Important New Evidence on the Journey to HIT-Assisted Health Care

 On February 2, ONC had a major announcement related to the Direct Project.  Media were in the audience and on the phone.  One questioner in particular was picking on the value of EHR's, citing a recent Stanford review that suggested EHR's had questionable benefits.

Sitting in the front row of the audience, it was easy to gauge Dr. Blumenthal's heartfelt feelings, that this interviewer, and the referenced study, had it wrong. Now in a systematic and thorough literature review, Dr. Blumenthal, Melinda Buntin, Matthew Burke and Michael C. Hoaglin address these criticisms head-on and find consistently overall favorable affects of Health IT.

Check out this interview: Reaping the Benefits of Health IT: Q&A With ONC's Dr. David Blumenthal

And here's Dr. Blumenthal's response, from the ONC Blog:

Tuesday, March 8th, 2011 | Posted by: Dr. David Blumenthal

When Christopher Columbus set sail from Palos in the Gulf of Cadiz, he knew he had theory and experience on his side. The theoretical conception of the Earth as an orb was as solid as it could be. And Columbus had experience of the trade winds that could speed him both westward and eastward. Yet the final evidence was his to provide.

In deploying health information technology (HIT), including ubiquitous use of interoperable electronic health records (EHRs), we also are at the cusp that is faced by every pioneering enterprise: When all is said and done, the proof is in the pudding.

In 2009, building on a bipartisan foundation of many years’ making, Congress and the President authorized a very substantial national investment in transitioning from paper-based to HIT-assisted health care. We knew the benefits that should ensue, and we had important data from several large HIT “leader” providers, such as the Veterans Administration, Kaiser Health Plan, and others.

Yet, in truth, it is only as we approach the shore of adoption and meaningful use of EHRs that we will truly know the dimensions and consequences of our investment.

Today in the policy journal Health Affairs, an article by several ONC authors shows tantalizing hints at what may await us: Strong evidence regarding the benefits of HIT.

Using assessment methods that were employed by two previous independent reviews, the new study finds that 92 percent of recent peer-reviewed articles on HIT reached conclusions that showed overall positive effects. The study also finds increasing evidence of benefits for all health care providers, not just the larger HIT “leader” organizations that have provided much of the data regarding experience with HIT in the past.

This article brings us much more up-to-date, both in our confidence regarding evidence of the benefits of adoption and use of HIT, and also in our understanding of problem areas that still need to be addressed. This review is important because it helps us correct for the lag in evidence that occurs naturally in the literature, where research has trailed the now-accelerating implementation of HIT.

The review looks at articles published from July 2007 up to February 2010, following up on earlier reviews that had looked at articles from 1995 to 2004 and from 2004 to 2007. This update screened more than 4,000 articles, of which 154 were found qualified for the parameters of the study, a number similar to the previous efforts. It found positive results in 96 of the articles (62 percent), and mixed but predominantly positive results in 46 other articles (30 percent).

Negative findings in the study were most often found in studies of provider or staff satisfaction. According to the article, these findings “highlight the need for studies that document the challenging aspects of implementing HIT more specifically, and how these challenges might be addressed,” such as through strong leadership or staff participation when adopting and implementing HIT. There is also a pressing need to make EHRs more user friendly.

So even as our confidence grows that the nation has made a wise investment, we need to carefully monitor for course correction and continual improvement.

Today’s article adds significantly to strong, evidence-based confirmation that we are headed in the right direction. It likewise confirms what we know intuitively: There will be challenges, surprises, and bonuses throughout this journey to universal adoption and meaningful use of HIT.