AJMC Works To Measure The Value Of Health IT
By Megan Williams, contributing writer
Relating the value of health IT to your clients can be difficult. While they are likely hyper-aware of the importance that IT holds in the industry and the benefits it can potentially bring them, addressing the definition of applied value can be a challenging.
A recent paper The Value of Health Information Technology: Filling the Knowledge Gap (available via the American Journal Of Managed Care) has addressed this issue.
Purpose
The paper is primarily focused on figuring out more reliable ways to determine the actual value of health information technology (HIT), as it states: “…systematic reviews of HIT have found that the evidence for value is inconclusive and that existing studies suffer from major limitations. This finding is true even of the most recent literature reviews, despite a greatly increasing number of studies evaluating HIT.”
Measurement
HIT has been evaluated for value in many different ways including cost and time savings, physician satisfaction, patient satisfaction, and safety improvements. While they are all important, the paper maintains that they are limited in assessing true value. It asserts that evaluation of HIT should look at three, core principles around the definition of value:
- value is comprised of both cost and benefits
- value accrues over time
- value is dependent on stakeholder perspective
Cost And Benefits
Studies that report costs alone tell only part of the value story. The paper presents three examples of how cost can fall short in determining value, one involving the value of healthcare in the U.S. at large,
“…the United States as a whole spends far more on healthcare now than it did in 1950, in large part due to technological advances. A newborn in 1950 could expect to require $8000 worth of medical care over the course of his or her lifetime (in 2001 dollars discounted to birth), whereas the comparable figure for a newborn in 1990 was $45,000, a nearly 600 percent increase. Yet, as Cutler and McClellan argue, based on an analysis of 5 medical conditions (heart attacks, low birth weight babies, depression, cataracts, and breast cancer), despite the rapid rise in costs, the benefits of medical progress (in terms of quality-adjusted life years) more than justify the added costs ($7 in benefits for every $1 in increased spending for heart attack treatments, for example).”
Value Accrued Over Time
The paper specifically uses EHR implementation to illustrate the difficulties in determining the value of an EHR.
Setting up a system requires installation expenses, training, hardware, and software. Over the long term, it will require maintenance, replacement, and retraining — all of which are a time burden on existing staff. Benefits also shift from error reductions, clinical monitoring, and disease management depending on time and who is determining what those benefits are.
Relative Perspective
In the discussion of perspective, the paper emphasizes the importance of the fact that there are possibly “winners” and “losers” in costs and utilization of health IT. It uses the example of EHR implementation at the Veterans Health Administration, where doctors “lost” in the form of longer entry time, and the VHA “won” in terms of cost reduction. Patients also “won” by getting more preventive services.
Improving Studies
The paper suggests the following criteria be met by all HIT reports to improve the understanding of value:
- longer time horizons
- consideration of multiple stakeholder perspectives
- reporting implementation details and contextual variables
- evaluations that include both benefits and costs