Why has health care been so slow to implement information technology?

As a physician, it is hard for me to admit that we in medicine would be behind in anything! We like to be at the forefront of science in the never-ending quest to improve the lives of patients. But it has become clear to me -- over my years of school, training and practice -- that there is one area we consistently lag: information technology. That is part of what drew me to Vencore. We are using cutting edge technology developed in the defense industry and applying it to health care. It seems like an approach that makes sense; why re-invent the wheel to bring information technology to health care? Doug Dreyer takes a brief look at this subject for us this week.

Tara Grabowsky, MD

I have been reading a lot about the business of health care lately. I like this definition of Health Information Technology (HIT): “A health care information system comprises the data as well as the procedures to collect, store, analyze, transfer and retrieve those data, ” Gerald F. Kominski, Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management. The key word in that definition is “procedures.” Since health care delivery is so procedure-driven, the success or failure of HIT implementation is often measured by the performance of the resultant new procedures -- not the HIT functions. Kominski goes on to define a “Biomedical Informatics and Domains of Application Model”, which provides a framework definition of biomedical informatics as the “…interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific, problem solving, and decision making, driven by efforts to improve human health.”  When we consider the question of why implementation of HIT is so slow, we can think about any industry that has adopted information technology (IT). There are many factors that affected the rate of IT adoption in those industries, including financial incentives, organizational culture, IT capability and information sharing. 

Before any organization makes a decision to implement a new IT system, it needs to understand the financial incentives to implement a new system.  A way to measure this incentive is by calculating return on investment (ROI). Our health care system has a fragmented set of stakeholders: providers, payers and patients. As a result it may be difficult to understand the ROI of a HIT investment when it creates costs for some stakeholders and provides benefits for others. Kominski argues that most of the cost savings from providers’ information system investments accrue to payers and purchasers. So why would one organization make the large financial investment when someone else in the health care system reaps the benefit? There are examples of closed systems where the relationship of cost and benefit is more direct and within one stakeholder. One example is the Geisinger health system that serves 44 counties in Pennsylvania. Geisinger is well known for innovative delivery and is considered an early adopter of HIT systems. In the case of Geisinger, it is provider and payer for many of the patients it serves. Therefore, any HIT investment by the provider (Geisinger), provides benefit to the payer, which is also Geisinger. You can see how this ROI is much easier to justify in a closed health care network.

Doug Dreyer
SVP, Vencore

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