HealthAffairs: VA spends more, achieves higher levels of health IT adoption
In comparing health IT within the Department of Veterans Affairs (VA) to the standards in the private sector, researchers from the Center for IT Leadership in Charlestown, Mass., determined that the VA spent proportionately more on IT than the private healthcare sector spent, but it achieved higher levels of IT adoption and quality of care.

The study, appearing in the April edition of HealthAffairs, estimated the potential value of the VAs health IT investments to be approximately $3.09 billion in cumulative benefits net of investment costs. The investments, consisting of EHRs, radiological imaging and laboratory and medication ordering and administration, known as the Veterans Health Information Systems and Technology Architecture (VistA), is associated with significant reductions in unnecessary and redundant care, process efficiencies and improvements in care, said Colene M. Byrne, senior analyst and lead author of the study.

Through a benchmarking analysis, the authors sought to compare levels of health IT system adoption by the VA to the private sector, as well as whether this adoption is associated with changes in the care process and the level of health IT spending that is necessary to sustain adoption. 

According to the researchers, the analysis quantified and compared the VA’s experience to the private healthcare sector in three areas:
  • IT spending: IT-related budget metrics, including overall IT spending, capital investment for new projects and costs for ongoing IT operations and systems maintenance;
  • IT adoption: The types of systems, their capabilities and the sophistication of systems across inpatient and outpatient care settings; and
  • IT-related quality of care: National quality measures, reported by both the VA and private sector organizations, aligned with the use of health IT.

The study found that the VA has higher ratios thnt the private sector in terms of health IT total spending, as well as for IT operations and maintenance costs.  In terms of capital expenses, however, the VA is at or below the industry averages, wrote the authors.

For IT adoption, the VA has achieved nearly 100 percent adoption rates of several VistA components since 2004, compared to the private healthcare sector, which has not reached significant adoption of any of these systems, the study found. The researchers wrote that currently, adoption of inpatient EHRs stands at 61 percent; use of inpatient bar code medication administration is at 22 percent; computerized physician order entry adoption is at 16 percent and outpatient EHR adoption stands at 12 percent.

In terms of IT-related quality of care, Byrne and colleagues determined that the VA had higher performance from 2004–2007 compared to the private healthcare sector. For example, they wrote that the VA averaged about 15 percent higher than the private sector on preventive care for patients with diabetes and 17 percent higher for patients with diabetes who have well controlled cholesterol.

According to the authors, cumulative reductions in unnecessary care attributable to prevention of adverse drug event–related hospitalizations and outpatient visits as a result of VistA investments was the largest source of benefit found by their study, with an estimated value of $4.64 billion, or 65 percent of the total estimated value.

Citing potential limitations to their study, the authors wrote that differences in capital, operations and maintenance spending between the VA and the private healthcare sector may reflect differences in their relative stages of adoption and most organization in the private sector may be in the preliminary adoption stages.

“As private-sector healthcare organizations increase health IT adoption and use, it is likely that their IT cost ratios will increase to match those of the VA,” said Byrne.

Citing their study as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs, the researchers concluded that the results of their study are consistent with previous research.