In two years, hundreds of thousands of American physicians and
thousands of hospitals that fail to buy and install costly health-care
information technologies-such as digital records for prescriptions and
patient histories-will face penalties through reduced Medicare and
Medicaid payments. At the same time, the government expects to pay out
tens of billions of dollars in subsidies and incentives to providers
who install these technology programs.
The mandate, part of the 2009 stimulus legislation, was a major goal
of health-care information technology lobbyists and their allies in
Congress and the White House. The lobbyists promised that these
technologies would make medical administration more efficient and
lower medical costs by up to $100 billion annually. Many doctors and
health-care administrators are wary of such claims-a wariness based on
their own experience. An extensive new study indicates that the
caution is justified: The savings turn out to be chimerical.
Since 2009, almost a third of health providers, a group that ranges
from small private practices to huge hospitals-have installed at least
some “health IT” technology. It wasn’t cheap. For a major hospital, a
full suite of technology products can cost $150 million to $200
million. Implementation-linking and integrating systems, training,
data entry and the like-can raise the total bill to $1 billion.
But the software-sold by hundreds of health IT firms-is generally
clunky, frustrating, user-unfriendly and inefficient. For instance, a
doctor looking for a patient’s current medications might have to click
and scroll through many different screens to find that essential
information. Depending on where and when information on a patient’s
prescriptions were entered, the complete list of medications may only
be found across five different screens.
Now, a comprehensive evaluation of the scientific literature has
confirmed what many researchers suspected: The savings claimed by
government agencies and vendors of health IT are little more than
To conduct the study, faculty at McMaster University in Hamilton,
Ontario, and its programs for assessment of technology in health-and
other research centers, including in the U.S.-sifted through almost
36,000 studies of health IT. The studies included information about
highly valued computerized alerts-when drugs are prescribed, for
instance-to prevent drug interactions and dosage errors. From among
those studies the researchers identified 31 that specifically examined
the outcomes in light of the technology’s cost-savings claims.
With a few isolated exceptions, the preponderance of evidence shows
that the systems had not improved health or saved money. For instance,
various studies found the percentage of alerts overridden by
doctors-because they knew that the alerted drug interactions were in
fact harmless-ranging from 50% to 97%.
The authors of “The Economics of Health Information Technology in
Medication Management: A Systematic Review of Economic Evaluations”
found no evidence from four to five decades of studies that health IT
reduces overall health costs. Three studies examined in that McMaster
review incorporated the gold standard of evidence: large randomized,
controlled trials. They provide the best measure of the effects of
health IT systems on total medical costs.
A study from Regenstrief, a leading health IT research center
associated with the Indiana University School of Medicine, found that
there were no savings, and another from the same center found a
significant increase in costs of $2,200 per doctor per year. The third
study measured a small and statistically questionable savings of $22
per patient each year.
In short, the most rigorous studies to date contradict the widely
broadcast claims that the national investment in health IT-some $1
trillion will be spent, by our estimate-will pay off in reducing
medical costs. Those studies that do claim savings rarely include the
full cost of installation, training and maintenance-a large chunk of
that trillion dollars-for the nation’s nearly 6,000 hospitals and more
than 600,000 physicians.
But by the time these health-care providers find out that the promised
cost savings are an illusion, it will be too late. Having spent
hundreds of millions on the technology, they won’t be able to afford
to throw it out like a defective toaster.
It is already common knowledge in the health-care industry that a
central component of the proposed health IT system-the ability to
share patients’ health records among doctors, hospitals and labs-has
largely failed. The industry could not agree on data standards-for
instance on how to record blood pressure or list patients’ problems.
Instead of demanding unified standards, the government has largely
left it to the vendors, who declined to cooperate, thereby ensuring
years of noncommunication and noncoordination. This likely means
billions of dollars for unnecessarily repeated tests and procedures,
double-dosing patients and avoidable suffering.
Why are we pushing ahead to digitize even more of the health-care
system, when the technology record so far is so disappointing? So
strong is the belief in health IT that skeptics and their science are
not always welcome. Studies published several years ago in the Journal
of the American Medical Association and the Annals of Internal
Medicine reported that health IT systems evaluated by their own
developers were far more likely to be judged “successful” than those
assessed by independent evaluators.
Government agencies like the Office of the National Coordinator of
Healthcare Information Technology (an agency of the Department of
Health and Human Services) serve as health IT industry boosters. ONC
routinely touts stories of the technology’s alleged benefits.
We fully share the hope that health IT will achieve the promised cost
and quality benefits. As applied researchers and evaluators, we
actively work to realize both goals. But this will require an accurate
appraisal of the technology’s successes and failures, not a mixture of
cheerleading and financial pressure by government agencies based on
Mr. Soumerai is professor of population medicine at Harvard Medical
School and Harvard Pilgrim Health Care Institute. Mr. Koppel is a
professor of sociology and medicine at the University of Pennsylvania
and principal investigator of its Study of Hospital Workplace Culture