Medical laboratory professionals will be surprised to learn that some experts claim American healthcare will not see a return on investment from use of EHR systems
It is the popular wisdom today that universal adoption of electronic health record (EHR) systems will lead to significant improvements in patient outcomes, while also delivering substantial cost savings to the American health system.
However, this trend also requires clinical laboratories to spend substantial amounts of money to provide electronic interfaces between their laboratory information systems (LIS) and EHR systems of their client physicians.
Until recently, very little criticism of these federal EHR subsidies has appeared in the media. However, some experts now assert that tens of billions of dollars hospitals and physicians are spending to implement EHRs and integrate their information systems will never be recouped by downstream savings.
Recently The Wall Street Journal published such criticisms from two prominent experts, who did not mince words about what that they thought about savings expected from universal adoption of EHRs. “The savings claimed…are little more than hype,” alleged authors Stephen B. Soumerai, Sc.D. and Ross Koppel, Ph.D.. Their views were published by The Wall Street Journal in an opinion piece earlier this fall.
The McMaster Overview Study of HIT Cost-Effectiveness
The purpose of the McMaster study was to review and synthesize the evidence on the cost-effectiveness of health information technology (HIT) in the medication process. The study was first published in the Journal of American Informatics Association (JAMIA) on October 7, 2011.
Authors of the MacMaster paper reviewed a number of published studies relating to the use of healthcare information technology to support patient care. From that group of studies, they identified only 31 studies that specifically examined patient outcomes within the context of the cost-savings claims for use of HIT.
Soumerai and Koppel refer to the McMaster study as “a comprehensive evaluation of the scientific literature.” The McMaster study researchers reviewed almost 36,000 HIT studies.
Soumerai and Koppel concluded that the McMaster study “has confirmed what many researchers suspected.” The two experts then characterized the findings of the McMaster study by stating that “the savings claimed by government agencies and vendors of health IT are little more than hype.”
Soumerai and Koppel referenced, without citation, three studies examined in the McMaster review which found, respectively, no savings, an increase in costs, and a “small and statistically questionable savings.” From that, the pair concluded: “With a few isolated exceptions, the preponderance of evidence shows that the systems had not improved health or saved money.”
Soumerai and Koppel do not indicate any timeframe reference point with regard to either:
- what may be a reasonable timeframe for wide-scale implementation of HIT, nor
- what may be a reasonable timeframe for assessing the ultimate effectiveness of HIT.
The conclusions of Soumerai and Koppel appear to be at odds with those expressed by the authors of the McMaster study, as presented in the discussion and conclusion sections of the study.
For example, the McMaster study authors stated in the discussion section of the study abstract, “Most studies [involved in the overview] merely provided cost data; however, useful economic data involves far more input [emphasis added]. A full economic evaluation includes a full enumeration of the costs, synthesized with the outcomes of the intervention [emphasis added].”
Further, in the conclusion section of the study abstract, the McMaster study authors stated: “A few studies found that HIT may offer cost advantages despite their increased acquisition costs. However, given the uncertainty that surrounds the costs and outcomes data and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for the money.”
But, the findings of the McMaster study may not be so conclusive. According to the abstract, only five of the reviewed studies performed full economic evaluations. “Relative to the volume of research evidence…the amount of literature evaluating the economic impact of these systems lags far behind,” the study authors wrote.
Is It Premature to Comprehensively Assess HIT Effectiveness?
Some industry observers suggest that it is too early to draw definitive conclusions regarding the ultimate value of HIT. “The cost savings [from EHR adoption and use] envisioned by the government are based on a fully digitized and connected healthcare system that leverages a full array of decision support and business intelligence tools,” stated Ken Congdon, Editor in Chief at Healthcare Technology Online (HTO) in an HTO posting, titled “Health IT Savings Are Not Hype”.
Even the McMaster study authors wrote that the promise of HIT is to increase efficiency of care delivery, improve quality of care, reduce costs, and save money over the longer term.
In voicing their criticisms of the larger national effort to encourage universal provider use of EHR systems, Soumerai and Koppel stated that the McMaster study “found no evidence from four to five decades of studies that health IT reduces overall health costs.” In the discussion section of the study’s findings, the McMaster study authors noted that 74% of the articles reviewed were published since 2001. Further, they acknowledged that the quality of available economic evidence to assess cost-effectiveness of HIT is poor.
“Studying the impact of IT on the entire healthcare industry today is like studying the impact of the airplane on the travel industry based on the Wright Brothers’ plane,” Congdon declared.
Observers Agree that HIT Has Shortcomings
Congdon agreed with Soumerai and Koppel that HIT is “generally clunky, frustrating, user-unfriendly and inefficient.” However, he attributed the shortcomings to the fact that the technology in its infancy. “The federal government is essentially motivating mass adoption of a technology that is not yet mature,” Congdon stated. He observed that the economically crippling cost of healthcare is the likely reason behind the federal government’s decision to “force the issue.”
Pathologists and clinical laboratory managers should consider the criticisms of Soumerai and Koppel—as published by a national media source like The Wall Street Journal—to be the opening round in the coming debate about the true cost-effectiveness of widespread EHR adoption. Other voices of opposition to the structure, design, and financial cost of the federal EHR subsidy program should be expected.
In the meantime, clinical labs and pathology groups must face today’s reality. As the proportion of physicians using EMRs continues toward 100% adoption, labs will need to provide the informatics integration necessary to support electronic test orders and electronic test reporting from their client physicians.
—Pamela Scherer McLeod