1. Kelly Worden
KEW544
The Double-edged Sword of HIT:
The potential of HIT to influence the outcome of health care reform
Electronic health records have been cited as a way to improve the American health care
system since the beginning of the of the Bush administration. A decade later we are
finally proving our confidence in the ability of EHRs by providing financial incentives for
doctors who implement and use EHRs. However, accompanying these financial
incentives should be a warning about the double-edged sword nature of HIT. If done
the proper way, HIT has the potential to greatly improve our health care system and
propel health care reform forward. At the same time if HIT fails, it could bring down the
entire health care reform movement with it.
Proponents of HIT brag about its ability to reduce cost by streamlining the administrative
process and reducing the amount of unnecessary testing. Standardized insurance
claims forms and electronic submission of these claims could reduce the amount of
processing and middle men involved in the claims submission process. A reduction in
these middle steps could lead to overall reduced cost. HIT also provides an opportunity
to increase transparency within the entire billing process which could be used to
decrease costs. Additionally, HIT can improve the overall quality of care by reducing
medical errors and increasing reliance on evidence based medicine. Clinical decision
support, computerized physician order entry and e-prescribing would help decrease
medical errors by pointing out dangerous drug interactions, eliminating the problem of
illegible prescription scripts and creating a standard level of care that is received by
every patient. Some aspects of HIT such as PHRs (Personal Health Records) and
patient portals could lead to patient empowerment and transitively could also increase
the overall quality of care. In addition to improving quality of care, patient empowerment
could be utilized to decrease costs. Providing patients access to online databases
containing information about physiciansʼ performance on core quality measures as well
as the cost of services would allow patients to become informed consumers in the
healthcare market. It could be viewed as a “Travelocity” or “Expedia” website for
healthcare, a place where patients could look up the quality and cost of care provided
by different physicians and hospitals. In the current American system the patient is
almost always a completely uninformed consumer. Uninformed consumers are unable
to make good decisions about how to spend their money. HIT provides us with the
opportunity to transform healthcare from an industry-driven market to more of a
consumer-driven one. Although healthcare should never be a totally consumer-driven
market, giving patients some bargaining power might kill two birds with one stone by
increasing quality while also decreasing cost.
However, there are many ifʼs in this equation. HIT will positively affect health care
reform IF it is implemented properly, IF physicians utilize EHRs to their full capacity and
IF patients take the time to invest in their own health. In the overall journey of HIT
through the healthcare reform process there are many points where the efficacy of HIT

2. could be decreased. At the same time, the current approach to HIT and universal EHR
implementation is a little reminiscent of how we got ourselves in this healthcare system
mess in the first place. The American healthcare system of having multiple payers
wasnʼt really planned or designed but instead just happened. This lack of planning and
coordination led us to the disjointed system we are forced to deal with today. Currently
many different software vendors are developing and selling different types of EHR
systems, without any steadfast standards or direction. Although this free-market
approach fosters creativity and possibly development of the best system, it does not
foster increased efficiency or interoperability.
My fear is that HIT will not be as successful at improving our healthcare system as it
could be. The government is investing in HIT by providing incentive money to
physicians and grant funding for HIT development as well as education programs but at
the end of the day if physicians arenʼt excited about HIT they likely wonʼt use it to its full
capability. If EHR systems arenʼt being fully used then they are functionally unable to
improve the healthcare system and our “golden ticket” is void. Getting support from the
general public for health care reform and getting it passed through Congress was
extremely difficult. Adamant health reform critics will likely seize any opportunity they
can to demonstrate that healthcare reform was a bad idea. Because EHRs and HIT are
rather expensive to implement and it can take time for the financial benefit of HIT to
emerge, it is possible that upon analyzing the initial effect HIT has on the healthcare
system it could be a negative one. This is where the double-edged sword part comes
in. On one hand HIT is able to positively revolutionize the American health care system,
however on the other hand over-reliance on HIT as our healthcare system solution
could cause us to actually backtrack on healthcare reform if HIT fails.
It seems that throughout the health care reform discussion HIT has been presented as
an all-encompassing solution to our health care troubles by reducing cost while also
increasing access and quality. However, health care reform will not be a quick fix.
Because our current system is extremely complex and disjointed, it is likely that the
solution we are looking for will be equally complex. Among other changes,
improvement of the American health care system is going to require a combination of
HIT, a reduction of pharmaceutical drug costs, an increase in the availability of
affordable and healthy food options, a fundamental change in the way many doctors
practice medicine and an overall cultural change in the way the American public views
their health. I am confident in the ability of HIT to carry us towards an improved and
more efficient health care system but HIT alone is not enough. As Bill Gates stated,
“The first rule of any technology used in a business is that automation applied to an
efficient operation will magnify the efficiency. The second is that automation applied to
an inefficient operation will magnify the inefficiency.” In the case of our health care
system I think everyone would agree that currently we have a very inefficient operation.
Therefore in terms of HIT and health policy, we have to be very careful that we donʼt
simply automate this inefficiency by throwing HIT into the mix without first changing the
way we conduct business.