Electronic health records are a tool, the bottom floor on creating standards to move from mere billing and data collection into a platform to change the way health care is delivered, the way it is paid for, and the manner in which patients are engaged, according to Farzad Mostashari, M.D., Sc.M., the national coordinator of health information technology at the U.S. Department of Health and Human Services.
Mostashari’s optimistic view of EHR implementation, presented at Health Journalism 2013 in Boston, was challenged by Stephen Soumerai, Sc.D., professor of population medicine at Harvard Medical School. Soumerai that the government’s investment of $1.6 trillion in building the health information technology infrastructure is unsupported by any research that it will create the predicted return on investment, citing the recent Rand Corporation study that said cost savings would not occur. The investment was being made without any evidence that changes in delivery, outcomes, quality and cost savings can be achieved.
Striking a middle ground in the conversation was Ken Mandl, , M.D., M.P.H., director of the intelligent health laboratory at Boston’s Children Hospital. He has been working to develop a series of health apps to solve the lack of technology prowess in many of the software packages as well as enable the data, in a secure manner, to be mined in real time by providers and patients alike.
“You can’t have an accountable care organization if you can’t count,” Mandl said. His laboratory is seeking to have innovators create apps that can be downloaded to any of the existing 700 brands of EHR systems on the market, similar to the way apps can be downloaded on smart phones.
Journalists asked the panel what role patients would have in the process. Mandl answered that there was an emphatic need to understand how health IT looks at the patients.
Another reporter challenged Mostashari about his emphasis on science over art in the practice of medicine. Mostashari responded that health IT was a tool, and that the health care system is broken. “We don’t have a system to apply the stuff we already know,” he said, endorsing the need for the infrastructure investment. “You have to begin with a floor, not a ceiling.”
A third reporter asked how these kinds of investments, which tended to play out well for places such as Boston, would work in more rural communities. Mostashari countered that evidence from his work in New York City to use health IT to improve care for Harlem residents had successfully moved the needle from 40 percent to 59 percent in achieving health outcomes for the better.
In addition, a reporter from NPR asked asked Soumerai what kinds of research would be best to conduct in order to create the kinds of evidence moving forward with health IT implementation. Soumerai replied that objective reach, done by those without a conflict of interest, was necessary.
