Medicare's next voyage: encouraging physicians to adopt health information technology

Although there is growing consensus that health information technology (HIT) will be critical to improving health care quality and reducing costs, physicians' investments in technology remain limited. As the largest single U.S. purchaser of health care services, Medicare has the power to promote physician adoption of HIT. The Centers for Medicare and Medicaid Services should clarify its technology objectives, engage the physician community, shape the development of standards and technology certification criteria, and adopt concrete payment systems to promote adoption of meaningful technology that furthers the interests of Medicare beneficiaries.     

Promoting health information technology: is there a case for more-aggressive government action?

Health information technology (HIT) could save $81-$162 billion or more annually while greatly reducing morbidity and mortality. However, gaining these benefits requires broad adoption, effective implementation, and associated changes in health care processes and structures. The policy options that could speed the adoption of HIT and the realization of these benefits include incentives to promote standard-based electronic medical record (EMR) system adoption; subsidies to develop information-exchange networks; and programs to measure, report, and reward performance. Investments in these and other identified policy options should pay for themselves while also laying the foundation for needed transformation of the U.S. health care system.     

Health information technology and quality improvement for community health centers

The U.S. Department of Health and Human Services (HHS) is committed to promoting health information technology (HIT) throughout health care. However, selection, acquisition, and implementation of HIT for quality improvement (QI) are beyond the means of many federally supported community health centers (CHCs). In the absence of federal leadership and investment, adoption of HIT will be slow, haphazard, duplicative, and wasteful. HHS should actively support HIT to improve quality in CHCs. This will maximize HIT benefits, minimize costs, and ensure that CHCs have the tools to address the needs of vulnerable populations.     

Health information technology is a vehicle, not a destination: a conversation with David J. Brailer. Interview by Arnold Milstein

The first U.S. national health care information technology (IT) coordinator estimates that if the current rate of interoperable electronic health record (EHR) adoption is sustained through 2014, it would create a launchpad for quality gain and health care spending reduction in excess of 50 percent in the subsequent decade. But in this conversation with Leapfrog Group cofounder and U.S. health care purchasing innovator Arnold Milstein, David Brailer identifies several environmental changes as critical to the materialization of this dividend. These include providers' ceding control of clinical information to patients, universal public availability of provider performance comparisons, and moving health policy from a no-man's land between government and market control.     

Health care information technology in rural America: electronic medical record adoption status in meeting the national agenda.

Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The status of technology use in the transformation effort is reviewed by examining electronic medical records (EMRs), analyzing the existing rural environment, identifying barriers and factors affecting their development and implementation, and recommending needed steps to make this transformation occur, particularly in rural communities. A review of the literature for HIT in rural settings indicates that very little progress has been made in the adoption and use of HIT in rural America. Financial barriers and a large number of HIT vendors offering different solutions present significant risks to rural health care providers wanting to invest in HIT. Although evidence in the literature has demonstrated benefits of adopting HIT such as EMRs, important technical, policy, organizational, and financial barriers still exist that prevent the implementation of these systems in rural settings. To expedite the spread of HIT in rural America, federal and state governments along with private payers, who are important beneficiaries of HIT, must make difficult decisions as to who pays for the investment in this technology, along with driving standards, simplifying approaches for reductions in risk, and creating a workable operational plan.     

Health care spending and use of information technology in OECD countries

In 2003, the United States had fewer practicing physicians, practicing nurses, and acute care bed days per capita than the median country in the Organization for Economic Cooperation and Development (OECD). Nevertheless, U.S. health spending per capita was almost two and a half times the per capita health spending of the median OECD country. One proposal for both lowering health spending and improving quality is the adoption of health information technology (HIT). The United States lags as much as a dozen years behind other industrialized countries in HIT adoption--countries where national governments have played major roles in establishing the rule, and health insurers have paid most of the costs.     

U.S. hospital efficiency and adoption of health information technology

This study empirically examines the association between hospital inefficiency and the decision to introduce electronic medical records (EMR) and computerized physician order entry (CPOE) in a national sample of U.S. general hospitals in urban areas in 2006. The main research question is whether the presence of hospital cost inefficiency or other factors driving inefficiency in the production process of a hospital explain low adoption rates of health information technology (HIT) in a hospital setting. We estimated a logistic regression of HIT adoption as a function of hospital cost inefficiency scores obtained using a stochastic frontier analysis. The results demonstrate that hospitals with a greater degree of cost inefficiency were more likely to introduce EMR, suggesting that the benefits of EMR implementation in terms of improved efficiency were likely to outweigh the costs of adoption compared to hospitals that are more efficient. The results showed no association between cost inefficiency and the CPOE adoption decision.     

