Health care experts warn of challenges for IT adoption

WASHINGTON--President Obama has called health information technology the "low-hanging fruit" of health care reform, but implementing the use of electronic medical records nationwide will be incredibly difficult, experts warned Wednesday, especially without larger health care reforms.

The Congressional Budget Office estimates (PDF) that the use of electronic medical records could save the nation $12.5 billion over 10 years, and other analyses give more optimistic figures.

At a forum here on Wednesday, hosted by the conservative think tank the American Enterprise Institute, health care providers and buyers attested to the improved quality of care and efficiencies that can result from the use of properly implemented electronic medical records. Yet without new policies to incentivize the use of health IT systems, the stimulus funds may go to waste, they said.

"We have an incredibly complex industry that doesn't necessarily want to change," said Joseph Swedish, president and CEO of Trinity Health, a nonprofit health care provider that includes 44 hospitals in its network. "I think the stimulus can prime the pump, but we have to recognize the daunting task ahead of us."

The American Recovery and Reinvestment Act directs health care providers to electronically record patients' health information for "biosurveillance and public health" and "medical and clinical research" as part of a "nationwide system for the electronic use and exchange of health information."

However, Swedish and other health care experts said providers will be reluctant to share data--or even use health IT systems in the first place--because of the pay-for-service structure and other institutional characteristics of the health industry.

Coordinators of a federal health care IT initiative have said developing a national health IT network will be extremely difficult and slow going because of the endless number of varying standards for medical health records applied in different states and localities.

Yet Benjamin Sasse, an assistant professor at the University of Texas at Austin, said Wednesday that providers themselves--not a lack of consistent standards--are the biggest roadblock to a nationwide health information exchange.

"The standards problems are absolutely real, but if you want a sticky patient, why would you ever make a patient portable and available to your competitor?" he asked. "Most of the reasons we don't have (health) IT have nothing to do with IT."

Trinity Health, along with Kaiser and the U.S. Department of Veterans Affairs, has one of the nation's largest integrated, single-platform data management systems and is using its repository of information to adopt more evidence-based treatment. However, Swedish said, Trinity is not sharing data with Kaiser or other providers.

"There are a lot of complexities with the sharing of data," he said. "I don't envision in the near term being able to work with others."

Trinity rolled out its health IT network in 2000 and incurred operational costs that greatly exceeded estimates, Swedish said, but also achieved more benefits than anticipated. Its hospitals, for instance, administer emergent medications 40 percent faster, and Trinity's nurses have increased their bedside attendance of patients by 8 percent now that they spend less time on paperwork.

"We have witnessed lowering costs and what we believe is better quality," he said. "We believe the investment is absolutely the right thing to do in the modern world we live in today."

Still, he said, the process took years to implement, the benefits would not have been possible with just the IT--a change in culture and staff processes was also necessary.

The economic structure of the health industry does not only deter providers from sharing information, but also from simply adopting health IT in the first place, Sasse said.

"Health IT is (part of) a much larger debate around payment reform that would provide much higher care than the fee-for-service system does today," he said.