Submitted by Marc D. Paradis MS on Mon, 11/23/2009.
Excellent post Jim, and honestly, not too surprising - Joe's analogy to a book is apt. An EMR is just software, software is an enabler, it is nothing in and of itself. To look only at the EMR without also evaluating all of the organizational, behavioral and process changes that must simultaneously be effectively and correctly implemented in order for success, is to frame the problem so as to find failure.
Furthermore, the EMR is probably only one piece of the necessary software. You can buy, read, and understand an Introduction to French textbook, but you will hardly be fluent until you have bought, read, understood and practiced several more textbooks.
Jim you also hit the nail on the head with the emphasis on CDS. The role of CDS shouldn't be to replace the provider, but rather to reduce unnecessary and extraordinarily costly, variations in care. The huge store of clinical information necessary to elucidate and elimiate variation requires an EMR, but without CDS, CPOE and workflow-oriented interfaces, EMR is a cost sink rather than a value source.
Finally, there is also a necessary economy of scale and interactivity. For one hospital to implement is not the same as for a critical mass of hospitals to implement on an interoperable platform or platform(s). What's more, the functionality and interoperability must extend well beyond the hospital and into the clinics, offices, centers and ambulatory practices.
In the end, I agree, it is merely an assertion, and a vague one at that, that "HCIT will lower healthcare costs and improve quality". We can't know this to be true until HCIT is fully implemented. But based on everything we know and have seen from the adoption and implementation of IT in other industries, this assertion is well supported by existing evidence.
Excellent post Jim, and honestly, not too surprising - Joe's analogy to a book is apt. An EMR is just software, software is an enabler, it is nothing in and of itself. To look only at the EMR without also evaluating all of the organizational, behavioral and process changes that must simultaneously be effectively and correctly implemented in order for success, is to frame the problem so as to find failure.
Furthermore, the EMR is probably only one piece of the necessary software. You can buy, read, and understand an Introduction to French textbook, but you will hardly be fluent until you have bought, read, understood and practiced several more textbooks.
Jim you also hit the nail on the head with the emphasis on CDS. The role of CDS shouldn't be to replace the provider, but rather to reduce unnecessary and extraordinarily costly, variations in care. The huge store of clinical information necessary to elucidate and elimiate variation requires an EMR, but without CDS, CPOE and workflow-oriented interfaces, EMR is a cost sink rather than a value source.
Finally, there is also a necessary economy of scale and interactivity. For one hospital to implement is not the same as for a critical mass of hospitals to implement on an interoperable platform or platform(s). What's more, the functionality and interoperability must extend well beyond the hospital and into the clinics, offices, centers and ambulatory practices.
In the end, I agree, it is merely an assertion, and a vague one at that, that "HCIT will lower healthcare costs and improve quality". We can't know this to be true until HCIT is fully implemented. But based on everything we know and have seen from the adoption and implementation of IT in other industries, this assertion is well supported by existing evidence.