinical decision support systems on patient care.

Open clinical, a knowledge management website, shown below, highlights a few research articles which investigate the use of clinical decision support systems and their effect on quality across various dimensions including diagnostic decision making, disease management, etc.  If you click on the picture, you can access these articles.

 After going through the literature, make up your own mind about the overall effect of CDSS on quality.

When you do, let me know what you decided.

Up next, the story of Oleg and Sama 

Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 3)

Unintended Consequences of Clinical Decision Support Systems

Source:SailingScuttle

Now, I will go a step further to discuss the unintended consequences of CDSS. These can be seen as side effects or unforeseen consequences of the implementation of these systems. A lot of the information in this article will be taken from the article by Joan Ash and colleagues at the School of Medicine, Oregon Health and Science University in Portland Oregon. For the complete paper, click here.

The authors of this paper highlighted a few unintended consequences of clinical decision support systems which they found during their qualitative research in the form of observation and formal interviews. They noted that these unintended consequences were derived from either the content of the information or the way the information was presented to the health professional in question.

Source: Creative Nursing Education

Major consequences related to content included the fact that the database had to be updated pretty frequently due to new evidence and expanding knowledge in various fields. Sometimes this is not done quickly enough and can give rise to problems later on. Another related problem is that the content might just be plain incorrect due to errors in the algorithmic process or inaccurate information leading to a general mistrust and lack of use of the system in general.

Possible consequences related to the way the information is processed include the major problem of alert-fatigue,when the sheer number of alerts causes you to ignore most of the alerts which are considered superfluous but also mean some important alerts are likely to be ignored.

Other consequences can include input errors like typographical errors and mis-insertion of data like choosing the wrong option on a list as well as rigid systems which might not be configured to meet the exigencies of medical practice which is invariably more flexible.

These unintended consequences need to be factored in when designing clinical decision support systems and steps taken to remedy these problems when they arise.

Do not forget to comment on the discussion section in the previous post. Stay tuned for part 4

Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 2)

Clinical Decision Support Systems (CDSS) are a part of the spectrum of the capabilities of health information systems which have a transformational effect on the way medicine is practiced. They are defined by Musen et al., as any computer program designed to help healthcare professionals to make clinical decisions.  These tools are generally divided into:

1. Tools that focus attention e.g. focus on information that might be overlooked by the physician. An example is “case 1” in my previous post
2. Tools for information management: these tools help to retrieve information like textbooks and stored personal notes in a timely manner
3. Tools for providing patient specific recommendations: these provide advice based on data that is specific to individual patients.

These systems can be used for preventive care, diagnosis, planning or implementing treatment, follow-up management, hospital provider efficiency, cost reductions and improved patient convenience according to Berner et al.

These different uses of clinical support systems are not so clearly delineated but there are many areas of overlap. However, according to Musen et al., they can also be divided into tools that help with patient diagnosis and tools that help with patient management. These two are important distinctions and the authors discussed that there are two modes of interaction with these systems viz.: the consulting model in which the program advises the physician about patient care and the critiquing model, where the system evaluates the physician’s proposed line of management and corrects the choices he makes.

Despite the various classifications, it is clear that the systems cannot stand alone like the gadget in the movie, Star Trek which could be pointed at a sick person and make a diagnosis on the spot. Rather, it works hand in hand with the physician to make more effective choices that are beneficial to the patient. Some people think however, that there might be an effect on the clinical ability of the physician in the long run. I will resist the temptation to discuss this now, but will address this in subsequent posts. I will however like to know your thoughts on the matter as I have posted in the discussion session below. The utility of these systems and potential side effects will be discussed in my next posting. Stay tuned.

Below, is a video by Tom Garithe, the Editor-in-Chief of the American Journal of Obstetrics and Gynecology describing the difference between Electronic Medical Records and CDSS:

For discussion: 

Do you think clinical support systems will reduce the clinical acumen of physicians in the long run?

Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 1)

Scenario 1:
 Imagine a cancer patient with a cocktail of medication. The physician wants to prescribe another medication for a recently discovered symptom. Should she prescribe drug A or B? Will there be any interaction with the current medication? She can tell if it will interact with some of the drugs, but not all- she decides to prescribe it anyway. Immediately she places the order, the computer system gives a warning beep followed by  sign: "potential drug interaction!" the doctor is thankful- she would not have thought of that problem and the pharmacist might not even have detected it. Such is the role of clinical support systems. Consider a similar warning sign below:

Source:Journal of Medical Internet Research

Scenario 2:
A physician is seeing a rare form of a disease. He last saw a similar patient during his residency program three years ago. He decides to place the patient on a particular line of management, as was done with the previous patient. As soon as he does this, a gentle alert is shown stating that studies show that there is a better line of management available, so he should re-consider his disease management plan.
These two hypothetical scenarios highlight the importance of clinical decision support systems.


In our ongoing discussions about quality in healthcare and the role of information technology, I have decided to discuss clinical decision support systems. In general, any intervention or program that can support a physician in making a diagnosis is a clinical decision support tool. An example of this might be a clinical handbook in a physician's pocket, a pharmacopoeia or prescribing guidelines- these provide support to the physician making a diagnosis and help her make appropriate decisions about the care of the patient. You would however have noticed that these tools are only useful at the point of care. There is no point having these tools after the patient has been discharged. These tools are also only for support and should not try to supplant the clinical acumen of the physician or his "cultivated intuition".

