RAND Walks Back HIT Savings Estimates
"We're moving as fast as we can"
John Halamka, MD, CIO at Beth Israel Deaconess Medical Center in Boston, says that the savings from EHR haven't been realized yet because "we are still at an early stage of EHR implementation, healthcare information exchange connectivity, and decision support. Meaningful Use Stage 2 in 2014 will take us to a new level that will begin to reduce redundancy, over treatment, and waste. Stage 3 in 2016 will take us even further by enhancing outcomes."
"We're on a journey and I have every expectation we'll change the practice of medicine to improve its value (quality/cost)," Halamka wrote in an email exchange. "We're moving as fast as we can to accomplish this and I believe by 2016 we'll realize the improvements we're seeking from the meaningful use foundation we've built. Expecting significant cost reductions by 2013 is not realistic at this point in the process."
A lot of the nagging HIT problems
Jeff Smith, assistant director of public policy with the College of Healthcare Information Management Executives, concedes that HIT has been off to a sluggish start in some areas, but he says that is to be expected.
"It is something that you see especially in the technology world when you have these great expectations about what technology can do and when you start to implement the technology especially on such a wide scale you see that it doesn't always meet the highest expectations," Smith says. "I think when they came out with the $81 billion annual savings that was a high expectation first of all and it's a difficult calculation to come up with consistently."
That said, Smith adds that the report also identifies a lot of the nagging problems with HIT, including issues with interoperability and usability, the fragmentation of the vendor market, and a lack of patient-generated data.
"When we are looking at academic articles, they are relying on data in a high-tech world and even data up until now is going to have a certain bias towards the old way," he says. "So when you look at this article and other articles that focus on 'is health IT worth the ROI?' you really have to think 'well the data they are using is by and large contingent upon a world that was fragmented.'"
Stage 1 took great leaps and bounds toward the adoption of election health records, but it's not going to be until we get to Stage 2 that we start to see things coalesce, especially around standards that will lead to greater interoperability," he says.
"My initial reaction is [that] if they revisit this same study in another five years and they may the same conclusions then we might have some problems, we might really need to reassess what is going on.
"But the pieces that have been put in place in Stage 1 meaningful use generate data that didn't exist before and the pieces for Stage 2 will align the data in a standardized way so people can use it, and you are going to see a leapfrog effect."
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