Day Two did provide more meat, in particular a session on ROI of HIT and another on e-Prescribing were good. The “Town Hall” event was a mixed bag and the session on Privacy and Security of HIEs was disappointing – not necessarily from a content perspective though.
Quick synopses of sessions:
ROI of HIT:
Investments in HIT do not demonstrate a good ROI by traditional financial measures – providers will need to look elsewhere.
One area that is seeing increasing attention is to look at cost effectiveness and cost avoidance metrics. A VP at Texas-based Baylor informed me that they are now turning to this approach, for example looking at the number of adverse drug events (ADE) avoided. The challenge they now have is determining what is the value of such avoidance. For example: Is a life saved by avoiding an ADE worth $1M? If yes, then the return from their HIT investments is quite impressive.
Despite the many sessions on HIT’s contribution to improving the quality of care, research to date has found no clinically significant statistically link that HIT improves quality.
If done properly, HIT will improve efficiency and effectiveness of providers, especially in chronic-care situations. There is less measurable impact to doctors, most is with secondary and tertiary care providers.
Privacy and Security:
Government contractor RTI International is leading the Health Information Security and Privacy Collaboration HISPC initiative for AHRQ. They did a comprehensive nationwide survey (some 4000 respondents) on privacy and security of healthcare information finding about 4000 different views of what constitutes privacy and security of health records. More info on RTI’s research can be found here.
Right now, States are struggling to get their own privacy and security house in order in terms of consistency, clarity and compliance.
Based on what I heard at this session, from RTI and several states, the broadly publicized Presidential mandate to create a National Health Information Network is but a pipe dream. We are many years, if not decades from such occurring.
During the Q&A session, I asked: What about the accelerating move to Consumer-driven Health and the PHR train coming down the tracks, e.g., Dosssia – how will they address privacy and security of health records in the PHR setting, what policies and strategies are they putting in place today for this eventuality?
Pretty much got just blank stares. The representative of NY did state that during Phase One of their effort (couple of years back) they did bring up the topic of PHRs, but tabled it and have no plans to go back to it at this time.
All I can say is WOW! Looks like we have a very long road ahead of us here and unfortunately, I do not see anyone at the Federal or even State level really grabbing this one by the proverbial horns.
Is everyone hoping that Consumer-driven Health and PHRs are just a passing fad?
Speaking of PHRs…
My BIGGEST complaint about this event is almost a complete and total avoidance of the subject during my two day attendance. Not sure if it’s just that AHRQ is not funding such research or the results aren’t in yet, either way this is not a topic that should be ignored to the extent that AHRQ did here. What gives AHRQ?
e-Prescribing:
Several AHRQ sponsored studies on e-Prescribing (eRx) found no clinically significant impact on minimizing ADE (adverse drug events) through use of eRx. This is a BIG finding as many proponents of eRx have been promoting its adoption to minimize ADE as a key selling point. With ADE related costs in excess of $3.5B/yr in hospital settings, $1B in long-term care and who knows how much in ambulatory settings, its back to the drawing boards to find another avenue to lower ADE as it won’t happen with the eRx solutions that are available in the market today.
Doctors are not the ones using eRx tools, it is the nurses and other clinical assistants at greater than a 4 to 1 margin in some settings.
eRx may not lower ADE, but it does save providers many precious minutes, particularly in determining eligibility. In a harried care environment, this can be significant.
In one case study, the use of eRx actually increased the average cost of medications and decreased the use of generics. This may be an anomaly, but if this starts showing up in future studies, another key selling point for adopting eRx (heavily promoted by payers) will also fall to the wayside.
Often, eRx can be quite difficult as it depends on more than just installing the software. It also requires a robust network. In one case study, when the eRx solution went live there were numerous false alerts leading caregivers to distrust the system and go back to traditional methods. In another, the lack of a robust network to pharmacies resulted in patient subscriptions not being delivered. Again, caregivers quickly lost faith in the system and efforts to encourage re-adoption have for the most part failed.
Wrap-up:
Yesterday’s posting was a little hard on the organizers of this event. It could be my background, having worked in both a government regulatory agency and academia and have seen more than my fair share of questionably funded research with equally questionable quality of research and dissemination of results. What I found during Day Two was still a preponderance of questionable research projects with equally questionable methodologies and an all too obvious disconnect to business/competitive issues, but let’s not throw out the baby with the bathwater. There is within AHRQ and among attendees a very real and earnest desire to improve the quality of healthcare and for that they deserve a round of applause. Take a bow AHRQ and attendees of this event.
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