Source: juneshlam.com

Information technology seeks to make the use of these tools more efficient and relevant. To do this, the technology  has to have the features I mentioned above and more. Clinical decision support systems were thus developed to have the functionality of all these tools and be more accessible, but more importantly, they usually ride on already established health information systems or electronic health records. Without this, they would be relegated to the background or better termed "clinical reference tools"

How are these systems used and what can they do? These will be discussed in part II of this series. In part III, I will discus potential "side effects" or unintended consequences of these tools. In Part IV, I will discuss their impact on quality and if there is any evidence in this regard.

I would be glad to read your comments.

Practical Examples of Use of IT to Improve Processes and Save Costs

In this new post, I will be sharing a few examples of hospitals around the world that have incorporated information technology into their clinical as well as allied operations. These hospitals are known as "digital hospitals" and many of them declare that they have markedly improved patient outcomes, reduced medical errors while resulting in cumulative cost savings in the long run. These sophisticated systems are indeed a sight to behold and may indeed become the "hospital of the future".

1. Hackensack University Medical Centre, New Jersey

Source: Business Week

This hospital was featured by Business Week. According to the article, it has spent over $72 million in advanced technology infrastructure and has achieved a 16% decline in mortality. The images and reports are stunning. Click here to view the full article.

2. Bumrungrad International Hospital

Source: Global Health Travel

This hospital is best experienced than explained. Situated in Bangkok, Thailand, it is a major destination for international medical tourism and one of the "all digital" hospitals. See below for a video tour of the hospital:
Virtual Tour of Bumrungrad Hospital (Video)

3. St. Olav's Hospital, Norway

Play video by clicking here

4. SingHealth Group
This public hospital was a finalist at the Copenhagen Challenge 2008 for its innovation in digitalizing healthcare. Click for website: Sing Health

5. University Clinic of Jena, Germany
Click on this link for a video on this digital hospital in the heart of Europe

This list is by no means exhaustive, but gives you an idea of how many hospitals are leveraging on information technology to improve the care they provide for patients and save costs in the long run. Hopefully, more hospitals will follow suit.

Supply Chain Management: A Vital Role for IT in Health Care Quality Improvement

Variation, Fluctuation, Volatility, Deviation. These terms are anathema to a quality control executive. Imagine that every time you bought your favorite drink, say a diet coke, it tasted different every time, or worse, if you took a pill, say acetaminophen (a pain-killer), you had different constituents in every pill. Wouldn't that be disastrous?

In many industries like manufacturing, engineering, the military and even many service-oriented industries, quality control has been a major part of operations management for a very long time and is just gradually making inroads into the healthcare industry.

Historically, quality in medical care has been discussed in terms of patient outcomes, but with the prevalent drive to reduce costs, health care managers have been investigating innovative ways to drive down cost and improve quality at the same time. What better way to do this than to focus on supply chain management? According to the Association for Healthcare Resource and Materials Management, supplies cost almost as much as 31% of a hospital's expenses on a per case basis, a rise of nearly 40% between 2003 and 2005, as reported by the W.P. Carey School of Health Management and Policy. Supply chain management also directly impacts patient quality, particularly in areas of healthcare that are heavily reliant on supplies like Orthopedics, Cardiac Surgery, etc. This means that any method that can make a hospital's supply chain management more effective will go a long way to improve patient outcomes as well as reduce cost.

Supply chain management is increasingly being used in the healthcare industry to manage inventory levels and improve operational efficiency. An example is the Sisters of Mercy Health System in St. Louis, Missouri which is composed of about 18 acute care hospitals. They employ a Resource Optimization Innovation (ROI) system which is designed to fully automate and integrate all supply chain processes for the consortium. According to the Vice President of Performance Consulting, Marita Parks, this system resulted in increased revenue of $24 million in 2007 with a 7.4 to 1 return on the initial investment. This is not an isolated case as other large hospitals and hospital chains in the US like the Nebraska Orthopedic Hospital and the Johns Hopkins Hospital Group have put in place fully, automated supply management systems to deliver superior results.  See this link for the full article.


Outside the United States, Apollo Hospitals Group, an India Based consortium have also implemented such systems. More impressive however, is the Bumrungrad hospital in Bangkok, Thailand that has been called the "all digital hospital". According to Ravi Aron, the hospital has installed fully automated processes for supply chain management and total quality control, which has assisted the company to post record profits in the 90th percentile compared to its counterparts.

(c) Baldwin Medical

While there is a lot more to be said, it is obvious that information technology offers huge potential benefits in the areas of cost reduction in supply chain management, which makes up a large chunk of hospital expenses. It should not just be seen as inventory control, but rather, a platform to integrate hospital procurement ans supply processes, to avoid redundancy and waste. Of course, we are doing these things to avoid those strange bedfellows I mentioned above: Variation, Fluctuation, Volatility and Deviation and in the process, saving valuable costs.

