While a recent clinical study found that health IT systems have the potential to reduce deaths by 15 percent, in addition to saving costs, the lead investigator advises that a unified paradigm shift and proper planning across a health system is required to produce effective results and improve patient care.

A study published in the January issue of the Archives of Internal Medicine found that hospitals which automate some aspects of their information systems, have lower death rates, reduced costs and patients appear to have fewer complications.

For the study, physicians from 41 urban hospitals across Texas rated their facilities’ automation in four areas in 2005 and 2006. The researchers 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 this timeframe.

The researchers divided the hospitals’ clinical information system into four categories: electronic medical notes and records, test results, computerized physician order entry (CPOE) and clinical decision support (CDS) systems. They wrote that clinical or health IT—such as EMR, CPOE and CDS systems—“have emerged as one antidote, promising reductions in waste, gains in communication, improvements in quality and new accountabilities through automated performance measurement.”

The researchers chose to examine heart attack, heart failure and bypass surgery because “these types of conditions and procedures have been assisted through the standardization of care and following certain protocols,” according to lead investigator Ruben Amarasingham, MD, from the department of internal medicine at the University of Texas Southwestern Medical Center in Dallas.

“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,” Amarasingham notes.

For all of the medical conditions studied, a 10-point increase in automation of notes and records was associated with a 15 percent decrease the adjusted odds of in-hospital deaths. At hospitals with higher CPOE usage scores, the incidence of heart attack death was 9 percent lower (in adjusted odds), while the odds of dying following coronary artery bypass graft were 55 percent lower. Notably, patients with all causes of hospitalization were 16 percent less likely to develop complications at hospitals with highly automated CDS systems.

And with safer care came lower costs, too. Higher scores on test results, CPOE and CDS were associated with lower costs for all hospital admissions (-$110, -$132 and -$538, respectively), according to the authors.

Amarasingham says that the technologies generally improve outcomes in a number of ways, including assisting with the growing complexities of medical decision-making and instituting a paradigm shift away from the current fragmented structure of care.

Proceed with caution

Despite the fact that these systems have the ability to save lives and produce a clear return on investment, Amarasingham advises against blanket, unplanned adoption.

In reflecting on the current economic recession, he acknowledges 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.”

“Hospitals shouldn’t be thinking about what they can afford, but instead about the proper sequence [of system adoption] 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, electronic notes and decision support,” he says.

Amarasingham acknowledges that it is easier for large provider settings to implement health 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 says. “We need to focus attention as a national healthcare community on how we can breach this digital divide.”

Amarasingham stresses 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.”

Bradley Erickson, MD, PhD, a professor of radiology and informatics at the Mayo Clinic in Rochester, Minn., agrees that forethought is essential to a successful deployment or conversion. “There is a timing discrepancy with regards to properly planning and implementing the IT systems necessary to transition from paper to electronic setting,” he says. “It’s not necessarily realistic for an institution that never planned to convert to electronic records to suddenly change course due to the stimulus package, and perform a complete conversion in a short period of time.”

Will the stimulus package stimulate quality improvements?

Considering the impact of the $2 billion allotted for health IT adoption in the American Recovery and Reinvestment Act signed into law in February, it “seems that much of that money will be available through competitive grants which could present opportunities for innovative projects,” according to Erickson.

“In addition to the stimulus funds directed at health IT, there are other sources of money [approximately $10 billion] that have become available through organizations such as the NIH [National Institutes for Health] and NIBIB [National Institute of Biomedical Imaging and Bioengineering],” Erickson says. “There is some interest on the part of these organizations, particularly NIBIB, to advance health IT.”

In addition to first-time adoption providers, there are institutions, such as Mayo, that have well-established electronic environments, and yet, could benefit from IT investments, Erickson says. “For example, we have a number of fully planned projects that were shelved due to the economic downturn of the past year. We hope to apply for grants to fund those projects, and we know exactly how many jobs this will translate into with those dollars. We are not unique; a large number of institutions are in similar situations.”

These providers, which already use EMRs, may not be “catching all the press,” Erickson notes. However, these types of providers, like Mayo, are dusting off health IT projects that have been deferred, and drafting up grant applications to justify their worth. “Mayo and similar institutions are currently prioritizing the importance of each project, evaluating how many jobs they would equate to, assessing the healthcare quality impact and totaling costs to prepare a complete package, in anticipation of a government request for grant applications,” he explains.

The biggest incentive will be tied to quality, Erickson says. “Increasingly, it is becoming clear that the use of health IT systems makes documenting certain quality metrics easier to do. Electronic systems facilitate the measurement of important quality parameters. These stimulus monies can document the current state of quality and provide a metric for future improvements.”

“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,” Amarasingham says.