NEJM: Release your inner health IT productivity
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Spencer S. Jones, PhD, from Rand in Boston, and colleagues defined the paradox as the relationship between the rapid increase in IT use and the simultaneous slowdown in productivity. “There is ongoing debate about the wisdom of the $27 billion federal investment in driving the adoption of health IT under the HITECH Act,” Jones et al wrote.
Proponents expect IT to transform healthcare delivery into a lean, mean, integrated machine while skeptics suggest productivity benefits of health IT have been overhyped.
The authors noted that explanations for the IT productivity paradox fell into three categories: mismeasurement, mismanagement and poor useability. “Mismeasurement explanations traced the paradox to shortcomings in research; the latter two categories highlighted shortcomings in practice.”
In resolving the original IT productivity paradox, the mismeasurement challenge was addressed through a combination of detailed data and improved empirical techniques that better accounted for service outputs, the authors stated. “Similarly, assessment of the value of healthcare outputs could be improved through the more sophisticated use of clinical data to understand access, convenience and health outcomes. Such a measurement approach may prove far superior to simple counts of tests ordered or services delivered.”
“Healthcare professionals are tempted to simply digitize paper-based workflows, but swapping out the medical record cabinet and prescription pad for a computer is proving insufficient to realize the benefits of health IT,” the authors asserted. “Instead, newly IT-enabled processes that support teamwork, care coordination and innovative approaches such as interactive patient portals have the potential to yield greater convenience, access and quality for patients and physicians at a lower cost.”
According to the authors, new health IT systems risk failure if useability isn’t carefully addressed. User-centered design calls for end users to be involved in every stage of product development. Citing smartphones as an example, Jones and colleagues noted the merits of such design processes stating smartphones have come a long way from their early monochromatic displays to today’s high-definition touchscreens.
Maximizing the productivity of health IT will require that commercial IT vendors also adopt user-centered design principles, they added.
“In the meantime, avoiding broad claims about overall value that are based on limited evidence may permit a clearer focus on the best ways of optimizing IT’s use in healthcare,” they concluded.