"Meaningful Use"

Addressing the Triple Aim

How does or can HIT influence costs, quality, or access?

In a financially stretched healthcare market, Health Information Technology (HIT) is sometimes seen as an expensive luxury. Trends that impact cost and access to quality healthcare are the main reasons the US Healthcare system is steadily changing (Hoovers, 2017). The past few years have been tumultuous for many healthcare organizations as prescription drug prices, aging populations, and the increasing costs of HIT have created the need for rapid transformation in just about every area of healthcare distribution and management. However, the use of HIT has been promoted as having tremendous promise in improving the cost-effectiveness, quality, access, and safety of medical care delivery in our nation's healthcare system (Adler-Milstein, Cohen, Markovitz, & Paustian, 2014). 

Costs- Global healthcare markets are experiencing significant cost constraints as the aging population, cost of prescription drugs, and other medical expenditures continue to increase. For new products to be taken up by healthcare providers, they will need to actively show their cost against the measurable improvement they can provide to overall patient health (Lee & Davies, 2013). While HIT is thought to play a significant role in supporting new models of care delivery, we know little about the extent to which HIT improves cost and quality outcomes. It is estimated that half of all medical expenditures are squandered on account of repeat procedures, the expenses associated with more traditional methods of sharing information, delays in care, errors in care or delivery, and the like. With an electronic and connected system in place through HIT, much of that waste can be contained. Other industries have lowered costs and improved quality through heavy investments in information technology; the healthcare industry would be wise to follow suit. 

Quality- As HIT proliferates throughout the country, we must assess the extent to which it will achieve expected goals. The healthcare system does not have sufficient resources to engage in this expensive new technology without tracking its return on investment; not only financially, but in terms of quality improvement and improved efficiency (Lee & Davies, 2013). HIT significantly influences the quality of healthcare because it provides a way for knowledge about patients, diseases, therapies, medicines, etc. to be more easily shared, which results in fewer medical errors and better coordination. As knowledge is more readily passed back and forth between providers and patients through systems such as Electronic Health Records (EHRs) and other systems available through HIT, the practice of medicine gets better; something that aids everyone within the chain of care, from hospital administrators and physicians to pharmacists and patients. 

Access- Interpersonal relationships and information are intertwined as essential cornerstones of healthcare. Patients are becoming more aware of their health status and an increase in access to healthcare information has patients unwilling to rely solely on the advice of medical professionals. Readily available information and data enable patients to have open discussions with their providers about prevention, diagnosis, treatment alternatives and health care costs (Santilli & Vogenberg, 2015). When patients have electronic access to their own health history and recommendations, it empowers them to take their role in their own health care more seriously.

By moderately expanding efforts to discover the best ways to improve patient care; prevention and wellness, we can identify key approaches for enhancing overall quality care, improving and increasing patient access to health information, and moderating the growth in spending.

References

Adler-Milstein, J., Cohen, G. R., Markovitz, A., & Paustian, M. (2014). The impact of HIT on cost and quality in patient-centered medical home practices. AMIA Annual Symposium Proceedings, 232-239. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419912/

Hoovers. (2017). Health care sector. Retrieved from hoovers.com: http://subscriber.hoovers.com.ezproxy.umuc.edu/H/industry360/overview.html?industryId=1374

Lee, R., & Davies, G. (2013). Technology: the cure for rising healthcare costs? Retrieved from MIT Technology Review: https://www.technologyreview.com/s/518946/technology-the-cure-for-rising-healthcare-costs/

Santilli, J., & Vogenberg, F. R. (2015, February 08). Key strategic trends that impact healthcare decision-making and stakeholder roles in the new marketplace. Am Health Drug Benefits, 8(1), 15-20. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415172/

The triple aim effect of HIT on quality, cost, and access is one that has positively influence the healthcare system. To better explain the impact of HIT on quality, cost, and access, I will use my present clinical experience as a dialysis nurse.

