Why IT may not be the cure for what ails healthcare


If all you have is a hammer, everything looks like a nail. And to government proponents of health IT, technology provides the solution to nearly every problem in the healthcare system. That much, at least, is clear from the 2011-2015 strategic plan of the Office of the National Coordinator for Health IT (ONC).

While I agree that the widespread adoption of health IT is a prerequisite to real healthcare reform, much more than computer applications will be required to turn this huge ship around. Healthcare transformation will take more than the digitization and exchange of healthcare data -- even with a garnish of Meaningful Use. It will require us to rethink how healthcare is delivered, our relationships to one another, and our core values.

Now that I've gotten that off my chest, here's what the national strategic plan calls for: increasing adoption of electronic health records and health information exchange through Meaningful Use; improving care and reducing costs; building confidence and trust in health IT; empowering individuals to improve their own health; and accelerating the development of health IT.

There are some major barriers to achieving these goals. For example, ONC points out, the nation lacks an "interoperable infrastructure to securely exchange health information nationwide among providers, between providers and patients, and between providers and public health agencies." Where that will come from between now and 2015 is not clear.

Improving care and reducing costs will require practices and healthcare systems to engage in population health management--a change that will require a major effort and expenditure of resources. To expect the health IT regional extension centers (RECs) to help physician groups make this leap, as ONC does, is a leap of the imagination: given the shortage of trained health IT professionals, the RECs will be lucky if they can successfully help small primary-care practices boot up their EHRs.

Building confidence and trust in health IT is something the government can actually do, given its regulatory authority. The same is true for promoting health IT innovation with government incentives. But the empowerment of individuals to manage their own health--another big thrust of ONC--is perhaps best left to the private sector, which is rapidly increasing its investment in applications for care management, health coaching and mobile telehealth.

One obvious omission in this master plan is any mention of the Stage 2 requirements for Meaningful Use. ONC has recommended pushing those off from 2013 to 2014--a move that many providers would welcome. But the Centers for Medicare and Medicaid Services (CMS) has not signed off on the idea yet.

To judge by the tenor of the strategic plan, ONC will push as hard as it can for stringent requirements in Stages 2 and 3. There's some evidence indicating that that might be the right direction to go in. A new Health Affairs study, for example, shows that the Stage 1 Meaningful Use criterion for computerized physician order entry (CPOE), which requires that hospitals use CPOE to order medications for 30 percent of patients for whom drugs are prescribed, is insufficient to cut deaths from heart attacks and heart failure in hospitalized Medicare patients; but raising the CPOE level to 60 percent, as has been proposed for Stage 2, could reduce mortality significantly, the study says.

The problem is that only a quarter of the hospitals in the country have CPOE, and even many of those have a long way to go to implement it fully. To rampage ahead and require that 60 percent of medication orders be placed electronically might discourage some hospitals from adopting the technology at all.

ONC's strategic plan is meant well, and it addresses most of the key issues for health IT over the next five years. But it's an open question as to whether any more of it will be accomplished in that period than was achieved in previous strategic plans from the same office. All the industry can do is try and hope for the best. - Ken (@FierceHealthIT)

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