Better IT is not the same as better information - the health care example

From the Emperor's New Clothes file comes a story in yesterday's New York Times, Doctors' Journal Says Computing Is No Panacea. The story tell how

research papers and an editorial published today in The Journal of the American Medical Association cast doubt on the wisdom of betting heavily that information technology can transform health care anytime soon.

It seems that the fancy new IT which the President and others are pushing as a solution to our health care costs is as likely to cause errors as eliminate them.

Anyone who has every worked with a computer understands that the machines often seem to create as many problems as they solve. Part of the problem is poor system design. As the Times story relates:

One paper, based on a lengthy study at a large teaching hospital, found 22 ways that a computer system for physicians could increase the risk of medication errors. Most of these problems, the authors said, were created by poorly designed software that too often ignored how doctors and nurses actually work in a hospital setting.

I firmly believe that well-designed IT systems can reduce the risk of errors, as was pointed out in the Institute of Medicine (IOM)(a sister organization to the National Academy of Science) study To Err Is Human: Building a Safer Health System. But the systems must be built around the information and how the information is used -- not around the latest technological wiz-bang technique. And the IOM study contained a comprehensive set of recommendations, including behavioral changes such as learning from errors -- not just throwing more computers at the problem.

I also firmly believe that the claims of more IT will reduce health care cost are likely to fail. There is a long history of new technologies that have improved the quality of health care while at the same time increasing costs. Theoretically, improved information will improve productivity. In practice, health care is a very labor intensive activity -- part of the High-Touch economy.

There are also many other things that can be done to improve the quality of health care. In 2003, the IOM published Priority Areas for National Action: Transforming Health Care Quality. That study outlined a number of areas we should focus on:
- Care coordination (cross-cutting)
- Self-management/health literacy (cross-cutting)
- Asthma-appropriate treatment for persons with mild/moderate persistent asthma
- Cancer screening that is evidence-based-focus on colorectal and cervical cancer
- Children with special health care needs
- Diabetes-focus on appropriate management of early disease
- End of life with advanced organ system failure-focus on congestive heart failure and chronic obstructive pulmonary disease
- Frailty associated with old age-preventing falls and pressure ulcers, maximizing function, and developing advanced care plans
- Hypertension-focus on appropriate management of early disease
- Immunization-children and adults
- Ischemic heart disease-prevention, reduction of recurring events, and optimization of functional capacity
- Major depression-screening and treatment
- Medication management-preventing medication errors and overuse of antibiotics
- Nosocomial infections-prevention and surveillance
- Pain control in advanced cancer
- Pregnancy and childbirth-appropriate prenatal and intrapartum care
- Severe and persistent mental illness-focus on treatment in the public sector
- Stroke-early intervention and rehabilitation
- Tobacco dependence treatment in adults
- Obesity (emerging area)

With all this work to be done, focusing our health care policy on one area-increased use of IT-seems to me to be extremely short sighted.

Health case is enabling sector for the rest of the economy. Improving health care will improve the productivity and well-being of the overall economy. And bringing down costs will help our competitiveness. But just don't look to more IT to be the panacea.