Anticlue

How health care organizations use IT

Several ideas floating around blogsphere and the web on how healthcare organizations use information technology and why hasn?t advanced well beyond the current point.

For example there is the MedScape?s article, Information Technologies: When Will They Make It Into Physicians' Black Bags? The article analyzed the Commonwealth funds data from 2003 for adoption rates of technology in the practice setting.

<-- snipped from MedScape -->
For clinical management, the most common tool is computerized access to laboratory results (59%). Other tools are less prevalent: Twenty-seven percent of respondents use EMRs routinely or occasionally; 27% prescribe or order tests electronically; and 12% receive electronic alerts about potential drug-prescribing problems. Only 24% of surveyed physicians practice in a "high-tech" office setting. Physicians in groups of 50 or more are significantly more likely to use any IT tools and to practice in a high-tech office, as compared with physicians in solo practice (odds ratio = 7.7). The top 3 barriers to adoption of IT are start-up costs (56%), lack of uniform standards (44%), and lack of time (39%).

The article concludes with the suggestion of focusing on policies and business models to increase the adoption rate.

The commonwealth fund performed an analysis of the Medscape article. The reported barriers to IT adoption where system start-up costs, recurring maintenance costs, the lack of standards, and the time needed to obtain, implement and utilize a practice based clinical system.

The medical informatics weblog entry, Cash Reward Not an Incentive to EMR Adoption, cites several programs where cash is exploited as an incentive to implement an EMR. Unfortunately the case offered is minimal in light of the cost of an EMR for a practice.

Health Signals new york also comments on the medical informatic?s entry suggesting the idea of asking the docs what docs want.

Enoch also ponders this dilemma in the entry, You can lead docs to water, but how to keep them drinking? Enoch points out competition among practice provider organizations as a means to increase the adoption rate.

With all of these ideas floating around, it looks like the beginning of a cultural change. Health care organizations are notoriously risk adverse. According to Gartner, most health care organizations are a TYPE C, see the chart below.

Being a Type C is a hard place to be. First, IT is not viewed as a part of strategy or increasing tactical productivity. We are the utility of the organization. We keep the place running, but we aren?t used to enhance it. So then departmentally, there occurs grass roots spending on IS which is outside the IS Budget, in order to attempt to bring in innovations.

Now an EMR, with results, order-entry, care plans, and other clinical documentation is a strategic move. Its costly in cash, redesigned workflows, organizational standardization, and several other areas. An EMR has long term benefits like improved patient safety and modes of reducing medical errors. But I think the adoption rate problem stems from the switch of using IT as a utility to bringing IT in and having it be used to the strategic advantage of the organization. In order for this to occur, health care as a whole needs a culture change in the way health care IT is utilized. This will bring a symbiotic relationship necessary for the EMR implementation. Once that has occurred, and EMR implementation maybe be a smoother road to travel.