The effects of health information technology on the costs and quality of medical care

Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.     

Functional gaps in attaining a national health information network

We describe the health information technology (HIT) required for a model of a national health information network (NHIN). Specifically, we define the functional HIT capabilities of an attainable NHIN and determine the gap between the current state of HIT and its likely state in five years, given current trends of adoption. Administrative functionalities will be more prevalent than clinical functionalities in five years. Smaller stakeholders, such as home health care agencies, will lag in adoption. Policy changes, such as financial incentives to HIT end users or regulatory measures, may help accelerate the adoption of HIT for a model NHIN.     

Market structure and performance: evaluating the U.S. health system reform

First, U.S. health system evolution over the last several years is assessed and found to be in line with what could be anticipated from economic theory. The immature market appears to be giving way to the concentration and the oligopolies of the mature market. This is explained in a manner accessible to non-economists. Next, the performance of market competition as a vehicle for health system reform is assessed in the areas of cost containment, quality of care, access, research/education and social mission. Overall, results have not measured up to promise. Market competition has not succeeded in bringing U.S. health care costs in line with those of other industrialized countries. There is no evidence of sustained quality improvement. Market based reform has not expanded health insurance coverage but has rather, directly or indirectly, increased the number of underinsured and uninsured Americans. Medical research and education have suffered and medicine's social mission has declined. These failures could probably have been anticipated, in advance, had policy makers carefully examined economic theory concerning market evolution. While these are some reasons to be hopeful for market performance in the future there are also potential pitfalls. Non-market oriented policy alternatives for health system reform are worth considering based on the experiences of the states and other countries.     

Women's health: marketing challenges for the 21st century. The future of women's health care reflects demographic, social, and economic trends. MHS staff

The notion of a separate "women's health" component within the U.S. health care system emerged in the 1980s as many health care organizations recognized the opportunities offered by this market. While originally addressed traditional women's needs such as OB services, the 1990s witnessed as expansion of the scope of women's services as baby-boom women became a driving force for consumerism. For health care marketers, the female market is in many THE market for health care for the future and health care organizations have responded to this opportunity in a variety of ways. Demographic, social, and economic trends will only serve to increase the importance of women as health care consumers. For both providers of care and marketers, the women's market is clearly a force to be reckoned with as health care enters the 21st century.     

Myths as barriers to health care reform in the United States.

The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) "Everyone gets care anyhow;" (2) "We don't ration care in the United States"; (3) "The free market can resolve our problems in health care"; (4) "The U.S. health care system is basically healthy, so incremental change will address its problems;" (5) "The United States has the best health care system in the world"; and (6) "National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative." Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.     

Clinical health information technologies and the role of medicaid

Clinical health information technologies (HIT) are widely viewed as essential tools for improving the quality and efficiency of health care delivery. Medicaid agencies make substantial investments in information technology (IT), have much to gain through the widespread use of clinical HIT, and can have significant influence on the adoption of HIT by providers. Medicaid agencies, however, face legal, regulatory, and financing challenges in relation to supporting HIT adoption, use, standardization, and interoperability. This article summarizes the issues related to Medicaid's participation and support of clinical HIT, and makes recommendations for addressing policy challenges at the State and Federal level.     

Evidence-based decision making: when should we wait for more information?

We discuss the challenge of managing innovation in and access to health care interventions in an evidence-based, cost-effective way, and we describe a decision-making framework (using U.S. and U.K. case studies) for health care payers considering the adoption of new technologies. We argue that providing reimbursement for what could be a cost-effective technology "only in the context of research" will be appropriate if the costs of delaying implementation are offset by the value of "keeping one's options open" by waiting for more information. We conclude that there is a need for better integration of health care decision-making processes with research policies.     

