A negative study on hospital automation from Harvard, which can easily be seized on by automation opponents, is in fact a condemnation of the approach the trade group HIMSS used in selling hospitals through the middle of the decade.
Vendors made promises of cost savings to accountants and administrators, the team of Dr. David Himmelstein concluded, but did not deliver results on the "shop floor." (Picture from Harvard. Nice beard, doc.)
The study looked at systems put into place between 2003-2007, measuring their costs against competitors within their Medicare regions, and concluded that those on the "most wired" list did no better than others on quality, costs or administrative costs.
In fact, the high cost of systems sold then actually increased administrative costs.
This was no surprise to Michael Painter at Thehealthcareblog:
Most do not think that simply adopting, even widely, a technology would ever magically on its own improve quality or lower costs. I’m not sure why these authors seemed to say otherwise. The point as many have noted over and over again is for health professionals to adopt and then USE (remember our year long discussion regarding meaningful use?) the technology FOR improved quality, including improved efficiency.
The short version. It's the data, stupid.
As any IT professional will tell you collecting data does not improve efficiency unless you are basing efficiency on data collection. Having bar codes on pallets, trains and products does not make your store better unless you use that data to change how you do business.
In the case of health care this has not happened, although there are some important things we know based on the data we already have:
- Improve the management of chronic conditions and those people won't be in the hospital as often.
- Lifestyles have to change for people to get better results on their own health care.
- Incentives have to change, and conflicts of interest outlawed, before major players will participate in a change program.
A lot of this comes back to a study Dr. Ralph Snyderman offered at the Predictive Health conference in Atlanta last December.
Hospitals don't have an incentive to lower the cost of care. Customers do. For a hospital, saving money for patients means less money coming in for operations. It's the fast way to the firing line.
What hospital automation as sold by HIMSS really did was give administrators the equivalent of bar codes on their warehouse pallets. But Wal-Mart is not a warehouse. It's a system that extends from suppliers in China to store shelves. The data is just a means to the end.
Until data is used to change the health care system, and until incentives are in place that advantage those who do the best job, automation is just bean counting.