In a March 8th press release by HHS and an article on the ONC Health IT Buzz web site Dr. David Blumenthal touts that a “new study finds that 92 percent of recent peer-reviewed articles on HIT reached conclusions that showed overall positive effects.” While I don’t doubt the validity of the study, I am hesitant to draw overly broad conclusions from statements like this one. Both the press release and the article accurately cite facts from the study to help the casual reader draw the conclusion that the HIT is helping hospitals and physician practices (both large and small) achieve new levels of efficiency and patient safety while reducing the cost of healthcare.
The study The Benefits of Health Information Technology: A Review of the Recent Literature Shows Predominantly Positive Result was published by Health Affairs this month (March 2011). It reviewed the published results of 154 studies on the use of HIT to determine if they reported generally positive or negative results. The study did find that 92 percent of the articles reached conclusions supporting positive results, however there are some important details that from the study that are not included in the press release by the ONC.
The first point that that readers should understand from the study is that one of the limitations noted in it is that there is a bias in publications against publishing negative findings. It goes on to illustrate this by referring to another study that showed in clinical trials, studies with positive findings are four times more likely to be published than negative findings. It goes on to point out that, “We anticipated that authors more often approached studies looking for benefits rather than adverse effects.” These are fairly important biases that would significantly skew the study’s findings.
Another important negative finding was that small and rural hospitals were challenged in both implementing HIT, changing business processes and realizing the clinical benefits of HIT. The study cited “a lack of clinical leadership, staff skepticism, leadership turnover.” and several other factors as barriers that hindered their success. While this probably doesn’t surprise anyone, it is extremely significant since rural hospitals account for approximately 40%* of all hospitals, and nearly 50%* of all hospitals are less than 100 beds. Small and rural hospitals represent a significant portion of our nation’s healthcare system and are already facing significant economic challenges.
I do believe that EMRs, HIE, ePrescribing and other HIT are vital to the future of healthcare. I support the goals of the HITECH Act and the ONC, and I believe that, over time, we will see better, more efficient, and more effective healthcare outcomes as a result. While it’s encouraging to see there are success stories and models we can emulate, we need to set realistic expectations. I believe we can get there, but we are years away from seeing these goals achieved in a universal and meaningful way.
*2005 AHA Annual Survey.