Healthcare Information Technology: Effects on Cost Access and Quality

It is not unreasonable for a patient to expect particular services from their healthcare providers. What services should be considered reasonable and which fall under the context of unreasonable? Should the specialist, your family physician referred you to, have access to your past medical history? What happens when you are traveling and have to make a trip to the emergency room, will your physician at home get all the information from that visit or will the ER physician have access to your medical history? Medical information recorded in paper format makes these tasks very difficult, if not impossible. "Fortunately, there is a growing movement to change that, using electronic information technology[3]." The use of this type of technology allows for "high-quality, safe, well-coordinated, and efficient care[4]." Society today is ever changing, we change jobs, location of residence, and doctors frequently. Many of our doctors and hospitals remain stuck in the medical stone age. While people speak of a medical "system," American medicine is in fact very unsystematic: it lacks standards, measures, and the ability to exchange information that constitute a true system. The medical industry has taken to every kind of clinical technology; from digital thermometers to CT scanners. However, the adoption of information technology in the medical industry lags behind the rest of our economy.

Health informatics is best described as the point where information science, medicine, and healthcare all meet. It encompasses the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and the use of information in health and biomedicine. Health informatics incorporates tools such as: computers (hardware and software), clinical guidelines, formal medical terminologies, and information/communication systems. Healthcare informatics is comprised of several areas: clinical, nursing, imaging, consumer health, public health, dental, clinical research, and pharmacy. Health informatics consists of many components, the main components focused on are electronic medical records, clinical decision support systems, and telemedicine. The electronic medical record (EMR) is a medical record in digital format. EMR's facilitate access of patient data by clinical staff at any given location, accurate and complete claims processing by insurance companies, building automated checks for drug and allergy interactions, clinical notes, prescriptions, scheduling, and sending /viewing of labs. Research has shown that electronic health records provide greater accessibility, accuracy, and completeness of clinical information: therefore reducing uncertainty[2]. Clinical decisions support systems are computerized systems designed to assist physicians and other health professionals in decision making. Telemedicine is the use of information technology and communication to deliver care. Telemedicine uses electronic information and communications technologies to provide medical diagnosis and/or patient health care when distance separates the participants.

When looking at the use of healthcare information technology from an administration standpoint, the question becomes; in what way will the use of such practices produce a worthwhile benefit? The foundation of healthcare delivery consists of three major elements: cost, access, and quality (The Triad)[5]. Therefore, this paper will focus on the relationship between these three elements and the effects healthcare information technology will/can have on them.

Healthcare cost is defined in three ways: system-wide healthcare spending (national healthcare expenditure), price of healthcare services, and cost of producing healthcare. Healthcare cosst have grown to an estimated $1.9 trillion annually, which is 16% of the Gross Domestic Product. The high-cost of healthcare is often blamed for the increasing number of uninsured in America, 46 million people[8]. Therefore, finding a practice or a system which will positively effect the cost of healthcare is constantly sought after. So, how is the implementation of healthcare information technology going to effect the cost of healthcare? Electronic medical records have been shown to have a positive effect on decreasing healthcare costs. These savings are seen in all areas: administrative[7], patient, healthcare organization, and government/private insurance.

Administrative costs have been seen through time not spent finding, filing, and retrieving patient charts. Time equals money, and a decrease in employee time equals less money spent by the employer. Cost savings are also seen through elimination of transcription, transferring, and transporting of patient charts. Billing components within EMR packages can provide cost savings through generation of direct billing and reimbursement, this process shows great potential for reduction in billing errors[7]. Errors made during the billing/reimbursement process result in dollars lost or not recovered for the organization, which in turn drives up the cost of healthcare. The Centers for Medicare and Medicaid Services reported (in 2003) that a 10% error rate, regarding payments, resulted in 18.4 billion dollars in overpayment in fee-for-services payments[11].

Emergency room visits generate the most costly healthcare provided, EMR access during an emergency room visit could provide cost reduction. This cost reduction is seen through lab and other diagnostic testing not being unnecessarily repeated, immediate access of previous results allow treating physicians to make a quicker more informed decision[7][15]. Also, time spent not performing these tests or procedures frees up provider time for other patients and procedures; allowing more patients to be seen (equals more profits). These savings directly effect the provider, patient, and payer. Not only are savings seen in the emergency room from unnecessarily repeating labs, radiographs, and other diagnostic tests, but the availability of results from all of these within an EMR provides savings across the board.

Some healthcare technologies are seen as unnecessary or it is felt they are used inappropriately; it is felt that they add to the rising healthcare costs. Many practitioners feel there are alternative cost-effective procedures that are currently underused. The use of evidence-based decision-making, a decision support system, to collect information and analyze data leads to informed decisions regarding medical technology acquisitions, technology adoption and dissemination, coverage and reimbursement policies, usage levels of health technologies and associated costs, potential impact on revenue, best practices and clinical outcomes[13]. This is a tool that aids in the