We all know that cost management is important to the success of Massachusetts health reform and that there are a lot of ideas out there. One that nearly everyone agrees on is the need for greater health information technology (HIT) adoption, particularly electronic medical records (EMR) and computerized provider order entry (CPOE).
The New England Healthcare Institute released a report last week that showed that universal adoption of CPOE across Massachusetts would save $170 million a year and avoid 55,000 potentially serious adverse drug events. That means each physician could expect to avoid 9 adverse drug events a year and could prevent three life-threatening ones every five years. Only 10 of 73 Massachusetts hospitals have adopted CPOE at present. The promise is just as great with EMR and the adoption rate just about as grim.
Unfortunately, hospitals with tight budgets and physician practices with limited resources feel that they cannot afford the needed step of HIT adoption. Aggravating the problem is the fact that most of the costs of adoption accrue to these same doctors and hospitals while the savings accrue upstream to the insurers and employers – a classic case of non-aligned incentives.
A simple set of policies could fix this, including mixing incentives and requirements to push providers ahead, with some financial help from other sectors of the healthcare economy. HIT is not a panacea but it clearly will be the foundation of a more rational, less fragmented system that costs less and delivers improved quality. We can’t afford to simply watch and wait.
David Torchiana, MD
Massachusetts General Physicians Organization
There are certainly opportunities as well as potential land mines here. I’ve written about cost-sharing schemes and thoughts on cost-benefit analyses with respect to EHRs and more recently about balancing act required when it comes to secondary uses of EHR data — all issues relevant to the roll-out of CPOE systems. There may be great pressure on health care providers brought to bear by big pharma or PBMs to gain access to data concerning prescribing patterns as well as individual prescription information. So long as the costs are spread appropriately, and putting more patient data on line does not have a negative impact on patient confidentiality, these are clearly powerful tools that can improve care both at the individual level and at the population level.