Monday, March 12, 2012

Harvard Study: Do eHealth Initiatives Add to the Cost of Healthcare?

 

According to Jesse Hirsh on CBC Radio this morning, a recently published study by Harvard researchers shows that eHealth initiatives may be too successful in that they make it too easy to access and take action on patient data. "It's a classic case of the hidden effects of technology; any time you try to solve one problem, you're inadvertently going to create another."

The Harvard study, published in Health Affairs, looked at two groups of physicians: one that used eHealth technology and one that didn't. The study found that the physicians using eHealth technology were 40% to 70% more likely to order extra tests for their patients. As a result, healthcare costs rise where eHealth technology is used. The study's abstract provides a brief conclusion to the research:

We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.

Now, this study, or at least the media coverage of this study, begs the question of the purposes for which eHealth record initiatives were introduced in the first place. Before we trumpet the failure of a certain technology to deliver cost savings, we need to look at the larger picture

One of the purposes for which eHealth records were introduced in the US was certainly to drive healthcare cost efficiencies. But the equal, and in some ways opposite, objective was to improve patient outcomes. (See the IOM's report Crossing the Quality Chasm: A New Health System for the 21st Century, published in 2001.) It is certainly possible to see how ordering additional tests could lead to better patient outcomes.

The conflict is not a new one. We see it all the time in business. It reminds me of the frustrations of a friend who worked in a call center some years ago. She felt she had been given conflicting objectives. She thought it was unrealistic that management should expect her to improve customer service while decreasing call time.

But are these objectives necessarily in conflict? No, they are only in conflict if we take them as absolute imperatives, and that's simply not how the world works. There have to be tradeoffs, and the real challenge for the customer service representative in the call center, and for the doctor using eHealth technology, is to balance the needs of the customer/patient versus the sustainability of the system.

Triage is not practiced only on battlefields and in emergency rooms. While decisions in the call center or the physician's practice may not always be life or death, they still require a triage mentality that balances the needs of the one against the needs of the many. Anyone who is concerned for the viability of an enterprise makes these decisions every day. To mix a metaphor, do we escalate or do we cut bait? The technology does not take away the need for human beings to make decision, balance priorities, and practice an ethic.

So, are the additional healthcare costs a result of a technological failure. No, they are more likely the result of a failure to train technology users sufficiently, a failure to adapt, and thus perhaps also a failure of vision. It's hard to satisfy your examiners when you are unaware of the criteria on which you are being judged.

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