Updated on: June 22, 2012

$20 Billion for Healthcare IT: How to Impact Quality

Original story posted on: February 4, 2009



By: Joan R. Duke, FHIMSS


ED NOTE: As the U.S. Senate takes up the $819 billion American Recovery and Reinvestment Bill this week, also at stake is the fate of the $20 billion proposed by the Administration to advance healthcare IT (HIT) that made it through the House version of the bill last week. Even as the bill was being debated, RACMONITOR.COM asked one of healthcare's visionary IT leaders for thoughts on the state of the Electronic Health Records (EHRs) that the Congressional Budget Office estimates approximately 70 percent of hospitals and 90 percent of physicians will be using within the next decade. Here with her point of view is Joan R. Duke, founder of Health Care Information Consultants, LLC of Baltimore, Md.


I think that HIT is very important to solving the problem of implementing effective and efficient healthcare, but it is not HIT itself, but rather the ways it can be used to support the delivery of care for the patient and provider, that will make the difference.


In saying that, I recognize that the way our healthcare services are reimbursed, on an incident basis (unrelated to outcome), rather than on an episode basis, does not substantially reward the changes in behavior needed to promote the improvements that can be gained by access to information.


There is not enough reward (payment or capitalization) available in the current system for the coordination of care among providers that is enabled by the EHR and sharing of information among the various settings and providers of health care.


There is also little reason to collect data about patient outcomes and measures of population health as we focus on payment for services rather than outcomes.


To change and effectively use HIT to impact the quality, efficiency and cost of care, we need to tackle our reimbursement system that generally rewards doing more services rather than less; and provides few incentives to share information except within enterprises where there are common goals.


As long as organized healthcare systems are fragmented and EHRs are islands of information locked within organizations, they will not realize the major benefits gained from providing the automated information needed for efficient care processes and effective diagnosis and treatment.


The best example in my mind is the medication record. No one is charged with preparing and coordinating an active medication list for the patient except the patient, who most often has little understanding or skill necessary to make such a list. As the patient moves from hospital to community to various providers, this record is in a constant state of flux. A provider is faced with collecting the information each time he sees that patient and is getting what is probably less than an accurate picture of the patient's medication. This is the beginning of many errors and problems that are inadvertent, but built within our system. It is also a poor use of scarce resources.


Others have written on this subject, but there is a huge investment in the status quo and a lack of political will or capital to drive such a major change in healthcare organizations and payment systems.


About the Author


Joan R. Duke is the principal and founder of Health Care Information Consultants (HCIC) and has been involved for over thirty years in all aspects of health care information systems. In 1990, she founded HCIC to assist organizations in healthcare information technology management. HCIC focuses on solving problems relating to systems management, organizational readiness, and technology integration. She has assisted a variety of organizations including health systems, hospitals, home care, long-term care, hospice, behavioral health, clinics, physician groups, health care technology vendors, and non-profits unify their organizational and information technology resources.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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