Health Affairs: Too early to judge healthcare IT patient safety impact

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Although the use of healthcare IT has had little effect on patient safety thus far, current programs in practice, such as those implemented in New York state, are shedding light on the necessity for  further examination, according to studies published in the March issue of Health Affairs.

In the first study, funded by the Agency for Health Quality and Research (AHRQ) and the Changes in Healthcare Financing and Organization initiative, researchers from the Univeristy of Minnesota's Carlson School of Management and the School of Public Health examined nationally representative Medicare data on more than 10 million hospital inpatient stays for the years 1999-2002. They looked at the effects of three different healthcare IT applications on three separate patient safety indicators. The IT applications examined were EMRs, nurse charts and automated imaging. The patient safety indicators examined were infection, post-operative hemorrhage or hematoma and postoperative pulmonary embolism or deep vein thrombosis.

They found that EMRs are the only IT application to have a clear, though marginal, effect on patient safety; they reduced infections, but had no effect on the other patient safety indicators that were studied. The benefits of EMRs did grow with time, according to the authors.

The findings suggested that early adopters of healthcare IT were typically large academic medical centers that provide high quality care and likely have better-than-average outcomes. Consequently, generalizations from early healthcare IT adopters could overstate healthcare IT's value on a national scale.

"While this is an interesting result, it is clear that much more research is needed on this issue," said Stephen Parente, associate professor in the Carlson School of Management and a study author. Parente and colleagues agree that planned federal investment in healthcare IT should be accompanied by investment in the evidence base needed to evaluate its effectiveness.

Model for adoption

In the second study, investigators at Weill Cornell Medical College suggested that active and functioning healthcare IT programs in New York state could serve as models for new federal initiatives.

"Programs such as these could transform the way health care is delivered nationally and locally," said senior author Rainu Kaushal, MD, chief of the division of quality and clinical informatics and associate professor of pediatrics, public health and medicine at Weill Cornell Medical College.

If implemented correctly, IT systems--including EHRs--have the potential to improve quality of care, increase efficiency and cost savings, reduce medical errors and enhance continuity of care.

At present, New York state is substantially ahead of the game, with approximately $250 million allocated for healthcare IT and, specifically, EHRs that can connect to other healthcare IT systems through the statewide health information exchange network, or "interoperable" healthcare IT.

The Healthcare Efficiency and Affordability Law for New Yorkers Capital Grant Program (HEAL NY) is the largest state-based investment of its kind, surpassing the next largest state program by a factor of eight. Currently $160 million in HEAL NY funds have been granted and $230 million in private sector dollars committed to health IT infrastructure, bringing New York's current investment to $390 million.

The authors conducted a longitudinal survey of the 26 grantees that were funded under the first phase of HEAL NY, starting in 2005. Each grantee consisted of a consortium of health care institutions in a given community. The grantees had received a total of $53 million for this phase of the project. The authors also assessed the implications of New York's healthcare IT strategy on the grantees approach and progress.

Eighty-five percent of the communities studied were still actively pursuing health information exchange, and more than one-third met the formal criteria for a regional health information organization, an information-technology model that connects hospitals, doctors' offices, pharmacies and laboratories.

One-third of grantees had actual users for their systems.

"New York state is leading the nation in health IT. These successes could help shape the federal government's approach to health IT," the authors wrote.

The Commonwealth Fund provided the grant, which funded the study.