HIT can positively influence the quality of healthcare by ensuring consistency in patient care as well as enforcing compliance with evidence-based practices. HIT promotes consistency through programed processes and guidelines. “EHRs and CPOE systems require clinicians to follow a menu of defined procedures when requesting services, tests or drugs for patients. Such systems, when combined with clinical decision support tools that provide doctors with best practice guidelines for medical procedures, help to enforce greater compliance and support adoption of standard operating procedures and evidence-based best practices” (Bardhan, & Thouin, 2013). An example is the use of anemia algorithm for anemia management in patients with chronic kidney disease. As a dialysis nurse, most of my patients suffer from anemia related chronic kidney disease. Our system is programmed to titrate patient’s lab results, medical history, and medication to provide guidelines on medication adjustment, request for additional lab orders, as well as send an alert to the patient healthcare team. This system has not only increase patient quality of care, it also reduces healthcare cost as a result of decrease in hospitalization rate for anemia.

HIT helps reduce cost as a result of effective healthcare management. In the example stated above, with the use of HIT as a guideline for anemia management, the number of hospitalized patient as a result of anemia decreased. Anemia in chronic kidney disease is been diagnosed early with cheaper treatment options without the need for blood transfusion. In addition to decrease in hospitalization, my company also partner with local hospitals within the area due to new Medicare mandate for patient bundle payment plan. The bundle payment plan promotes coordination of care between providers by making a one-time patient for specific diagnosis which is then shared among providers. The bundle payment plan has increase exchange of medical records with other healthcare providers which promotes not only continuation of patients care, but also help reduce cost by eliminating duplication of diagnostic test such as labs, X-rays, and many more.

HIT increase health information assess through health information exchange which is essential in promoting quality patient care and reducing cost. “The potential of health information exchanges (HIEs) is significant for enhancing the quality of care, eliminating duplicate services, avoiding unnecessary hospital admissions, and decreasing the costs of healthcare” (Fincham, 2012, p. 340). With the use of HIT, my company and nearby hospitals now shares pertinent patient information such as laboratory results with nearby local hospitals, as well as treatment record to promotes continuation of care. This reduce cost associated with lab duplication, and also promotes quick decision making based on assess to lab result.

References

Bardhan, I., & Thouin, M. (2013). Health information technology and its impact on the quality and cost of healthcare delivery. Decision Support Systems, 55(2), 438-449. doi:10.1016/j.dss.2012.10.003

Fincham, J. (2012). Significant potential for health information exchange in enhancing quality of care and reducing hospital admissions in the united states. American Health And Drug Benefits, 5(6).

There is no doubt that healthcare delivery is very different than in the recent past; this is obvious to anyone who has been a consumer of healthcare services over the last 10 plus years.  One of the most obvious changes is the use and expansion of Health Information Technology (HIT).  In fact, as the American population ages, the emphasis to expand HIT has become more prominent.  The challenge healthcare leaders face is how to maximize the use of HIT to improve quality, access and costs; also known as “Triple Aim”.    

Several of last week’s readings reviewed the “Triple Aim” approach to healthcare strategic planning.  Berwick, Nolan and Whittington (2008) and Carroll (2012) agree that the components of “Triple Aim” are not independent of one another, therefore focus on one area can have either a negative or positive affect the other two.  One consistency of all three areas, however, is that they are all influenced by HIT in one way or another. 

First, HIT has improved the quality of healthcare provided to consumers.  Implementation of electronic medical records (EMR) has made data entry more efficient, easier to read and easier to share with other providers.  Computerized physician order entry (CPOE) and clinical decision support systems (CDSS) are two additional HIT systems that are being utilized to improve the efficiency, effectiveness, coordination and responsiveness to the quality of care provided to consumers (Pinsonneault, Addas & Dakshinamoorthy, 2017).  While these HIT systems overall have had a positive impact on the quality of care administered there are also challenges that must be addressed to ensure the privacy and security of the data being stored and shared. 

Second, HIT has improved healthcare accessibility to consumers.  This has been seen through the expansion of mobile devices that help manage chronic conditions by way of symptom or medication management.  In addition, telemedicine, telehealth and ambulatory services are being implemented to improve access for non-acute healthcare needs (Pinsonneault, Addas & Dakshinamoorthy, 2017).  This, in turn, frees up hospital beds and decreases unnecessary emergency room and office visits; ensuring access to these areas for patients that need them.  On the flip side, there are also challenges to these forms of HIT such as security, limitations of the consumer understanding how to use modern HIT and lack of face to face contact with providers.   

