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While this solution may seem obvious, physicians and other healthcare providers have been extremely reluctant to install electronic patient networks, because they believe they have little to gain and much to lose.
Their concern is that such a system would require a substantial investment and, despite paying the freight, they would not take part in the economic benefits that accrue from it. In fact, their incomes could be lowered because improvements in care would limit the number of times patients need to be seen, and minimize the number of diagnostic procedures doctors perform.
Providers pay about $10,000 a year for electronic clinical data systems, according to an analysis by Partners HealthCare System in Boston, but of the $19,000 they save, two thirds ends up in the hands of those who pay for care.
To overcome this resistance to electronic clinical files, some patient advocates and insurers are taking steps to realign the healthcare model more along the traditional approach used by other industries. They are making those who stand to gain the most from the technology pay for it.
California's pay-for-performance system is one example.
Insurers, which profit directly from lower medical costs, are essentially subsidizing technology initiatives on the part of providers who could achieve savings in cost of treatment. There are about three dozen other similar pay-for-performance programs across the country, many backed by corporations whose healthcare costs are among the highest in the nation, including Ford Motor Co., General Electric Co., United Parcel Service Inc. and Verizon Communications Inc.
Ford Vice Chairman Allan Gilmour recently said the automaker spent $3.2 billion on healthcare in 2003 for 560,000 employees, retirees and their families, a tab that increased the price of each car and truck built in the U.S. by as much as $1,000.
Meanwhile, HHS, through its healthcare modernization plan, which calls for a universal electronic patient records system within ten years, is working on a program that would offer low-interest loans and grants to encourage physicians and hospitals to install this information technology.
The federal government's recommendations and initiatives carry enormous clout, because its massive healthcare agencies, particularly Medicare and Medicaid, are responsible for about 40 percent of the nation's medical payments.
"Everyone in healthcare supports universal electronic records, but the disagreement is over how to get there," says IHA's Williams. "There needs to be an organizing force, and only the federal government has the power and leverage to play this role."
|How Do We Get Value From Healthcare It?|
|Metrics should focus on the relationships between healthcare IT and the following:|
Cost reductions issuing from decreased administrative clinical staffing and resource requirements (i.e., elimination of paper chart pulls and transcription services).
Revenue enhancements resulting from improved charge capture and charge entry to billing times.
Productivity gains stemming from increased procedure volume, reductions in average length of stay, and increased transaction processing rates.
Service delivery advances from better adherence to clinical protocols and improvements in the stages of clinical decision-making (i.e., initiation, diagnostics, monitoring and tracking, and acting).
Clinical outcomes improvements represented as reductions in medical errors, decreases in morbidity and mortality, and expedited recovery times.
Stakeholder satisfaction improvements resulting from decreased wait times, improved access to healthcare information, and more positive perceptions of care quality and clinician efficacy.
Risk mitigation resulting from decreases in malpractice litigation and increased adherence to federal, state and accreditation organization standards.
Source: Center for IT Leadership, Partners Healthcare system
There's also motivation for some large hospital systems to install electronic records on their own, because improved patient care could lead to better agency rankings and, ultimately, additional revenue. That was the conclusion of the University of Pittsburgh Medical Center, which in 2000 developed one of the most successful computerized clinical care networks yet, a system the hospital calls eRecord.
This network, which will cost about $500 million over 12 years, allows doctors and other clinicians at eight of UPMC's 20 hospitals to see a patient's full medical record during treatment and to input additional steps or results learned during the session. In addition, prescriptions are entered electronically and automatically sent to the hospital's pharmacy to be filled immediately.
The system helps in decision-making, reminding a doctor ordering a CT scan that one was just conducted the day before, or alerting nurses and pharmacists that the patient has an allergy to the a drug they're contemplating prescribing. It also offers advice, such as sending a note to a physician that a patient on antibiotics who has been in the hospital for a long time and whose white blood count has gone up could be at risk for colitis.
UPMC executives are pleased with the results of the network, although so far, those results are mostly anecdotal. Write-ups of as many as 10,000 reports per month are instantly available to all clinicians now and are virtually free to compose and distribute, compared with the 38-hour delay and $10 per report fee that were the norm before the technology was installed.
Pharmacy costs at UPMC's largest hospital were about $34 million last year, down from $35 million the year beforean impressive achievement considering that total pharmaceutical expenditures in the U.S. were up about 12 percent last yearbecause of more efficient pharmacy management.
These gains, of course, potentially benefit the hospital, particularly its reputation, and insurers, who are paying less for patient care. But so far they're of limited value to physicians' pocketbooks and, thus, could repel rather than attract top clinicians. UPMC argues that physicians have to see the hidden value in clinical data systems, because one way or another, within the next decade these systems will help transform healthcare to the point where physicians will be able to treat some patients with common or recurrent symptoms completely by e-mail.
"Docs won't adopt this technology without remuneration, but they have to consider its possibilities," says Dr. Dan Martich, vice president of eRecord at UPMC and co-director of the cardiothoracic intensive care unit at the hospital center. "If you're a critical-care doctor seeing 20 patients in a day, you're working 8 a.m. to 6 p.m., or something like that, and getting from $10 to $60 a visit. If you lop off two or three visits, go home an hour or more earlier and instead do a dozen e-consults from home at $5 a clip, the whole thing is revenue neutral. And you get to spend more time away from the office. Or you could see more patients in the same amount of time because the technology makes the visits much more efficient. So you walk away with more money."