With Better Funding and More Trust, Regional Successes Can Become Nationwide
Information technology can substantially reduce medical errors and translate into major cost savings, says Janet M. Marchibroda, MBA, Chief Executive Officer for the eHealth Initiative/Washington, D.C. Marchibroda, speaking at the Third Annual Health Legacy Partnership (HELP) Conference and eHealth Initiative Annual Meeting, "The technology exists," she says, "But it requires that the communities to work together to realize the greater good that can come from sharing information to support better patient care." She adds that regional initiatives reveal that the key barriers to IT cooperation are funding and lack of trust between health systems.
Implementing an interoperable electronic infrastructure that connects different health care systems including electronic health records could save thousands of lives and at least $80 billion per year, Marchibroda says. She points to a 1999 report by the Institute of Medicine that found between 44,000 and 98,000 people die in hospitals each year as the result of medical mistakes, creating costs of approximately $37.6 billion each year, with $17 billion linked directly to preventable errors. Using findings from a study of two prestigious teaching hospitals, The IOM report further noted that almost 2% of hospital admissions experience a preventable medication error, resulting in an average increased hospital cost of $4,700 per admission or about $2.8 million annually for a 700-bed teaching hospital.
Clinical Data-Sharing Reduces ED Charges
"One study of intensive care patients found that when physicians used a computerized system, the incidence of allergic drug reactions and excessive drug dosages dropped by more than 75%," Marchibroda says. "The average time those patients spent in the unit dropped from 4.9 days to 2.7, slashing costs by 25%."
Marchibroda further notes that one hospital’s use of a community-based clinical data-sharing network resulted in a reduction in emergency department charges of $26 per encounter, while switching to electronic records saves annual paper storage costs that range from $4,000 for a small facility to $100,000 for a large center. Brigham & Women’s Hospital found that using computerized physician order entry reduced error rates from 10.7 to 4.9 errors per 1000 patient days and potential adverse drug events by 84%.
Weaning Protocols More Successful Using Handheld Computers
A recently published study1 further points up IT’s potential for improving patient care. Researchers who evaluated 352 patients requiring mechanical ventilation in the medical ICU at Barnes-Jewish Hospital/St. Louis found that using interactive weaning protocols on a handheld computer significantly improved clinical outcomes and overall compliance with the weaning protocol. The study’s authors observed that using protocols can reduce the occurrence of medical errors and that one evidence-based guideline "recommends the use of interactive education and reminders directed at non-physician healthcare providers when developing weaning protocols. Our experience suggests that the use of handheld computers programmed with an interactive weaning protocol may be one way to follow this recommendation."
Despite such impressive evidence that maximizing use of information technology results in better care at lower cost, the US health care system as a whole has yet to take the IT plunge. However, Marchibroda notes there have been some stunning successes at the regional level including the Santa Barbara Care Data Exchange and the Indianapolis Network for Patient Care.
The baseline assessment done by the Santa Barbara group before implementing an interconnected infrastructure revealed that physicians who shared the same patient ordered the same drug, lab test or radiology exam 11% of the time; half of the time, the patients followed the duplicate instructions. The assessment also found that one out of every seven admissions resulted from missing information in emergency rooms or primary care settings and one out of every five lab and X-ray tests were duplicated because of medical record retrieval barriers.
Indianapolis Initiative Offers Working Model
Marchibroda describes the Indianapolis initiative as "a working model of our vision of an interconnected, electronic health information infrastructure" and says that the key factors in its success were commitment and involvement of the health systems at the executive level.
Marc Overhage, MD, a practicing clinician and senior investigator at the Regenstrief Institute for Health Care/Indianapolis, is responsible for much of the INPC’s success, which he attributes to community vision, outside funding and approaching the project from the clinician’s point of view.
"We’re fortunate to have very enlightened leadership here," Overhage says. "When we talk to the CEOs here, rather than seeing IT as putting their institutions at risk, they saw it as being good for the patients. And our focus was always on benefits to patient care and the clinical side."
Overhage observes that the fact that Regenstrief began the INPC project as research funded by the National Library of Medicine and the Agency for Health Care Research and Quality meant hospitals didn’t have to fork out the money themselves. "We weren’t a competitor knocking at the door suggesting we share data, he says. "We were a nonthreatening neutral party."
Resistance to using IT stems from the time and energy getting IT set up requires, and from irrational fears such as the possibility that competing facilities will be able to access data and use it to gain more admissions. "Most hospitals don’t have time, energy and sophistication to look at their own data, let alone monitor a competitor’s," Overhage says. "But there are always other things the institutional energy could and should be going toward."
IT implementation does carry some financial risk to hospitals. Though reducing emergency room charges by more than $25 per visit benefits patients and payers, "if you’re CEO of a hospital that gets 100,000 visits, your revenue would go down by $2.5 million," Overhage notes. "Part of the challenge-which is a fundamental health care problem-is getting the money back to the people who made the investment. And IT can actually reduce the number of hospital admissions hospitals."
Savings-Sharing Programs Could Help
Savings-sharing plans would do a lot to raise CEO enthusiasm, and Overhage says he’s heard that Columbia Presbyterian Medical Centers in New York has negotiated such a deal with an insurer whereby the hospital receives a higher rate of reimbursement because it uses physician-order entry.
The health history information ICU physicians and staff have available to them at the time of admission can be pure gold, Overhage observes. But once the first hours of an admission pass and facts about patients’ histories are known, the need for outside data drops dramatically as staff focus shifts to data generated internally.
Marchibroda notes that everyone-health systems, practicing clinicians, public health, payers and patients-can derive value from an interconnected, electronic health information infrastructure. "In the last couple of years, technology has evolved that can make this happen," she observes. "Once we have political will and funding we can vastly improve the quality of health care that is delivered in our country." (Contact info: Janet M. Marchibroda  663-8099; Marc Overhage  630-8685.)
1. Iregui M,et al. Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation. Crit Care Med. 2002;30(9):2038-2043.