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Faulty Arches: The Myth of HIT Adoption

February 9, 2009
by Pam Arlotto
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In ancient Rome, when the scaffolding was removed from a completed Roman arch, the law read that the Roman engineer who built the arch had to stand beneath it. The point was, if the arch came crashing down, he would experience problems first hand. Millions of dollars have been spent building electronic medical records and laying the ground work for a national health infrastructure. The federal government is preparing to incent HIT “adoption”. Yet, the recent report from the National Research Council’s Report - Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions and many articles on the unintended consequences of HIT indicate that we are building more than one faulty arch.

If we step back to examine the goal of “adoption”, what do we mean? For HIMSS Analytics, with the EMR Adoption Model, adoption means the system is turned on and operational within a provider organization. MGMA, The American Academy of Family Practice Physicians, the Commonwealth Fund and many other organizations track diffusion of specific functionalities within the physician community. Yet none of these models track effectiveness, outcomes or benefits of the deployments. Ultimately, our goal should be value not adoption. Once value is realized, adoption will occur.

In our book, “Beyond Return on Investment: Expanding the Value of Healthcare Information Technology” we defined value as technology’s impact on the business/clinical performance of the enterprise. In recent years, the industry has assumed that value was a given and assumed a “just do it” mentality. The reality, however, is that value realization must be planned for, managed and measured – and accountability must be assigned.

  • What is the return on investment to your healthcare enterprise of clinical and business technology during the past three years?
  • What specific applications in your portfolio are delivering value?
  • What incremental investments in the short term will take the value of your portfolio to the next level?

Many of the arches built in ancient Rome were not faulty – they are still standing today. To ensure a similar fate, we must shift the discussion away from adoption and toward value realization.



Agreed, stay tuned for more!

Pam, I Blog about the value of IT spending in my February 03 posting. More and more we see that realizing value from healthcare IT adoption is not easy•.

In healthcare, the incentives to deliver health benefits and adoptions are not all aligned with who makes the investment. In most economic transaction, the person receiving the benefit of the goods or services is expected to provide payment for receiving them however in healthcare, the patient receive care for which they pay only a portion of the cost or none at all. Therefore, those who receive the value of IT adoption in large measure make payments that are less than the perceived value of the benefits!

The "financial•bCrLf value for hospitals, physicians, patients, payers and administrators often conflicts. Because of this mismatch between the investing parties (hospitals, physicians) and the beneficiary (patients, the community), the business value for IT adoption investments in some cases are very difficult to assess.

I agree with Ms. Arlotto that the way to drive adoption is by a "value" model versus just adopting for adoption sake. "Value" needs to be from the perspective of the physician (i.e., his/her ability to effectively use the system to meet the goals which include increased productivity and enhanced quality of care). This adds the concept of "usability" to the equation.

Traditional EMRs to this point have largely overlooked this crucial concept of "usability." The focus has been feature-driven standards bodies, rather than benchmarking usability to achieve value.

If systems being contemplated for use by physicians embrace this concept of "usability," then the "value." Ms. Arlotto talks of will be realized and broad-market adoption will follow and physicians, patients and the healthcare systems will also benefit... and all can stand confidently under the arch.

Excellent perspective Evan! Usability is crucial to realizing value. IT adoptions will achieve "optimal value" if it positively impact workflow. Let's agree that IT value comes from creativity and from complements. Then the greatest benefits from IT adoption or EMR investment would appear to be realized when coupled with "complementary" investments such as in:
— New strategies
— New business processes and workflows
— New organizational structures.

Value then comes from the ease of interaction between system features, functions and the workflow into which it is ed — usability!

However. . . a major problem is that organizational change is time consuming, risky, costly, and value is likely to accrue over time.

Thanks for your thoughts Michael. Agreed, value is certainly in the "eye of the beholder•bCrLf and different stakeholders evaluate the benefits received differently. Some on based formal goals and many more on hidden agendas. Yet we have found that anything can be measured. Approaches vary from educated guesses to scientific models. Organizations have more information than they think and typically measurement is much simpler than they realize. Often the reasons organizations don't examine ROI/value is that someone would have to be accountable, no one has the expertise or interest and, until the recent economic crisis, we really haven't had to.