RAND Study Says Health Information Technology Can Improve Quality and Efficiency; More Evidence Needed About How to Put the Technology Into Wider Use

Electronic health records and other electronic healthcare technology can help improve the quality of care and increase efficiency, but more work is needed to show most health providers how to adopt the technology, according to a RAND Corporation study issued today.

“There is good evidence to show that health information technology can provide substantial benefits,” said lead study author Dr. Basit Chaudhry, a RAND researcher and UCLA physician. “What we don't have is evidence showing most health providers how to make the technology work in their hospital or in their office. They need better information about how to move from paper records to electronic records.”

The study, which reviewed past studies on the benefits of health information technology, found that there is enough evidence to conclude that the technology can improve compliance with medical treatment guidelines, reduce medication errors and decrease the use of potentially unnecessary medical care.

But most studies about adopting health information technology have been done in a few large academic medical centers. The experiences of these centers don't provide a roadmap for community hospitals and smaller physician practices that want to embrace the technology, according to the RAND Health study being published in the May edition of the Annals of Internal Medicine.

Chaudhry said future research should probe how to best adopt health information technology in a wide array of community health settings, including evaluations of systems that are commercially available. Those results should be reported in a standardized way that would allow different projects to be compared, the RAND study says.

In addition, research should address the institutional changes and management structures that are needed to make adoption of health information technology successful, according to the study.

“We need to give hospital administrators, physicians and other decision makers better tools so they can judge the financial impact of adopting health information technology,” said senior author Dr. Paul Shekelle of RAND and the Greater Los Angeles VA Healthcare System.

The RAND project was sponsored by the federal Agency for Healthcare Research and Quality to assess the status of research about health information technology. The Annals article, published online by the journal today, summarizes the full report released today on the Agency for Healthcare Research and Quality web site at www.healthit.ahrq.gov.

Health information technology includes computerized medical records and many other tools intended to help health professionals and patients. Some of those other tools electronically send prescriptions to pharmacies, check prescriptions for allergies and drug interactions, aid doctors in deciding the best treatment for illnesses, and remind patients about the need for screening or other preventative measures.

A study released by another group of RAND researchers in 2005 estimated that wide adoption of electronic medical records and other health information technology could save more than $81 billion annually and improve the quality of care.

Researchers from RAND Health, the David Geffen School of Medicine at UCLA, the Greater Los Angeles VA Healthcare System and Cedars-Sinai Medical Center performed a detailed review of studies about health information technology published through 2003 to assess the state of knowledge about it's impact on quality, efficiency and costs.

Of the 257 high-quality studies that reported findings about health information technology, one-fourth came from just four academic institutions that had adopted systems early, according to RAND researchers.

Findings from these institutions show there is strong evidence to conclude that health information technology can improve health care. However, the path followed by these institutions — developing their own computer systems and spending many years making them work — is not an option for community hospitals and other health providers that have fewer resources, according to researchers.

Researchers found only nine studies that evaluated commercially developed systems, which are the ones most likely to be adopted by smaller health providers.

While researchers found ample evidence that health information technology can improve some measures of health care quality, there were relatively few studies that examined its impact on health costs. One of the few studies that did directly measure savings found that health information technology cut hospital stays by almost one full day, saving nearly $900 per admission.

An additional shortcoming of studies done thus far is that few have focused on information technology systems geared towards the needs of patients and consumers.

In addition to the Agency for Healthcare Research and Quality, the project was sponsored by the Office of Disease Prevention and Health Promotion, and the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.

The Agency for Healthcare Research and Quality has launched a $166 million initiative to broaden research by sponsoring more than 100 projects where health information technology systems are being implemented, with an emphasis on commercial systems being used in community-based health care settings. Findings from the projects will widely distributed to help providers adopt health information technology.

Other authors of the report are Dr. Jerome Wang of Cedars-Sinai Medical Center, and Shin-Yi Wu, Margaret Maglione, Dr. Walter Mojica and Elizabeth Roth, all of RAND, and Sally C. Morton, formerly of RAND and now of the Research Triangle Institute.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.