'Health IT' Debate: Can It Cut Costs?
Policy Makers Wrestle With the Logistics of Electronic Medical Records and E-Prescribing
June 20, 2008 -- You don't have to go far to find a politician cheerleading
for the magical cost-cutting abilities of health information technology.
Democratic and Republican policy makers point to "health IT" like
electronic medical records and e-prescribing systems as a big potential money
saver for America's inefficient and expensive health system.
But in the glare of computer touch screens and smart cards, it's easy to
lose sight of what health IT can do -- and more importantly can't do -- for the
faltering U.S. medical system.
The 'Buttered Toast' Analogy
Now one of Washington's most important voices on health care costs is trying
to get Congress and the candidates to see health IT in more realistic
To Peter Orszag, director of the Congressional Budget Office (CBO), plugging
U.S. health care into computerized IT systems is a lot like plugging in a
toaster. It's just one step to having toast for breakfast. And if you think of
an efficient, cost-effective, and convenient health care system as having your
toast buttered, it's not even close.
"If you just plug the toaster into the wall, the toast is not going to
be buttered, especially if you haven't even bought the bread," Orszag told
a Capitol Hill forum on health IT on Friday.
Orszag says the point of his toast analogy is this: U.S. health care is
riddled with inefficiencies. A recent CBO analysis shows there's $700 billion
in potential waste. A lot of it comes from doctors and hospitals using
treatments, tests, and procedures without any clear evidence telling them which
ones work best, or cheapest.
So even if American hospitals and doctors get "plugged in," they
still won't have taken several other steps Orszag and other economists say the
country will have to take to get health costs under control. That includes more
studies to find out what really works, and then using the clout of government
programs like Medicare to only pay for the most efficient care.
"If you just plunk in health IT systems down in the middle of a
fragmented system ... you're not going to get very much," Orszag says.
Getting Doctors 'Plugged In'
Right now Washington is debating how to get more doctors and hospitals to
"plug in" to health IT systems. A study out this week in the New
England Journal of Medicine shows that fewer than one in 20 doctors in
small or medium-sized practices are using fully-functioning systems.
It's not that doctors, don't want their "toast buttered," says Sara
Rosenbaum, a professor of health policy at George Washington University and one
of the study's authors. It's that cost and legal concerns are still seen as a
"Despite the delicious nature of buttered toast, 83% of physicians have
no functional electronic health record," she said.
"Word on the street is, it takes at least a year to really get
comfortable with an electronic record system," adds Janet Wright, MD, vice
president of science and quality at the American College of Cardiology.
The Bush Administration just announced it will spend $150 million doling out
incentive grants to doctors in 12 U.S. cities in an effort to spur the use of
Orszag favors a little bit of coercion too. "We'll pay you five bucks to
plug in your toaster," he says.
But he also says Congress should set a deadline for doctors to plug in, and
once the deadline passes, Medicare should cut off doctors who haven't done
"I think that would get nearly universal plugging in of toasters,"