Harvard study: for healthcare, IT doesn't seem to matter

'You spend $25 million dollars and all it does is increase the time doctors spend inputting data'
Written by Joe McKendrick, Contributing Writer on

Maybe Nick "IT-Doesn't Matter" Carr has it right after all. At least, that's what some of his associates over at Harvard Medical School are now saying.  They studied 4,000 hospitals over a four-year time span and concluded that IT systems, far from improving efficiency, actually end up costing money than they save. Yes, there were some instances of process and service delivery quality here and there, but the report says any improvements have been minimal.

'You spend $25 million dollars and all it does is increase the time doctors spend inputting data'

The report, Hospital Computing and the Costs and Quality of Care: A National Study, makes the following conclusion:

“As currently implemented, health information technology has a modest impact on process measures of quality, but no impact on administrative efficiency or overall costs. Predictions of cost-savings and efficiency improvements from the widespread adoption of computers are premature at best.”

The study also did an analysis of hospitals at the cutting edge of computerization (as indicated by their inclusion on the “100 Most Wired List” compiled by Hospital and Health Networks magazine for 2005 and 2007), and found IT had little effect at these institutions.

While there have been many promises over the years that IT in healthcare settings would cut paperwork and speed up or improve processes, there has been little documentable evidence so far to back up such claims, Dr. David Himmelstein, an associate professor at Harvard Medical School and lead author of the study, said in a ComputerWorld interview. "For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner,” he is quoted as saying. “So the first thing we need to do is stop claiming things there’s no evidence for. It’s based on vaporware and [hasn't been] shown to exist or shown to be true.”

The problem “is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients,” he also told ComputerWorld. “First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system,” Dr. David Himmelstein, an associate professor at Harvard Medical School and lead author of the study, said in a ComputerWorld interview. “And for doctors, generally, it increases time they spend [inputting data].”

As stated in the report, the data just isn’t there yet:

“Unfortunately, these attractive claims rest on scant data. A 2006 report prepared for the Agency for Healthcare Research and Quality, as well an exhaustive systematic review, found some evidence for cost and quality benefits of computerization at a few institutions, but little evidence of generalizability. Recent Congressional Budget Office reviews have been equally skeptical, citing the slim and inconsistent evidence base. As these reviews note, no previous studies have examined the cost and quality impacts of computerization at a diverse national sample of hospitals.”

Still, there are voices that urge greater automation at hospitals to help them run more efficiently. David Brailer, who headed the Office of the National Coordinator for Health Information Technology from 2004 until 2006, is quoted by ComputerWorld as estimating the cost of a nationwide e-health records at between $75 billion and $100 billion. Such a system would reduce US healthcare costs by $200 billion to $300 billion a year "by cutting down on duplicate records, reducing record-keeping errors, avoiding fraudulent claims and better coordinating health care among providers." Brailer estimates that about a third of US hospitals have such efforts underway.

A couple of thoughts on the Harvard study. One of the things we keep saying here at this blogsite is that technology may get pitched as the means to profitability and growth, but that is misguided thinking. Technology is merely a tool. Profitability and growth come from good management practices and a culture that encourages innovation.

Look at the current state of the healthcare system — it’s broken. Healthcare organizations are overloaded, overburdened, understaffed, and over-litigated. They are buffeted by all kinds of external forces, and riddled with inefficiencies. Remember Mike Hammer's maxim: “When you automate a mess, you get an automated mess.”  As with automation in any industry, organizations need to first clear up and address underlying processes and issues before throwing software and systems at them.

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