Information Technology Reference
In-Depth Information
Chapter 8
What's Next
Before taking a look at a possible future, let's quickly review where we've been and
where we are today.
The core potential benefits of electronic records are to support providers in mak-
ing correct clinical decisions, to facilitate coordination of care, particularly for
chronic disease, and to provide data to improve medical knowledge, our under-
standing of treatments in a broad patient population and public health. There is also
the hope that properly designed and implemented systems will increase efficiency
by improving processes and workflows.
How the US delivers healthcare is unique and is best characterized as a “complex
adaptive system” in which there are many independent agents, each of whom acts in
their own perceived self interest and no one is in charge. This led to a long time
impasse in which providers were expected to invest in technology when most of the
financial benefits would accrue to payers. This was a major reason why adoption of
“fully functional” electronic records that could help achieve the desired benefits was
extremely low as recently as 2008. Other impediments were the complexity of the
technology and providers' reasonable concerns that they would not select the cor-
rect systems nor be able to properly implement them.
In 2001 the Institute of Medicine sounded an alarm. It said clearly that US health-
care was overly expensive, did not produce the desired results in an alarmingly high
percentage of cases and was even often unsafe. The IOM recognized the potential
role of information technology in solving these problems and soon thereafter called
for a new engineered approach to health delivery. During this same period, the fed-
eral government became, of necessity, increasingly concerned about rising health-
care costs. In 2004 President Bush proclaimed universal adoption of electronic
records as a national priority. In 2009 President Obama used the stimulus to bridge
the complex adaptive system and offer payment for adoption if providers used the
technology in a “meaningful” way that offered the prospect of reducing health costs
while increasing the quality of care, particularly through coordinated care for the
chronic diseases which now account for a substantial majority of US health costs.
In parallel Medicare and several of the major private health insurance companies
are offering outcome-based contracting for care under which providers are rewarded
