Which components of health IT will drive financial value?

A framework that describes the ability of specific health information exchange (HIE) and EHR functionalities to drive financial savings could help efforts to develop meaningful use measures and measure the financial impact of health IT, according to research published in the August issue of the American Journal of Managed Care.

“Previous work in this area has largely modeled the financial effect of whole health IT applications, assuming that the effects of those applications were similar across different contexts,” wrote lead researcher Lisa M. Kern, MD, MPH, of Weill Cornell Medical College in New York City, and colleagues. “This assumption may not be true because health IT is an inherently heterogeneous intervention. EHRs and HIE are themselves applications composed of functionalities that are variably implemented, configured and used.”

The researchers built a framework for judging specific functionalities by identifying and rating functionalities according to their potential to drive costs down in ambulatory, inpatient and emergency department settings.

They came up with 105 unique functionalities for EHRs and HIEs, and 84 for ambulatory care, 80 for inpatient and 69 for emergency department care, for a total of 233 functionality-setting combinations. Next, study authors graded unique functionalities on a three-point scale across three different domains in each setting. The result was 54 high-scoring, functionality-setting combinations, 27 for EHRs and 27 for HIE, that were brought to a group of 28 healthcare experts in 2007 for approval.

Kern et al then compared the top-scoring functionalities with meaningful use Stage 1 measures, of which 15 core and 12 menu measures aligned with the highly-rated functionalities. The framework was brought back to a panel of healthcare experts who determined that no changes should be made, as they believed it was consistent with and went beyond the scope of meaningful use Stage 1.

The study has important policy implications, they wrote. It suggests specific measures that, if incorporated into Stages 2 and 3 of meaningful use, could help providers choose among meaningful use menu measures, guide health IT implementation and shape quantitative evaluations of health IT’s actual financial impact as they are implemented.

“Although EHRs and HIE products are adopted as whole applications, different functionalities may be turned on or off by individual technicians and users of these systems,” Kern et al concluded. “Thus, our finding that some functionalities have more potential for positive financial effects than others matters. If whole applications are adopted, but the most promising functionalities are turned off, then the likelihood of a positive financial effect for the whole application is low.”