AIM researcher advocates for healthcare IT adoption, with caution

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Ruben Amarasingham, MD, MBA. Image Source: University of Texas Southwestern Medical Center

While a study in the Jan. 26 issue of the Archives of Internal Medicine touts the cost and life-saving benefits associated with hospital healthcare IT adoption, lead investigator Ruben Amarasingham, MD, said that healthcare IT should always be accompanied with a strategic, collaborative deployment plan to achieve a successful outcome. 

For the study, physicians from 41 hospitals across Texas rated their facilities' automation in four areas in 2005 and 2006. The researchers then examined rates of inpatient death, complications, costs and length of stay for 167,233 patients older than 50, who were admitted to the hospital for a variety of conditions during the same timeframe.

The researchers specifically identified EMRs, computerized provider order entry systems and clinical decision support systems as beneficial.

The researchers specifically chose myocardial infarction, heart failure and bypass surgery because “these types of conditions and procedures have been assisted through standardization of care and following certain protocols,” Amarasingham said.

“Unlike previous studies about these technologies, we didn’t seek to identify how a particular system correlated with specific results. We sought to see if there was a general relationship between these technologies and the improvement of patient care outcomes,” noted Amarasingham, from the department of internal medicine at the University of Texas Southwestern Medical Center in Dallas.

However, he said that the technologies generally improve outcomes in a number of ways, including assisting with the growing complexities of medical decision making and with the fragmented, paradigm shift in the structure of care.

In reflecting on the current economic recession, Amarasingham acknowledged that many providers cannot currently undertake widespread IT adoption. He added that a hospital may not have a choice about which system to adopt first, because “it’s best done sequentially.”

For instance, decision support is really not possible without electronic order entry or electronic notes, even though it proved to be the most potent in improving outcomes. However, "it certainly cannot be undertaken without the other two, especially without order entry,” he explained.

“Hospitals shouldn’t be thinking about what they can afford, but instead about the proper sequence and what makes the most sense for their practice or hospital—and most of all, what makes the most sense for the patient. That usually means building an infrastructure that has automated test results, then order entry, then electronic notes and then decision support,” he said.

Amarasingham acknowledged that it is easier for large provider settings to implement healthcare IT solutions. “It’s just an economy-of-scale issue. A good system requires a lot of IT support and physician training. In our research, we learned that larger health systems are able to absorb some of the fixed costs associated with implementation.

“However, this could be a great way for state or federal governments to assist smaller or rural hospitals. There is a role for regionalization of information systems, so that these less well-funded institutions can participate in the knowledge and experience gained in larger systems,” he said. “We need to focus attention as a national healthcare community on how we can breach this digital divide.”

While the potential insemination of healthcare IT funds through the current economic stimulus package is encouraging, Amarasingham stressed that the best provider outcomes were associated when the hospital “created a culture wherein they seamlessly and harmoniously combined the technology with their unique processes and people. While I think investing in healthcare technology is a great use of stimulus spending, it needs to be accompanied by thoughtful implementation.

“If stimulus spending means rapid deployment and adoption, without careful consideration of the socio-technological environment of a hospital, how can we measure progress, or the success of the implementation, or the ease of use for physicians. I would caution that money by itself is not going to be sufficient,” he said.

Investing in healthcare IT could produce “wonderful” outcomes, but it always needs to be accompanied by a “thoughtful, potentially time-consuming evaluation of the environment of the implementation,” he concluded.