Health Information Technology: Improving Patient Safety and Quality of Care
Background
Medical technology of the 21st century is increasingly part of the digital revolution. The interoperable electronic health record (EHR) can make dramatic improvements in quality and cost reductions with savings estimated to be as much as $140 billion a year. The impact of digital technology, however, extends beyond the EHR. Digitally enabled medical technologies are already dramatically improving patient safety, quality of care, and the efficiency of our health care system. These medical technologies can remotely monitor, manage, and document a patient’s condition; capture and store patient information and test results; assist clinicians with decision support and outcomes studies; and manage drug and supply inventory. Some technologies that are improving patient safety and quality of care include infusion pumps which are preventing drug overdoses and remote patient monitoring which helps to manage disease by continuously monitoring a patient’s condition.
Case Studies
Intravenous drug administration and dosage checking improves medication safety by alerting health care providers before an error occurs. Infusion pumps and medication safety software for IVs work together to improve patient safety. Beginning in October 2002, St. Joseph’s/Candler Health System (SJC) implemented an infusion pump system1 to set dosing limits for IV drug administration in its three hospitals. In nine months of use, the system helped prevent 598 potentially serious medication errors and helped identify procedures with a high frequency of errors.
Remote physiological monitoring (RPM) increases efficiency by using an electronic device in a patient’s home to assist with disease management. RPM consists of an electronic device in the patient’s home that collects data on the patient’s condition, transmits analysis of those data, and a care delivery service that uses those data to communicate with and monitor the patient. In addition, these devices can assist providers in analyzing that data to refine and improve ongoing monitoring activities, make clinical diagnoses as necessary, and assess the need for treatment. The New England Healthcare Institute study2 found that using RPM resulted in:
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A 32 percent reduction in patient re-hospitalization;
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a total reduction of 132 patient days per 100 patients;
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net cost savings of 25 percent; and
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savings of $1,861 per patient over a six-month post-discharge period.
Barriers to Adoption
Despite the successful studies and outcomes identified with the use of health information technologies, many barriers to their adoption remain.
Financial
Each of these technologies requires a significant initial financial investment by the provider or the health system in order to purchase and maintain the systems and to train users. Despite the costs to providers, many health information technologies continue to lack appropriate reimbursement from private insurers or public payers even though payers will reap much of the savings from the technology. In addition, provisions of the Federal healthcare program anti-kickback statute prohibit the offer or acceptance of anything of value in return for patient or item/service referrals. Likewise, unless an exception is met, the physician self-referral law (“Stark” law) prohibits hospitals from billing for items or services provided by physicians who have financial relationships with the hospital. The interpretation of these provisions often prevents physicians and hospitals from adopting interoperable systems and sharing patient information. These barriers to the dissemination of resources should be modified to allow the use and adoption of HIT.
User Support
All of these systems require user acceptance. Infusion pumps and IV drug libraries typically require a change in clinical practice that is often challenging to implement. In addition, some technologies may not save time initially and may require continued support to achieve compliance and use by nurses and physicians.
Standards and Interoperability
These systems require interoperative electronic data systems that must be updated and maintained. A private, independent, certification body is the most appropriate means of creating a credible, sustainable mechanism for ensuring the distribution of functional, secure, reliable, and interoperable EHR products into a national health information network.
Congressional Action
To ensure appropriate access to lifesaving and life-enhancing medical technologies for patients, policies should continue to evolve with technology and transform into a system that supports technological advancement.
AdvaMed supports developing incentives that will overcome the barriers to implementation and foster the timely adoption of these health information technologies (HIT). Providers, payers, and health information technology/medical technology manufacturers must address these barriers in order to facilitate the effective and efficient use of technologies that improve the quality of care and patient safety, and health outcomes overall.
-May 6, 2005
1. Medley Medication Safety System with Guardrails® Software manufactured by ALARIS®
2 .New England Healthcare Institute. “Remote Physiological Monitoring: Innovation in the Management of Heart Failure,” NEHI Series, p. 25.
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