Supply Chain Management has a lot to offer the healthcare industry going forward, but without doubt, this will be driven by information technology and to borrow, the words of Professor Phil Carter, the supply chain industry of the future will "likely be complex, high-tech, supplier network-driven, and spread out across the globe"

Conclusive Evidence about Impact of IT on Health Care Quality?

In my previous entry, I opened up a discussion about the role of Information Technology in improving quality in healthcare and potentially reducing costs.

Source: Cartoon Stock

I did some more reading on the subject and found a fascinating paper or "systematic review" on the "Impact of Health Information Technology on Quality, Efficiency and Costs of Medical Care" by Basit Chaudhry and his colleagues at the Southern California Evidence Based Practice Center in Los Angeles, California. While I have a number of reservations about the methodology of this study and some of its selection criteria, I believe it might be useful in the current discourse.

The authors did well to note a few limitations of the study which include the number and scope of the articles used in the review. Due to the limited amount of quantitative data, they had to use primarily qualitative data, usually involving studies that were not all randomized controlled trials. In addition, they did not have the luxury of focusing on a specific set of technologies, but because the articles reported various types of technological innovations and used different methods for reporting the results, it was difficult to get a common measure of effect for all the various technologies under review.

Source: About.com

More importantly, the authors showed that there are some specific quality-related benefits of health information technology in the "benchmark institutions" they studied, particularly in the areas of increasing adherence to clinical guidelines focused on preventive care, clinical monitoring based on "large scale screening and aggregation of data" as well as increasing disease surveillance. As you might have noted, most of these quality outcomes are in the area of preventive health. I am not surprised that the authors did not report finding a lot of quality outcomes related to inpatient care or chronic disease care- this is partly due to the nature of the limitations reported above. They however found statistically significant findings on the reduction of antibiotics-related adverse drug events.

While I cannot mention all the findings here, it might be important to discuss the findings that relate to cost reduction. Firstly, the authors did not find many papers that investigated or reported this outcome or that could be relied upon. According to them, "most of the cost data available from the institutional leaders were related to changes in utilization of services due to health information technology. Only three studies had cost data on aspects of system implementation or maintenance. Two studies provided computer storage costs; these were more than 20 years old, however, and therefore were of limited relevance".

We definitely need more research on the role of Information Technology in health care. We however need to focus more on what the authors described as "commercially developed health information systems" which are different from home-grown or "internally-developed" systems. The reason is not far-fetched; with the growing demand for interoperability and "ready-to-use" systems, research with this focus, might be more useful to policy makers and organizatioins that need to implement these systems and do not have the time nor the funds to grow their systems from the scratch.

Source: WellSphere

What we need more importantly in my opinion, is a strong evidence base about the true role of Information Technology in reducing health care costs either in the long or the short run. This is important if you have even a modicum of belief in the trite mantra, "the rising cost of health care and the ever widening budget-deficit".

Share your thoughts with me.

Cost versus Quality in Healthcare: The Role of IT

I read an interesting paper today by Matt Thatcher and Jim Oliver, "The Impact of Information Technology on Quality Improvement, Productivity and Profits: An Analytical Model of a Monopolist". This paper made an important distinction between the cost reduction and quality improvement in health care especially as it relates to the role of information technology.

Copyright: Government Technology

In many articles and in discussions, many people take for granted that in the long run, information technology would inevitably lead to the reduction of cost and ultimately also lead to quality increases. These especially came to the fore during the health care reform debates when it was argued that health information technology would have these two desirable effects (see link for detailed description) without actually explaining how this would be so. In line with its goal of ultimately reducing costs while improving quality in the health sector, the Obama administration appointed David Blumenthal to head the Office of the National Coordinator for Health Information Technology, which is tasked with ensuring the smooth adoption of health information technology.
Despite these noble intentions however, the authors of the paper argue that cost reduction and quality improvement do not always go together and that "product quality improvements might come at the expense of firm productivity"

What then is the distinction? The authors argued that cost reduction occurs when the adoption of IT enables a firm produce more with less resources, thus reducing the unit cost of each product while quality improvement on the other hand occurs when IT helps to increase the desire of consumers to purchase or consume more of the product, in the medical field, it might be to make a more accurate diagnosis, to treat a disease more effectively and so on. The authors designed a model that suggested that you might  have one effect but not both- productivity might be affected- depending on the type of technology implemented

There is a caveat however. This model was developed for a single-product monopolistic firm. This is not true of most medical firms today. The question is how well this model will hold-up in the face of real companies and with real data.

The quest to improve quality is unending. The ability to reduce costs might not be so infinite- basic economics tells us so. The question is, in the words of a popular song, "how low can you go?"

Welcome to My Blog!

Hello,
Welcome to my blog. This blog was initiated at the request of Professor Ravi Aron of Johns Hopkins Carey Business School in partial fulfillment of the requirements of his course, IT Integration for Business. Even though the course is dedicated to Information Technology- thus, my initial posts will be devoted to mainly topics in IT and healthcare- I hope to utilize this blog to express some of my views and discuss some interesting issues over time.

Once again, I welcome you on this voyage of discovery. It promises to be an exciting one!