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.