Health IT Report: Coordinating Patient Care Takes Back Seat to Processing Claims

By M.L. Baker  |  Posted 09-17-2005
Over the next five years, health information technology is likely to focus more and more on administrative functions like claims processing than on clinical functions, like viewing patient care and test results.

That's the conclusion of a group of Harvard Medical School faculty and clinicians established to predict the status of networked health information in the next five years.

The report also concluded that health IT's ability to help patients is hampered because providers have different IT capabilities.

Hospitals are rapidly adopting health IT, but when patients are discharged, electronic records don't move with them.

"The quality benefits of HIT systems will be limited as patients move from highly computerized settings to paper-based outpatient settings," the report stated. "These handoff points are particularly susceptible to errors."

The Harvard study compared a so-called model NHIN (national health information network) that could be in place within five years to the likely NHIN that would exist if health IT trends continue at their current rates.

Information technology for handling administrative functions is already much more advanced than IT for clinical functions, but this study shows the gap widening, particularly for home health agencies and skilled nursing facilities.

The reason for the growing gap is simple: The financial benefits for administrative functions are clear, and those that pay for the systems reap the financial benefits.

In addition HIPAA has pushed institutions to submit claims electronically. A related report found that electronic health records could benefit small practices financially but would improve clinical care only slightly.

The benefit came largely through a process called "charge capture": physicians billed for more of the services that they were already providing.

Understanding exactly who benefits from electronic health records, and how much, is at the heart of a debate between health care providers and health care payers.

Clinicians say they are pressured to purchase expensive systems that primarily benefit payers.

Payers don't want to help physicians purchase systems that will help provide care to competitors' clients.

However, in regions where a handful of insurance companies cover a high percentage of patients, some creative collaborations are under way.

The Harvard group also concluded that financial incentives for clinicians or other regulations would accelerate health IT.

"Had a standard for electronic transaction not been mandated through HIPAA, paper-based claims submission would undoubtedly be far more prevalent today."

The study was published this week in the scholarly journal Health Affairs.

In an accompanying interview, the national health IT czar David Brailer said that common standards are a major barrier to a national health information network, but that any standards dictated by regulation would be out of date as soon as they were done.

The free market approach is working, though not as fast as it could, said Manuel Lowenhaupt, partner at Accenture's Health and Life Science Practice.

"We're seeing the market in the U.S. incrementally increase adoption; especially over the past year, we've witnessed a renewed industry and government commitment to tackling some of the existing hurdles. However, challenges remain in the area of privacy and the existence of competitive drivers encouraging the adoption of proprietary solutions."

For the maximum benefits, health IT must be interoperable, and for that to happen, vendors need to use common reference architecture and standards.

The technical expertise is abundant, Brailer said, it's the political will that's lacking. But he reiterated that health IT must progress through collaboration rather than regulation.

This week, the Department of Health and Human Services announced 16 commissioners of the newly instituted American Health Information Community, a group of thought leaders charged with recommending architecture, standards, certification process and a method of governance for ongoing implementation of health IT.

Brailer said the American Health Information Community, "people who are not technical experts but rather decision makers," would push IT forward and create a sense of urgency.

"The reason standard organizations are taking a long time," he said, "is because there's no one standing by the door to the doctor's office saying, would you please hurry up?"