Hospitals Should Not Adopt New Healthcare IT Program Too Quickly

Healthcare IT systems can improve care, but doctors must be given time to learn how to best use the software.

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In this photo taken May 4, 2010 a CT is performed on a patient at Cook County Stroger Hospital in Chicago. Americans get the most medical radiation in the world, even more than folks in other rich countries. The U.S. accounts for half of the most advanced procedures that use radiation, and the average American's dose has grown sixfold over the last couple of decades.

M. Eric Johnson is a professor at the Tuck School of Business at Dartmouth College and director of Tuck's Center for Digital Strategies.

Hot summer months seem to slow everything down in Washington, D.C.. Maybe that's a good thing for the nation's ambitious healthcare IT rollout. The Centers for Medicare and Medicaid recently announced that Electronic Health Record incentive payments skipped past $6 billion, with over 122,000 providers already taking part in the action. The incentive frenzy has really just begun, as this represents less than half of the 260,000 providers who have already registered to join the $27 billion funding party.

The Centers for Medicare and Medicaid working groups are toiling through August to finalize stage-two standards and make headway on the third and final stage of the incentive program. Each stage pushes healthcare providers to demonstrate deeper levels of Electronic Health Record "meaningful use." Translated, that means more physicians using more IT.

[See a collection of political cartoons on healthcare.]

Our recent research questions this "more is better" calculus. In an extensive study of 3,900 U.S. hospitals over a five-year period, we indeed found that some IT improves care quality. Hospitals that implemented Electronic Health Record capable of meeting the 2011 standards (stage one) for "meaningful use" saw care improvements for conditions like acute myocardial infarction, heart failure, and pneumonia. 

We also found that the improvement varied depending on the hospital's baseline quality performance, with low quality hospitals seeing the largest improvements. For those hospitals, we found that improved IT led to 11-16 more patients per 1,000 receiving the recommended treatment. This is good news as it shows that those hospitals that really need help do improve with more IT.

However, we also found troubling declines in quality associated with hospitals that implemented more advanced Electronic Health Record systems—those needed to reach stages two and three. In some cases, this decline may be related to the difficulty of improving already good quality scores. But as we have seen in other industries, too much IT too fast can also translate into confusion. The time required for healthcare professionals to adjust and make the most of complicated software should not be underestimated. Nor should the fact that software vendors need time to work out the bugs and improve the usability of their systems. So a hot, slow summer may just be what the doctor ordered.

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