A positive outlook, with some concerns

Mary Stevens, editor, CMIO

If the question used to be if IT could improve healthcare, it’s shifting now to how much can IT improve care. A recent review of literature from the Office of the National Coordinator for Health IT revealed fairly positive study results related to implementation of health IT, with a predominant focus on EHRs and computeized physician order entry (CPOE) systems.

The review examined a relative small sample of studies among early adopters from July 2007 to February 2010. Still, the results showed that health IT adoption is helpful and its utilization is increasing.

“We were pretty positive about EHRs and I was pleased [the review] showed such general positive results,” David Blumenthal, MD, National Coordinator for Health IT, told CMIO.

There’s plenty left to do, of course. Adoption has been a slow process because “a lot of the benefits just don’t drop to the bottom line of the institutions and practices that need to adopt,” said Blumenthal. “The difference between the evidence of benefit and the fact of entry cost is the challenge that we have to face. As valuable as this may be, it’s really hard to get where we need to be.” Provider satisfaction is a major issue as well, he said.

Nevertheless, the review is "as close to a clearly positive statement about a technology as you’re likely to get in a complex, empirical field,” he noted. “The conventional wisdom has shifted to affirm the fact that health IT is beneficial, so that when negative studies came along, they have a kind of ‘man-bites-dog’ quality that attracts the attention of the press. One of the reasons we did this review was to provide perspective and balance to the treatment of the evidence.”

“We will continue to see both positive and negative studies, but I suspect the positive studies will continue to outweigh the negative ones and that the day-to-day experience of practitioners will become progressively more positive as systems become more usable," he said. “We are … developing momentum, and the momentum will accelerate. We announced today that we now have 50,000 providers enrolled in our Regional Extension Centers. Almost 34,000 providers have signed up to become meaningful users. ... That shows the field is moving and once it goes in that direction, there will be no turning back.”

The strongest evidence of this, behind the studies, the review and the numbers, is this fact: “Physicians and nurses sometimes complain about their EHRs, but never want to give them up,” said Blumenthal. “[This is] as good evidence about their net positivity as any kind of evidence.”

Has IT wisdom shifted in your community? Tell me at mstevens@cmio.net.

Mary Stevens
Editor of CMIO