March 10, 2009
12:01 a.m. Eastern Time
Health Affairs Explores Benefits, Challenges To Nation’s Uptake Of Health Information Technology
Issue Highlights How Technology Has Transformed Care; Potential Roadblocks To Adoption Amid Massive Federal Investment In Health IT
Bethesda, MD -- As the U.S. government prepares to embark on major new investments in health information technology (IT), the March/April issue of Health Affairs explores the benefits, challenges, and potential risks of transforming the health care system through the use of IT. A series of papers and Perspectives suggests that the gains could be real and dramatic -- but will not be easy to achieve.
Among the highlights in the journal’s thematic issue on health IT, Catherine Chen and colleagues at Kaiser Permanente show that a comprehensive electronic health record (EHR) can result in a transformation of health care delivery -- and, in particular, could help address an increasing burden on primary care physicians. The system, which has been introduced throughout Kaiser Permanente, was initially rolled out in the giant health plan’s Hawaii Region in 2004. Among other features, the system allows physicians and patients to communicate via secure e-mail messaging in lieu of a traditional office visit. Chen and colleagues found that after the system was introduced, and patients availed themselves of the opportunity to substitute an "e-visit" for a physical visit to the doctor, primary care office visits fell by a dramatic 25 percent. http://content.healthaffairs.org/cgi/content/abstract/28/2/323
"Electronic health records have the potential to make care more efficient," said Catherine Chen, manager for National Clinical Systems Planning and Consulting at Kaiser Permanente. "However, few providers will adopt such technology unless public and private policies reward providers for care via online visits. Consumer preference for more convenient methods of care, where appropriate, also needs to be taken into account."
Kaiser Permanente, a health plan that covers an estimated 8.7 million patients in eight regions, has a health IT system that allows clinicians to document visits in the inpatient and outpatient settings; provides clinical decision support; and allows for instant connectivity to labs, pharmacy, radiology, and other services. Physicians can contact patients electronically; order consultations, laboratory, and other diagnostic work; and send prescriptions directly to the pharmacy. The system also allows for secure messaging between patients and providers and for messaging between providers that is automatically incorporated into patients’ records.
Chen and her colleagues examined the system’s impact on patient visits and patient-physician e-mail messaging at KP Hawaii, which was the first region to fully implement the system. Between 2004 and 2007, total office visits per member decreased by 26.2 percent, from about five visits per year, per member to about 3.7 visits per year, per member. Specialty care visits dropped 21 percent -- from about 1.4 visits per patient to 1.1 visits per year after the EHR system went into place. Total scheduled telephone visits per member increased almost ninefold. And secure messaging between patients and physicians went from 0 in 2004 to more than 51,000 messages, or 0.23 per member, by 2007.
Researchers also reviewed the system’s effects on quality and patient satisfaction. Overall quality remained unchanged. KP Hawaii member satisfaction surveys also remained essentially unchanged. The researchers did not examine the system’s effect on net efficiency or costs.
In a related paper, Kaiser Permanente’s Anna-Lisa Silvestre and coauthors detail consumers’ enthusiasm for the health system’s member Web site and online health services to exchange e-mail with physicians, schedule appointments, view their records, get test results, and manage their benefits, among other activities. As of July 2008, 2.4 million KP members had registered to access the site’s secure features. On average, 58,734 KP members register to use the site each month. Registrations began to increase rapidly in 2006, when personal health records (PHRs) became widely available. Web-site use was not limited to the wealthy and educated; half of the survey sample reported household incomes of less than $75,000 annually, and nearly half did not have a college degree. http://content.healthaffairs.org/cgi/content/abstract/28/2/334
Health IT Raises Privacy, Security Debates
Despite the promises health IT offers, protecting the privacy of people’s health information is a major challenge to ensuring the widespread adoption of health IT in the United States. Several papers in the March-April issue tackle the various debates over health information privacy and offer potential solutions to this thorny issue.
Economic Stimulus And Health IT
Separately, Health Affairs has released a series of articles online that offer perspectives on health IT and the recently enacted American Recovery and Reinvestment Act of 2009, the so-called economic stimulus plan. http://content.healthaffairs.org/cgi/content/full/hlthaff.28.2.w379/DC2
ABOUT HEALTH AFFAIRS:
Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.
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