U.S. medical students' attitudes about patients' access to care

OBJECTIVE: Accessing adequate medical services remains a major struggle for many Americans, but U.S. medical students' beliefs regarding access to care have not been thoroughly examined. METHODS: All medical students in the Class of 2003 at 16 U.S. schools were eligible to complete three questionnaires during their medical training: during freshman orientation, orientation to wards, and their senior year (n=2316, response rate=80.3%). Students responded to three questions about health care provision. RESULTS: Overall, 35% of students strongly agreed that "physicians have a responsibility to take care of patients regardless of their ability to pay;" only 5% disagreed. Only 8% disagreed that "access to basic health care is a fundamental human right." We found the same significant associations with opinions on access as we did with "responsibility to treat," although the associations tended to be stronger for access. Only 10% of students agreed that "Managed care, as it is now delivered, is a good way to deliver health care to the U.S. population." CONCLUSION: Most U.S. medical students support universal access to medical care, though variations in this support, its decline with additional years of medical education, and concerns about managed care are noteworthy, and have policy implications for America's health and health care workforce.     

The adoption gap: health information technology in small physician practices. Understanding office workflow can help realize the promise of technology

Health information technology (HIT) can promote higher quality, lower costs, and increased patient and clinician satisfaction. Yet small practice settings (where the vast majority of patient care is provided) have been slow to adopt HIT products and services. Successful adoption requires close attention to office workflow, or how tasks are organized and resources used to achieve outcomes. HIT improvements in the small physician office setting are achieved through strong leadership, strategic planning, process reengineering, change management, and customizing IT systems to match and support desired office workflows and health care outcomes.     

Market forces and efficient health care systems

The "market forces" to which economists ascribe the ability to motivate improvement in quality and efficiency are largely nonexistent in U.S. health care. One thus might ask, "Could market forces be made strong enough to deliver efficient health care systems?" There is some evidence to suggest that the answer is "Yes." This paper offers a short list of some changes that would be needed to create such a health care economy. Continued increases in costs and in the numbers of uninsured people will likely make a universal coverage model based on Medicare a politically popular choice, but such a model would not deliver efficient health care systems because it lacks sufficient incentives for consumers to choose less costly options.     

Health information technology: strategic initiatives, real progress

We fully agree with Carol Diamond and Clay Shirky that deployment of health information technology (IT) is necessary but not sufficient for transforming U.S. health care. However, the recent work to advance health IT is far from an exercise in "magical thinking." It has been strategic thinking. To illustrate this, we highlight recent initiatives and progress under four focus areas: adoption, governance, privacy and security, and interoperability. In addition, solutions exist for health IT to advance rapidly without adversely affecting future policy choices. A broad national consensus is emerging in support of advancing health IT to enable the transformation of health and care.     

The adoption and use of health information technology in rural areas: results of a national survey

Context: Health information technology (HIT) is a national policy priority. Knowledge about the special needs, if any, of rural health care providers should be taken into account as policy is put into action. Little is known, however, about rural‐urban differences in HIT adoption at the national level. Purpose: To conduct the first national assessment of HIT in rural primary care offices, with particular attention to electronic medical record (EMR) adoption, range of capabilities in use, and plans for adoption. Methods: A national mail survey of 5,200 primary care offices, stratified by rurality using Rural‐Urban Commuting Area categories, was conducted in 2007‐2008. Regression analyses were used to assess the relationship between office characteristics and EMR adoption, capabilities used, and future adoption plans. Results: A commercial EMR system was present in 31% of offices, with no significant differences by rurality. Of offices with EMRs, 12% reported using a full range of EMR capabilities, with 51% using a basic range and 37% using less than the basic range. Large Rural (adjusted OR = 3.71, P= .022) and Small Rural (aOR = 3.75, P= .049) offices were more likely than Urban offices to use a broader range of EMR capabilities. Among offices without EMRs, those in Isolated areas were less likely to have more immediate plans to adopt (aOR = 0.19, P= .02). Conclusions: HIT adoption and use in rural primary care offices does not appear to be lower than in urban offices. The situation, however, is dynamic and warrants further monitoring.     

The effect of consumer perceptions on generic OTC usage among the elderly

The rise of generic alternatives to branded over-the-counter products in the U.S. posits new strategic positioning challengers to marketers. Health care marketers who employ an "imitation strategy" have captured market share by emulating market leaders' product attributes. This implicitly calls for an understanding of the influence that consumers' product perceptions have on their choice of OTC offerings. This study investigates the influence of an elderly sample's perceptions of generic OTC characteristics on their adoption behavior.