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RAND Walks Back HIT Savings Estimates

John Commins, for HealthLeaders Media, January 14, 2013

EHR adoption "in its infancy"
Pamela McNutt, senior vice president/CIO at Dallas-based Methodist Health System, says HIT advocates were a little naïve early in the process.

"There was a bit of over-simplistic thought that if we just purchased and installed some software that suddenly everyone would start connecting and talking and it is premature," McNutt says. "Even people who have met high levels and are ready to meet Meaningful Use Stage 2 still have to work to get efficiencies."

"Adoption is happening, but it is still in its infancy," she says. "It is not mature, even for people who've met meaningful use Stage 1. That is the reason there are stages, they bring us to different levels of maturity. And this whole healthcare information exchange idea is also in its infancy. We haven't had enough time to see the impact. We do need organizational change. Things like shared-savings programs, medical homes that are going to drive the change from different directions. We are getting there but we aren't there. But nobody should be looking at this and saying it didn't work."

McNutt says the whole idea of "efficiencies" in HIT is a bit undefined. "We have to talk about what are the efficiencies we are looking for," she says.

"I don't think anyone went into this thinking that this would cut hours out of doctors' and nurses' time every day. But are we going to get better outcomes, less complications, less morbidity and mortality.  That all adds up to dollar savings in a different kind of way, but I don't think I'd call that efficiency."

McNutt says using HIT to reduce costs won't happen until it can be done on a population health basis.

"When records from all providers, post-acute, acute, pharmaceutical, when all of that can be put into a usable record, that is where we might begin to have some savings," she says.

"But the RAND study does make a point that probably is true—that even if you have all the tools in the world to see what is going on in the patient you have to change your work flow to use the information from those tools."


John Commins is a senior editor with HealthLeaders Media.

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2 comments on "RAND Walks Back HIT Savings Estimates"


Frank Poggio (1/14/2013 at 3:31 PM)
As one who has worked as a health provider CFO and CIO, systems developer/vendor, and health care consultant for over forty years I am not surprised Rand came to its current conclusion. I was really surprised when they said in 2005 we could save $80bill a year. In all my years of health care experience I have never seen a capital investment in healthcare/medicine actually save dollars when you take a total health system view. Think about it. Back in the 60's most lab procedures were done manually. So for better quality and efficiency we invented lab auto analyzers, they could do 2 to 4 chemistry tests all at once. In the 70's it went up to 20 tests, in the 90's it went up to 50 and it could be 'discreet' meaning you could pick and choose which test to run. Was all this more efficient? You bet it was. Was it better quality health care? Of course it was, and better quality (and quantity) generated far more information and as such identified many previously hidden patient medical problems. And finding more medical problems meant more health care was needed. The same can be said for Radiology, first simple Xrays, then CAT scans, PET scans,then NMR, and so on. More efficient, yes, better health care, yes, and more medical problems identified. In short, better diagnoses tools means you will always find more patient problems, which in turn demands more therapies, and more protocols, more specialists, and even more sophisticated tools. Then add to that an aging patient population, more chronic illnesses, and societal issues such as obesity. What we seem to forget (or ignore) is that health and medical care is not a zero sum game. We have absolutely no idea how many medical problems are out there. The human body is far too complex. Youare not born with with a maintenance manual or a trouble shooting guide. For over a thousand years, using trial and error, we have been trying to 'reverse engineer' the human body, trying to identify all these possible problems. Yet it seems for every one we do identify we find three more. All these wonderful medical devices have taken us deep into human biology and we still could fill an ocean with what we do not know. Looking at overall health expenditures and expecting EMRs to reduce them is like believing that the new screw driver set you just bought is all you'll need to fix your car. EMRs are no more than tool and a relatively simple one at that. Frank Poggio The Kelzon Group KelzonGroup.com

Jeff leston (1/14/2013 at 3:17 PM)
RAND- Those were the people who used to estimate how many millions would be killed in a nuclear war, right?