Scientific proof of health IT benefits lacking: So what?

As evidenced by the not-very-pretty online tit-for-tat between researchers who say there's evidence that electronic health records systems will increase costs and the National Coordinator for Health IT who says the study was flawed, there's still plenty of room for debate over the benefits of electronic health records and other types of clinical IT.

And, as I've said before, gold-standard research-double blind studies, large random samples, peer reviewed articles, etc.--is lacking in the health IT field.

But there is plenty of evidence. The only problem? None of it is conclusive.

There's evidence that health IT improves healthcare quality and evidence that it does not. There's evidence that it improves efficiency and workflow and evidence that it makes it worse. There's evidence that health IT will lower costs and--wait for it--evidence that it will not.

Some of the evidence is anecdotal, some self-reported, some from surveys. Some of it based on smaller sample sizes, such as hospitals in one healthcare system. Some of it focuses in on one narrow aspect of health IT such as physician's attitudes toward e-prescribing, the number of docs who have adopted EHRs or the clinical benefits of computerized physician order entry.

Among other things, Farzad Mostashari, M.D. accuses the researchers of making a grab at headlines. And researchers Danny McCormick, David Bor, Stephanie Woolhandler and David Himmelstein, among other things, accuse the ONC head of wishful thinking.

Both statements are a bit harsh, I think. It's true that some of the studies and surveys and what have you are conducted by the government, which has a stake in presenting evidence that the money it's spending on health IT will improve healthcare.  It's also true that some of them are conducted by skeptics questioning conventional wisdom.

I don't have a problem with debate--and I'm sure all of the parties involved in this latest spat would agree.

But putting aside the "he said, they said" of it all, I'm left wondering: So what? What does this mean to physicians, nurses, hospital administrators and health IT professionals?

Absolutely nothing.

The drive for more and better health IT will go forward. Incentive money will continue to flow--at least for now. Hospitals and health systems will continue to decide how to invest in health IT, whether it's to improve quality and patient safety or to qualify for incentive dollars, to prepare for payment reforms or to reap some combination of perceived benefits.

And physicians will continue to question the benefits of EHRs and continue to mull where best to retire before all those paper records hit the fan.

No single study, no impassioned blog post, no online retort to an impassioned blog post is going to change a single mind that's already made up about the benefits--or lack thereof--of clinical technology.

There are no quick, easy, indisputable answers to the questions about the benefits of health IT--not yet, anyway. Researchers are famous for ending their reports with the phrase "more research must be done." But in this case it's true.

Rather than squabbling, the focus should be on listening and working together and productive debate to make strides toward that definitive evidence--whatever the ultimate outcome. - Gienna

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