The fusion of x-ray capabilities with functional imaging technology such as SPECT and PET has resulted in hybrid equipment. The utilization of these modalities have resulted in greater diagnostic certainty and enhanced patient management through their advanced visualization capabilities. Until recently, fusing MRI with radiography has been problematic, with most solutions using a moving-bed patient system between MR and x-ray suites. A team from the department of radiology at The Ottawa Hospital in Ottawa has added to the armamentarium of fusion imaging with the creation and deployment of a MRI/radiography system.
Surely one of the most pronounced healthcare industry trends is towards "transparency." Hospitals are beginning to post various quality metrics on their Web sites. Patients can study the details of hospitals' performance and outcomes on common procedures. Others are disclosing the likely cost of these procedures. It's a profound shift, one that is long overdue--and needed, when you consider that we consumers will be increasingly asked to foot the healthcare bill in the years ahead.
But there is one area of pricing that remains in the clouds, namely the cost of new information systems and other technology. Software vendors love to tout their new contracts. My inbox is brimming with announcements. But ask them how much the deal was for, and more often than not, you will be stonewalled. Go to the hospital or medical group customer, and oftentimes, you get the same result. I have attempted to shine light on this topic in our "Deal" feature in HealthLeaders magazine, but it has been a struggle. Sometimes CIOs are just reluctant to talk about much the hospital actually had to ante up. Other times they have signed confidentiality agreements with their software suppliers to keep quiet.
Now, who exactly is being served by this murkiness around the cost of clinical IT? Well, it's certainly not potential purchasers of clinical IT. If buyers cannot obtain realistic estimates of cost prior to even sending out the RFPs, they are working in a vacuum. And for cash-strapped physician groups, the murkiness around cost may just result in suspicion that EMR vendors are an unscrupulous bunch.
My hunch is that software vendors like these confidentiality agreements because they are cutting deals left and right, charging the well-heeled customers way more than those of lesser means. Non-disclosure may also offer psychological protection to the insecure, who wonder if they have been gouged or got a good deal.
I guess you could say that the "value" of software is kind of like a house. It is only worth what someone is willing to pay for it. But at least with housing transactions, it's easy to see what somebody else paid. I'm all for free markets. I also think that transparency on cost helps keeps them that way.
The U.S. Congress needs to pass healthcare IT legislation before private companies develop multiple systems that don't talk to each other, according to members of the Health IT Now Coalition and the Information Technology Industry Council. The groups urged Congress to move ahead with health IT legislation such as the Promoting Health Information Technology Act, which would establish a public/private group to recommend health IT standards and certification and would budget $163 million a year for healthcare providers to adopt health IT products.
Blue Cross and Blue Shield of Massachusetts has announced that it will require all the state's hospitals to fully install a computerized medication ordering system within four years or face a loss of lucrative payouts from an incentive program promoting good-quality care. Currently, 10 hospitals in the state have fully adopted the computerized system that requires doctors to type in medical orders, including prescriptions, diagnostic tests, and blood work. The remaining 63 hospitals, mostly community hospitals, have been slower to embrace the new technology.
A study by researchers at the M.D. Anderson Cancer Center and the University of Texas has found breast cancer information was inaccurate or misleading on 5 percent of the 343 Web sites examined. Also, sites that focused on alternative or complementary medical approaches were 15 times more likely to contain problematic information, according to the report.
Like the chicken-and-egg conundrum, healthcare has its own longstanding riddle: Does technology lower costs or raise them? In search of an answer, I spent an afternoon last week poring through an exhaustive report from the Congressional Budget Office.
Technological Change and the Growth of Health Care Spending suggests that technology does as much to spur costs as to contain them. Surprisingly well written for a government document, the CBO treatise lays out the case that: a) healthcare costs are rising in an unsustainable way and b) the advent of new technology is a primary culprit. "On the basis of review of the economic literature, CBO concludes that roughly half of the increase in healthcare spending during the past several decades was associated with the expanded capabilities of medicine brought about by technological advances," it says.
Despite its potential to improve care and outcomes, new technology can spur price increases in several ways, the report says. For example, the very power of diagnostic imaging results in increased deployment. A diagnostic scan may be less expensive than costly surgery. "But by their nature they invite much greater use and therefore tend to increase total spending compared with previous methods," the report says. Likewise, life-extending coronary and dialysis procedures have become commonplace. True, patients are living longer, but in the meanwhile, they are running up more bills and creating more demand.
The report, however, does not lay the rising cost of healthcare exclusively at the doorstep of older people, saying that while elderly people incur higher costs than younger ones, the overall contribution of an aging population to spending is often exaggerated. Other social factors, such as rising obesity, also are driving up costs.
Technology creates its own silent time bomb of future cost. Consider IT storage. The unit cost of disk space has dropped remarkably in the last few years. Alas, the demand for more space has gone the other way. Modern hospitals now measure their data centers in terabytes. And as more images work their way into digital archives, the budget for storage will continue to grow--even though the hardware may be shrinking in cost and physical size alike.
The report is short on specific solutions to this problem, only suggesting that Medicare should revisit its payment policies on high-tech procedures. Ironically, the presence of health insurance in the first place may drive up costs, because it insulates consumers from the real cost of medical technology. We already know that technology races far ahead of the ethical debate around its use--witness the controversy on stem cell research. Now we can add that technology also races far ahead of our understanding of the economics surrounding its use.