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Access, Quality, & Cost — What’s Health IT’s Role?

When I speak to clinicians and other healthcare professionals, an important part of our discussion relates to the driving forces behind new policy, payment, and programs that, to some, seem to come out of nowhere. Whether it’s the medical home, medical home neighbor, EHR incentive program, ICD-10, ACOs, Comprehensive Primary Care, Bundled Payments, or other initiatives, fundamentally these are all about trying to address accelerating healthcare costs, mediocre quality indicators, and highly variable access to care. Access, Quality, Cost: Achieving a balance between these three factors is a major challenge, and the data suggest that the United States can certainly do better. Consider this:

  • The U.S. spends almost twice per capita on healthcare than the nearest OECD country (Organization for Economic Cooperation & Development).
  • By 2018, national health expenditures are projected to reach $4 trillion and 18.7% of the U.S. gross domestic project.
  • In 2009, 10% of the U.S. population accounted for approximately 65% of U.S. health expenditures.

For all that we spend on health care in the U.S., the results are not stellar. Here are a few statistics:

  • Nearly 2 million Medicare patients are readmitted within 30 days each year; many of these could probably have been avoided.
  • Approximately 33% of emergency department visits among Medicare beneficiaries are likely avoidable.
  • The U.S. was last in amenable mortality in 2006–2007 with a rate of 96 deaths per 100,000 compared to 55/100,000 in the best country (France).
  • In 2007, the U.S. had the worst rate of lower extremity amputations related to diabetes among OECD countries: 36/100,000 versus 9/100,000 in the United Kingdom.

Source: The Commonwealth Fund

In a survey of healthcare opinion leaders in 2011, (subscription required) 89% rated the U.S. healthcare system’s performance as unacceptable/very unacceptable with regard to efficiency (defined as avoidance of overuse or inappropriate use of services, preventable hospitalizations and readmissions, regional variation in quality & cost, administrative complexity, and use of information systems). I suspect many of you would likely agree with that assessment given your day-to-day experiences providing healthcare.

Since the AmericanEHR community is focused on health IT, how could technology support improvements in quality, cost, and access? Given the recent criticism of the RAND report from 2005, it is important not to overstate the potential impact of health IT on access, cost, and quality. However, if appropriately designed, implemented, and used, most clinicians would likely agree that health IT should be able to positively influence outcomes in at least some situations. Consider the potential effects of the following uses of health IT & EHRs:

  • Patient portals allowing a patient or family to request an appointment that aligns with the availability of their chosen clinician. (Access)
  • Emergency Departments and discharge nursing staff being able to access schedules for primary care clinicians to make follow-up appointments to assure appropriate transitions in care and clinical follow-up. (Access; Quality)
  • Population management features/functions that identify patients in need of appropriate follow-up based on clinical indicators, laboratory tests, and appropriate screening protocols. (Quality; Cost)
  • Clinical decision support that, in real-time, identifies gaps in care so that patients and clinicians can engage in shared decision-making and develop a care plan that is actively followed by both the patient/family and the clinical team. (Quality)
  • Dashboards that provide quality snapshots of specific patient sub-groups within a practice for targeted interventions and follow-up such as those recently discharged from the hospital; patients recently started on complex medication regimens or high risk medications; patients belonging to specific vulnerable populations. (Cost, Quality)

These are just a few ways in which health IT can help address the challenge of maximizing access and quality while controlling costs. Attaining Meaningful Use (MU) objectives & measures is important for practices to receive incentive payments. However, it may take a narrower focus on those health IT functions that can reasonably be assumed to result in a direct effect on access, quality, & cost before major improvements in outcomes will be realized.

What do you think?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP).

Comments:

3 responses to "Access, Quality, & Cost — What’s Health IT’s Role?"
  • February 15, 2013
    walter keyes
    said:

    I wish I could see an analysis of your quoted statistics of ameanable mortality in the US vs.France as well as the comparison of the rate of lower extremity amputation related to diabetes between the US and Britain.For example,it could be that the trend in Britain would be to go directly to ak or bk amps vs.a trend in the US to preserve as much function as possible for as long as possible.

  • February 20, 2013
    Uchechi Iweala
    said:

    I think that this won’t solve the problem. you can’t just program more convenience and hope that holds down costs. The answer is finding a business solution to serve the poorest of the community. That’s probably going to be involving government to some extent….like Private Public Partnerships that are for profit instead of just not for profit. But its also going to take research, and not clinical trials, research on how to deliver health at the the cost that is in the most effective manner. The rest of the world outside the US isn’t operating on the same level of income, so finding out the minimal that you have to treat a patient to save their life will result in lives saved across the globe. So in that sense if the convenience given to doctors via your system enables them to deliver the cheapest care possible to save lives (maybe by the data it collects and stores for later analytical research), then it will provide benefits on the fringe instead of figuring out the core to the matter.

  • February 28, 2013
    Mary Crowther
    said:

    It is difficult to compare the US with any country in the OECD, many of which are very homogeneous (e.g. Japan, Poland, Turkey, Korea….), or in the case of West European countries, have restrictive policies to limit immigration. As a doctor who has worked in the British NHS and now in the US, there is no comparison between the populations. Contained within the US statistics are people who arrive here from impoverished and disparate backgrounds, with their burden of ill health which the medical system here has to absorb, however imperfectly. Unless you are able to remove those people from the statistics, any comparison is meaningless.

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