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Here Comes the Stimulus Money, Now Spend It Wisely

Kathryn Mackenzie, for HealthLeaders Media, February 24, 2009

Now that the $787 billion American Recovery and Reinvestment Act has been signed into law and billions of dollars are about to be funneled into HIT, the promise of improved care through technology has become something of a mantra: If you implement an electronic medical record, you will save money and more of your patients will survive.

Seems like a fairly simple equation, and a recent study from UT Southwestern certainly bolsters that notion, concluding that hospitals that use EMRs, CPOE, and clinical decision support systems saw a 15% decrease in the odds of in-hospital deaths. But one of the study's lead researchers warns that simply acquiring and installing these systems won't be enough.

The study compared 41 urban hospitals in Texas using an instrument created by the researchers that measures physicians' interactions with information systems. The researchers examined the rates of inpatient death, complications, costs, and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same time frame in 2005 and 2006.

What they found was that, for all of the medical conditions studied, increased automation of notes and records was associated with a 15% decrease in the odds of in-hospital death. At hospitals with higher order entry scores, those patients with myocardial infarction had 9% lower odds of death and those undergoing coronary artery bypass graft had 55% lower odds of death.

Though Ruben Amarasingham, MD, assistant professor of internal medicine at UT Southwestern and associate chief of medicine at Parkland Health & Hospital System in Dallas, says he was encouraged by the study's outcomes, he cautions that hospitals should take the time to come up with a strategic, collaborative deployment plan before rushing out to spend their share of the stimulus money.

I recently had a chance to speak with Amarasingham, who shared his thoughts on the stimulus plan, the UT Southwestern study, and what's been holding up EMR adoption.

Kathryn Mackenzie: What effect do you think the $19 billion in the stimulus bill dedicated to healthcare information technology will have on EMR adoption?

Ruben Amarasingham, MD: It's hard to know how much money is needed. There have been some studies that have modeled this theoretically that would suggest it might be between $150 to $200 billion to really automate the entire country from head to toe. If that were the case, this would be at the minimum a down payment. These systems take a long time to implement and implementation has to be done very thoughtfully. One concern I would have is that hospitals that are somewhat naïve to the process would rapidly try to implement these systems and they may not have some of these cultural aspects worked out. Overall, I think it is the right move and is a very wise investment, but I would be concerned about the unintended consequences of doing it too rapidly and not taking the appropriate non-technological steps such as building the right culture and socio-technical environment.

I would also caution that hospitals need to carefully vet the various information technology products within this multi-billion dollar industry. There are some wonderful products out there, but there are also products that are sub-optimal. Smaller systems especially will have to have a good vetting process for that.

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