Finally, the impact of HIT on costs is even more complicated than the first two aims. On one hand HIT has made some small positive impacts on costs by reducing unnecessary tests, reduction in costly medical errors and realigning services to appropriate providers.  On the other hand, purchasing HIT systems is a huge financial burden causing providers to choose cheaper HIT, if any at all.  In addition, this has resulted in a wide range of HIT systems that do not interface well with others and can provide more opportunities for errors and breaches in confidentiality. 

References:

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008).  The Triple Aim:  Care, Health, And Cost.  Health Affairs, 27(3), 759-769. Doi: 10.1377/hlthaff.27.3.759

Carroll, A. (October, 2012). JAMA Forum-The “Iron Triangle” of Health Care:  Access, Cost, and Quality. JAMA.

Pinsonneault, A., Addas, S., Qian, C., Dakshinamoorthy, V., & Tamblyn, R. (2017). Integrated Health Information Technology and the Quality of Patient Care: A Natural Experiment. Journal of Management Information Systems, 34(2), 457-486.

How does or can HIT influence costs, quality, or access?

According to the National Center for Biotechnology Information one of the most important benefits of health information technology (HIT) is the reduction in human error.  HIT improves efficiency, cost effectiveness, quality and safety of medical care delivery.  HIT also reduces duplication of efforts by allowing users to see patient records and not duplicate tests, prescriptions, etc.  Ambulatory care, outpatient care, is broadened by HIT.  Younger patients are more comfortable and more likely to use smart phones to input and track their patient information.  Although healthcare costs are rising, installing HIT in hospitals is cost effective over the long run, though pricey initially.  Hospital administrators may feel that the initial cost of installing HIT systems is high but when checking their return on investments (ROI) reduction in errors, patient access, improvement in quality care should also be factored in to the equation. 

The National Center for Biotechnology Information article states that “In the ambulatory healthcare environment, the use of HIT offers a variety of benefits. First, it can improve the efficiency and financial health of the practice. For years, many offices have used computerized scheduling and financial systems to streamline office processes by tracking practice productivity and automating reimbursement processes. Second, the use of ambulatory electronic health records (EHRs) also offers an opportunity to monitor and improve clinical quality by improving information access and reducing duplicative documentation. And technology-based “e-prescribing” tools may improve the efficiency and safety of prescribing practices in the outpatient setting just as they have done in the hospital setting. Finally, the widespread adoption of HIT will allow the achievement of system connectivity and information exchange among providers of the same organization, among organizations, and ultimately regionally and nationwide.

However, the majority of medical organizations and providers have been slow to adopt HIT. Recent surveys of computerized physician order entry (CPOE) use show that only 9.6 percent of hospitals have CPOE completely available for use, and only half of these hospitals require use of CPOE.3 In the ambulatory setting, recent estimates place the use of electronic health records at 6 to15 percent of office-based physicians.4, 5 The potential advantages of widespread adoption of HIT in our nation's healthcare system make it vital to examine the scientific evidence that currently supports the relative costs and benefits of HIT, and the barriers to implementing various types of HIT systems across the spectrum of healthcare environments.” https://www.ncbi.nlm.nih.gov/books/NBK37992/

 

According to the Trustee, the American Hospital Association publication, HIT is the great enabler: technology

If cost is driving the rise in ambulatory care, technology is the great enabler. The use of technologies, including electronic health records, increasingly allows providers to offer care connected across multiple sites and the promise that it will be coordinated — reducing, if not eliminating, redundant diagnostic tests.

The other major component of technology — the smartphone and an ever-increasing number of apps and accessory devices — allows point of care and digital interaction to occur wherever and often whenever the patient-consumer desires. Younger consumers in particular often prefer a digital interface with health care providers. https://www.trusteemag.com/articles/1046-the-8-types-of-ambulatory-care-settings