Policy debate should move beyond federal incentives and requirements to adopt health IT
Reviewed by Emily Henderson, B.Sc.Oct 28 2020
Despite significant investment in health information technology such as computerized health records and clinical decision support, leveraging the technology to improve the quality of care will require significant and sustained effort by health systems, according to a new RAND Corporation study.
In order to accelerate change, better mechanisms for creating and disseminating best practices are needed, in addition to providing advanced technical assistance to health systems, according to the analysis based on in-depth interviews with leaders from 24 health systems.
The study is published online by the journal Healthcare.
"Health systems are spending the most effort on foundational activities such as standardizing data and work processes that may not directly improve performance, but lay the groundwork for doing so," said Robert S. Rudin, the study's lead author and a senior information scientist at RAND, a nonprofit research organization. "Our study findings may help explain why the hoped-for IT-enabled transformation in health care has not yet occurred."
The study suggests the policy debate should move beyond federal incentives and requirements to adopt health IT. Instead, there should be a reorientation toward supporting efforts that create and disseminate best practices for how to optimally leverage the technology to improve performance. Payment reform is helping to introduce better incentives but may be insufficient.
Leveraging IT to improve performance requires significant and sustained effort by health systems, in addition to significant investments in hardware and software. To accelerate change, better mechanisms for creating and disseminating best practices, and providing advanced technical assistance are needed."
Robert S. Rudin, Study Lead Author and Senior Information Scientist, RAND Corporation
Health system executives said that standardizing data and analytics across an organization was necessary to use the data for future activities to achieve high performance, such as monitoring areas for improvement. Health systems that were less advanced in this area were just beginning to establish a data analytics department and planned for it to be operational within a few years.
"Some health systems clearly had developed or adopted best practices for using health IT that others had not," Rudin said. "It is likely that many health systems are spending considerable effort rediscovering the same lessons that others have already mastered. If lessons could be disseminated better, it could make a huge difference."
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Federal officials in 2009 passed legislation that prompted a majority of physicians and hospitals to adopt electronic health records. The investment was expected to improve the health of Americans and the performance of the nation's health care system.
Despite the investment, the study notes that the performance of health systems across the U.S. continues to lag. The information technology revolution that has catalyzed transformations in industries such as finance and commerce has yet to yield the quality and cost improvements in health care that policymakers intended.
Researchers from the RAND Center of Excellence on Health System Performance collected information from 24 health systems across four states (California, Washington, Minnesota and Wisconsin).
A total of 162 executives from the health systems were interviewed about their experiences implementing health IT and whether IT is enabling them to make making meaningful changes in quality and cost control.
The researchers found a series of IT-related activities that could lead to higher performance, which were sorted into two broad categories: laying the foundation for performance improvement and actually using IT to improve performance. While the types of activities described were similar across health systems, some health systems were more notably advanced than others in their progress within these activities.
For health IT to make a big change in performance, the researchers say health systems may need direct help to accelerate change, such as through the widespread dissemination of proven best practices, and more targeted technical and implementation assistance.
"The benefits of health information technology won't come overnight – there's no silver bullet," Rudin said "Most health systems are working on building the foundation. It suggests patience and sustained effort over years and even decades is needed to realize the major benefits of health IT."