Featured column: Embrace IT to improve quality of care
Dear Colleague,
Why is healthcare so far behind other complex industries in implementing cutting-edge information technology? Some in healthcare might argue this is not the case. After all, aren’t computers embedded in everything we do? The answer is, quite frankly, no.
Billing was the first function the healthcare industry computerized, followed by laboratory results reporting. Today some hospital leaders are puffing out their chests and claiming that they have introduced bar coding into their pharmacy and medication management processes, but we should all remember that the earliest bar coding systems were developed in the 1970s. By the 1980s, bar coding had become commonplace in supermarkets, yet it took another 20 years for this technology to make its way into hospitals.
Now it’s time to invest in electronic medical records. With new funding from the American Recovery and Reinvestment Act of 2009, we are all poised for this next step, but my opinion is that we have been ready for a while. For example, when I applied for recertification in family medicine in the early 1990s, I was required to pull medical records of patients with common diagnoses, such as new onset hypertension or diabetes, and show how I had provided exemplary care. I was a good physician and was sure I could easily find “clean” records to demonstrate how well I cared for my patients. But when I actually looked closely at my own records, I was shocked to see how often I had overlooked even the basic best practices I thought I knew so well. An electronic medical record would have solved that problem with a few clicks.
One explanation as to why healthcare has been so reluctant to adopt new technologies lies in the hidden cost of poor quality. If FedEx ships a package to a wrong location because of a clerical error, it loses a customer, perhaps forever. If a hospital gives a wrong drug or wrong dose, unless there is a life-threatening or fatal complication, both the doctor and the patient have historically accepted such errors as inevitable given the complexity of healthcare. Even after an error, the patient is likely to return to the same institution in the future. And let’s remember that in the days before full disclosure, we frequently didn’t tell patients about our errors, nor did we recognize the high cost of errors (the average adverse drug reaction adds $3000 to the expense of a hospital admission).
But today we know this, yet we are still slow to adopt cutting-edge IT. Cost is obviously a big factor, but airlines, banks, shipping companies, and Wal-Mart don’t hesitate to spend 5-10% of revenues on IT. Hospitals and physicians, however, balk at the thought of spending that much.
I must confess that I don’t have a clear and convincing explanation. Perhaps it is because patients and third-party payers value highly visible technology over better information management. Perhaps it is because most physician practices still operate like mom-and-pop shops with tight budgets and little long-term planning. Perhaps it is because we have had so many nightmarish experiences implementing new software and hardware or because most physicians are not employees of large corporations that can make decisions about IT and require physicians to go along with implementation. Perhaps it is because so many physicians still cling to the cottage industry model, wanting to do things as they always have.
I welcome your thoughts on why, with healthcare consuming 16% of GDP and still rising, we are not fully automated, given the safety and cost-effectiveness that well-designed IT achieves in other complex, high-risk industries. More importantly, what can we do to finally take advantage of useful, powerful technology on behalf of our patients?
Please e-mail associate editor Liz Jones at ejones@hcpro.com with your thoughts.
All the best,
Rick Sheff, MD, CMSL
Chairman and Executive Director
The Greeley Company, a division of HCPro, Inc.