The U.S. has fallen behind other developed countries in implementing healthcare information technology by as many as a dozen years, according to a new study published in Health Affairs. The country's lagging pace in healthcare IT could have major implications as it struggles to cope with rising healthcare costs as the baby boom generation retires.
In the May/June 2006 issue of Health Affairs, health economic policy researcher Uwe Reinhardt of Princeton University in Princeton, NJ, and Gerard Anderson, Bianca Frogner, and Roger Johns of Johns Hopkins University in Baltimore analyzed the state of affairs in healthcare IT in the U.S (Health Affairs, May/June 2006, Vol. 25:3, pp. 819-831).
They began their discussion by citing published research indicating that the U.S. spends far more -- an average of $5,635 per citizen each year and 15% of gross domestic product (GDP) -- than other nations in the Organization for Economic Cooperation and Development (OECD). The implementation of healthcare IT is one possible method of controlling costs, but the U.S. track record in this area is hardly encouraging.
The study lays much of the blame on the fragmented nature of healthcare in the U.S., as well as the delay of the U.S. federal government in developing a national plan for implementing healthcare IT.
Only in 2004 did the U.S. establish a federal office to oversee health IT strategy, the Office of the National Coordinator for Health Information Technology (ONCHIT). Even then, ONCHIT did not receive the adequate budget appropriation originally requested by President George W. Bush, and had to rely on funds earmarked for other purposes to fund its operations.
By comparison, Germany was the first country to start developing a national healthcare IT network, in 1993, and will be the first to have a network completed this year. Canada formed its first governmental healthcare IT body in 1997, and in 2001 launched an IT program that is expected to have electronic health records (EHRs) for half the country's population by the end of 2009, the authors stated. The U.K. has launched an ambitious plan to implement healthcare IT throughout the country by 2014, and Norway and Australia have at least a six-year head start on the U.S.
Other countries also recognized early on the need for national healthcare IT standards to unify their fragmented infrastructures, the article states. "These countries found that national efforts have the advantage of ensuring uniform privacy and confidentiality standards, guiding efficient development and implementation of technology, and providing grants and incentive programs to encourage HIT adoption," the authors wrote.
Another problem is the resistance of U.S. physicians to adopting new healthcare IT technologies, according to the study. "U.S. physicians have been reluctant to adopt HIT primarily because they are concerned about lost productivity spent during training and inadequate financial incentives," the authors wrote. "Some researchers have estimated that start-up costs are $40,000 per physician in small group or solo practices."
But a number of other countries have implemented programs to encourage physicians to shift to healthcare IT usage, the authors stated. The U.K. and Australia identified early adopters and used them to lobby their colleagues to use healthcare IT, while Norway promoted adoption through federal grants to regional projects proposed by healthcare providers.
The article cites published literature estimating that it could cost $103 billion in capital costs and $53 billion in interoperability costs to establish a national healthcare IT network in the U.S. within five years. Other countries have found that they can implement their healthcare IT visions only with substantial funding from national governments.
At the same time, however, estimates indicate that the adoption of an EHR system could produce efficiency and safety savings of $142 billion in U.S. physician offices and $371 billion in U.S. hospitals in the next 15 years.
The article concludes by categorizing healthcare IT funding as a public good that is more likely to benefit patients and insurers rather than healthcare providers. Due to this dynamic, economic theory suggests that the private sector will underinvest in healthcare IT, the authors stated. Therefore, public subsidies should be used to establish healthcare IT systems, even those that will be used by the private sector.
By Brian Casey
AuntMinnie.com staff writer
May 17, 2006
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